Cancer Report Realistic But Offers Hope

Edition: April 2002 - Vol 10 Number 04
Article#: 1219
Author: Laura Thill

While cancer continues to be one of the most humbling diseases, there may be a small light guiding researchers toward cancer-related Healthy People 2010 goals, a comprehensive set of national health targets sponsored by the U.S. Department of Health and Human Services.

The National Cancer Institute's (NCI) Cancer Progress Report 2001 reflects the nation's advances toward these targets, suggesting that overall cancer death rates and rates of new cancers are decreasing. More cancer survivors are living longer, and the nation has grown even more health conscious in an effort to reduce the risk of cancer-related disease. In addition, more people are relying on screening tests for breast, cervical and colorectal cancers. Up to 30 million women over 40 years have had a mammogram in the last two years, according to the December 2001 National Women's Health Report, National Women's Health Resource Center.

These trends are good news, acknowledges the NCI, but they don't reflect the whole picture. Not all cancer rates are dropping. The incidence of lung cancer in women is still on the rise, as is the death rate from non-Hodgkin's lymphoma. The rate at which new melanoma cases and incidents of esophageal cancer are emerging also are on the upswing. And, in spite of a greater reliance on colorectal screening for early detection of this disease, these tests still are not used widely enough, according to the Cancer Progress Report 2001.

An estimated 1,268,000 cancer cases emerged in 2001. This included:

• 198,100 prostate cancers. • 192,200 female breast cancers. • 169,500 lung cancers. • 135,400 colon/rectum cancers.

In spite of definite gains in the battle against cancer, this disease remains a major health problem, says the NCI. And, the expense of cancer diagnosis and treatment continues to present an economic burden.

Cancer Progress Report 2001 Highlights
• Benzene. A natural part of crude oil, gasoline and cigarette smoke, benzene can cause leukemia in individuals who are exposed to high levels of it over extended periods. The good news is that benzene concentrations in the air are decreasing.
• Radon. Up to eight million homes in the United States, or one of every five homes, are estimated to have elevated radon levels, according to the EPA. Radon is the second leading cause of lung cancer, contributing to as many as 20,000 deaths annually, according to the NCI. Encouragingly, today more homes are being tested for radon.
• Secondhand smoke and smoking trends. The news here is less than positive. States are not moving as quickly as some have hoped to enact laws on smoke-free air. Still, the NCI is optimistic, as adult smoking rates have dropped slightly since 1990 and a one-time upward trend of high school smoking appears to be slowing down. And, since the early 1990s, more adults have been found to quit smoking.
• Sun protection. In spite of an ever-present threat of melanoma, less than half of adults in the United States can take credit for protecting themselves from the sun.
• Health and nutrition. Only about two-thirds of adults devote time to physical activity, according to the report. And, while more people are decreasing their fat intake, adult obesity has become an even greater problem in the United States. Obesity and increased body fat triple women's chances of acquiring endometrial cancer and double their risk for breast cancer after menopause. Excessive weight gain and increased body fat can lead to colorectal, esophageal and kidney cancers as well. In spite of the positive attributes linking fruit and vegetable intake to a lower risk of many cancers (including lung, mouth, pharynx, esophagus, stomach, colon, rectum, breast, pancreas, larynx and bladder), Americans do not consume much more of this food group than they did 10 years ago. Similarly, alcohol consumption has decreased only slightly in recent years, even though there is a strong association between alcohol intake and a risk of cancer of the mouth, esophagus, pharynx, larynx, liver or breast.

Treatment Costs
While the expense of cancer treatment has risen significantly over the last 40 years, this reflects an increase in total healthcare spending, an aging population, and the availability of advanced – but more costly – treatment options. The charts on page 16 (See Tables 1,2) provided by the NCI demonstrate cancer spending trends in the United States.

Realistic but Hopeful
While remaining realistic about gains – or lack of them – in the fight against cancers, the medical profession must congratulate itself on the recent decrease in late-stage diagnoses (there are fewer late-stage diagnoses for prostate, colon, breast, rectum and cervix cancer) and the definite improved five-year survival rates. Thanks to gains in cancer diagnosis and treatment, in 1977, over seven million Americans who at one time were diagnosed with cancer were still alive after 20 years. This included over 1.5 million breast cancer cases and over one million prostate cancer cases. Another million cancer survivors had also lived for over 20 years, according to NCI estimates.

Cancer treatment definitely is getting better with time, says the NCI. Survival rates are better for breast and colon cancer, leukemia, lymphoma and pediatric cancers. One obstacle to improved treatment, however, is the lack of patient participation in clinical trials. Possibly due to low physician and patient awareness, the NCI notes that only about three percent of all adult cancer patients take part in such studies. This number must increase in order to facilitate the search for more effective cancer treatments.

Furthermore, there is no national data system for tracking those treatments that appear to provide the best quality of care, according to the NCI. But, this is expected to change soon, as the NCI currently is working with Federal and private partners toward the development of a tracking system.

Among studies in progress to support the development of a national tracking system, the NCI has initiated the Cancer Care Outcomes Research and Surveillance Consortium, designed to help link measures of patient care to outcomes valued by patients. With improved tracking methods of quality treatment, the NCI anticipates including treatment trends for various cancers – i.e. breast and colorectal – in future editions of the Cancer Progress Report.

Table 1: National Cancer Treatment Expenditures in Billions of Dollars: 1963-1995.

YearCancer Treatment Spending (billions)Total Healthcare Spending (billions)Percent of Cancer Treatment Spending to Total
1963 1972 1980 1985 1990 1995$1.3 $3.9 $13.1 $18.1 $27.5 $41.21$29.4 $78.0 $217.0 $376.40 $614.70 $879.34.4 percent 5.0 percent 6.0 percent 4.8 percent 4.5 percent 4.7 percent

Source: Brown ML, Lipscomb J, Snyder C. The Burden of Illness of Cancer: Economic Cost and Quality of Life. Annual Review of Public Health 2001;22:91-113.

Table 2: Estimates of National Expenditures for Medical Treatment for the 13 Most Common Cancers – Based on Cancer Prevalence in 1996 and Cancer-Specific Costs for 1995-1998. (Expressed in 1996 Dollars)

Percent of All New Cancers (1998)Expenditures (in billions of 1996 dollars)Percent of All Cancer Treatment ExpendituresAverage Medical Payments per Individual in First Year Following Diagnosis
Breast Colorectal Lung Prostate Lymphoma Bladder Cervix Head/Neck Leukemia Ovary Melanoma Pancreas Esophagus All Other18.2 11.7 12.5 13.6 4.2 4.0 2.3 3.3 2.1 1.7 5.2 2.1 0.9 18.1$5.4 $5.4 $4.9 $4.6 $2.6 $1.7 $1.7 $1.6 $1.2 $1.5 $0.7 $0.6 $0.4 $8.7$9,230 $21,608 $20,340 $8,869 $17,217 $10,770 $13,083 $14,788 $11,882 $32,340 $3,177 $23,504 $25,886 $17,201

Source: Brown ML, Riley GF, Schussler N, Etzioni R. Estimating Health Care Cost From SEER-Medicare Data. Submitted to Medical Care.