For the first time since 1900, overall cancer death rates have shown a sustained decline, a new analysis has shown.
Although death rates of some particularly deadly cancers are rising, a study of all cancer deaths from 1990 to 1995 documented the historic drop.
Experts attributed the decline to preventive measures, especially anti-smoking efforts, and to improvements in early detection and treatment, which have increased the chances of surviving many common cancers.
"This is the news we've been waiting for," Dr. Richard Klausner, director of the National Cancer Institute, said. "The 1990s will be remembered as the decade when we measurably turned the tide against cancer."
The declining mortality rate suggests that the prediction that cancer deaths would overtake heart deaths early in the next century may be wrong. The death rate from heart disease, which has dropped precipitously since 1970, is still declining, but more slowly than previously.
The current analysis, to be published in the Nov. 15 issue of the journal Cancer, showed that the overall cancer mortality rate, adjusted for age, dropped each year from 1990 to 1995, for a total decline of about 3.1 percent.
In 1990, the cancer death rate peaked at 135 deaths for every 100,000 people. The rate then fell annually, reaching 129.8 deaths per 100,000 in 1995, or about 5 fewer deaths per 100,000 people than in 1990.
Cancer death rates in Maryland also appear to be in a decline. The five-year average in 1988-1992 was 191.4 deaths per 100,000 people. In 1993, the latest data available, it was 184.7 per 100,000, a decline of 3.5 percent.
Maryland had the second-worst cancer death rate in the nation in 1984-1988. In 1993 it ranked fifth.
State Health Secretary Dr. Martin P. Wasserman said yesterday that lung cancer rates in Maryland have leveled off, while breast cancer and cervical cancer rates have declined.
The researchers, Dr. Philip Cole, epidemiologist at the University of Alabama School of Public Health, and Dr. Brad Rodu of the university's School of Dentistry in Birmingham, attributed the bulk of the decline to the reduction in cigarette smoking among American men, which has resulted in a "major reduction" in lung cancer of 3.9 percent and a decline of 2 percent in other smoking-related cancers.
Dr. Harmon Eyre, chief medical officer for the American Cancer Society, said that while lung cancer deaths continued to rise in women, the rate had slackened in recent years and was expected to decline as a result of a reduction in smoking among women.
Also contributing to the fall in mortality rates has been reduced occupational exposure to cancer-causing agents like asbestos, radon, vinyl chloride and other carcinogenic industrial substances, Eyre said.
"Without lung cancer," he said, "beginning in the 1970s, all other cancer death rates began declining slightly."
Eyre attributed the "turnaround" in the overall cancer mortality // rate to the combined result of reducing the incidence of common fatal cancers like lung cancer and improving the cure rates for common cancers.
For example, the death rate from breast cancer, which has been declining since 1989, fell 6.3 percent between 1991 and 1995, the cancer institute reported.
An editorial in the same issue of Cancer, published by the American Cancer Society, said that the analysis by Cole and Rodu provided "new evidence that meaningful progress is being made" in the fight against cancer. Although the magnitude of the decline is not great, it said, "the trend is clear."
Also clear, the editorial noted, is that "there has been no magic bullet." Rather, the favorable mortality trend is the joint result of "several different cancer control activities." Eyre pointed out that death rates from some cancers were still rising, among them non-Hodgkin's lymphoma (partly because of a rise among people infected with the HIV virus), cancer of the pancreas, multiple myeloma and chronic leukemia in older people.
Another problem is that not all segments of the population have equal rates of cancer. Although the largest reductions in cancer death rates since 1991 have been among African-Americans, their death rates from cancer are still higher than among whites.
The journal's editorial pointed out that new problems will arise in the future, as more people live to ages causing cancer diagnoses and deaths to increase, and creating a greater need for prevention and a greater demand for medical care.
Pub Date: 11/14/96