A new report from the U.S. National Cancer Institute makes it clear that we are losing the battle against cancer in the sense that more and more of us are getting it. In the U.S., the incidence rate for all cancers except three (stomach, rectum, and cervix) has risen steadily since 1950; see Table 1. (Incidence rate means the number of people each year diagnosed with a new cancer per 100,000 population.) These are age-adjusted data, which rules out the explanation that "people are living longer so they're getting more cancer." At the same time that the incidence rate for 14 types of cancer has risen during the last 37 years, the death rate (the number of people each year dying of a cancer per 100,000 population) for 11 types of cancer has fallen while the death rate for only 6 types of cancer has risen; see Table 1. Some government officials, and some medical doctors want to put a good face on this and declare it a kind of victory to have more and more of us living with a cancer that we have to fight, sometimes for the rest of our lives. As the NEW YORK TIMES said recently (Feb. 4, 1991, pgs. 1, B6) there's a "Changing View of Cancer: Something to Live With." The TIMES story opens with a vignette of what it means to live with cancer:
"Margaretta Young was a Charlotte, N.C., teacher when she felt a tiny lump in her breast on Easter weekend in 1963. Since then, doctors have found tumors in her bones, liver, brain, parathyroid, and stomach.
"Mrs. Young has had seven operations, 30 sessions of radiation therapy, and 17 years of weekly chemotherapy. She is not cured, and after 28 years of cancer and treatment, she is weakened, scarred, and often in pain." But she is alive, the TIMES points out, and she says she still enjoys the life she is hanging on to.
The TIMES speaks of "real advances in treatment" for cancer, but goes on to describe the harsh reality that cancer patients face: "Most cancer patients say they are constantly aware of their disease, sometimes because of tangible reminders like having to take a pill every day, feeling pain, or dressing to cover up scars or prostheses. Many have serious side effects from treatment, including sterility, nausea, profound exhaustion or organ failure.
"And almost all cancer patients say there are emotional reminders, too, in the form of a new sense of mortality, added fear of the future, and a sense of somehow being apart from those who have never had cancer. Each new ache or pain, they say, brings with it a special terror that their cancer is growing or spreading....
"The expanded arsenal of cancer treatments, which still mostly involve some form of surgery, radiation, or chemotherapy, can be brutal, causing side effects that may be as severe a burden as the disease. So many patients with incurable cancers are faced with decisions about just how much they are willing to go through to stay alive for a few more years.... 'Some people feel we're prolonging living, others that we're prolonging death,'" says Dr. John Rowe, president of the Mount Sinai Medical Center in New York.
The new report from the National Cancer Institute (NCI) says, "Each race and sex group [in the U.S.] showed statistically significant increases in the overall incidence of cancer between 1973 and 1987." (Pg. I.1 of the NCI report, which is cited in our last paragraph, below.) In this overall negative trend, there are scattered bits of good news; for example, in the period, 1983-1987, the incidence of lung cancer among men declined 0.6% per year--no doubt related to changing patterns of tobacco use (pg. I.1). (However, among white females, both the lung cancer incidence rate and death rate more than doubled between 1973 and 1987 [pgs. I.7-I.8]--again a reflection of tobacco use: yes, you have "come a long way, baby" as the cigarette ads like to proclaim.)
Since 1980, the incidence of breast cancer among U.S. women has increased "rather dramatically" from 84.8 per 100,000 to 111.9 per 100,000--a 32% increase. (NCI, pg. I.2.) Better screening by mammography partly explains the change, but "these increases are a major concern" says NCI (pg. I.9). The incidence of malignant melanoma--an aggressive and deadly form of skin cancer--increased 78.8% among whites during the period 1973-1987.
The incidence of cancer of the colon and rectum increased slowly, 1973-1987, from 46 per 100,000 to 49. However it increased more rapidly among men (from 53.2 to 60.4). (Pgs. II.12, II.13).
Cancer of the prostate gland "has become the number one cancer for men," says NCI (pg. I.11). Prostate cancer incidence increased 46% between 1973 and 1987; it affects black men (132.0 per 100,000) much more than white men (88 per 100,000) (pg. I.11).
Between 1973 and 1987, the incidence of non-Hodgkin's lymphoma increased 50.9%; only malignant melanoma and female lunger cancer increased faster during the period (pg. I.11). Cancer of the testicles increased 37% during 1973-1987; the death rate from this cause dropped 60% during the period (pg. I.14.)
The incidence of urinary bladder cancer is rising at about 1% per year among white males but at more than twice that rate among black males. (Pg. I.14). The death rate among both groups is dropping.
Brain cancer increased slowly from 1973 to 1980; then "around 1980 the incidence of brain cancer began increasing at an alarming rate among people 65 and older with an increase of more than 3% per year," says NCI (pg. I.14). Survival rates for this cancer are "dismal," says NCI. An estimated 15,600 new brain cancers were diagnosed in 1990.
Incidence of cancer among children increased 6.1% during the period 1973-1987; the death rate dropped dramatically, however (36% overall, and 50% or more for four cancers). (Pg. I.15)
Get: Lynn A. Gloeckler Ries and others, editors. CANCER STATISTICS REVIEW 1973-1987 [National Institutes of Health Publication No. 90-2789]. Bethesda, MD: National Cancer Institute (NCI), 1990. Free from Office of Cancer Communications, NCI, Building 31, Room 10A24, Bethesda, MD 20892; phone (301) 496-6641.
Table 1 -- U.S. Cancer Incidence and Deaths in 1987, and the Percent Change in Rates of Incidence and Death per 100,000 U.S. Population, 1950-1987.
| Cancer type | Incidence in 1987 | Deaths in 1987 | Percent change in Incidence, 1950-1987 | Percent change in deaths, 1950-1987 |
|---|---|---|---|---|
| ------------------------------------------------------------------------------------------------------------------- | ||||
| stomach | 24,600 | 13,740 | -72.6 | - 75.3 |
| rectum | 43,000 | 7,638 | -12.5 | - 65.9 |
| cervix | 12,800 | 4,423 | -78.5 | -73.0 |
| colon | 102,000 | 49,613 | +24. | - 3.1 |
| ovaries | 19,000 | 11,838 | +0.6 | - 0.5 |
| larynx | 12,100 | 3,670 | +57.3 | -8.1 |
| testicles | 5,500 | 422 | +97.3 | -64.5 |
| bladder | 45,500 | 9,589 | +52.5 | - 35.3 |
| Hodgkin's | 7,300 | 1,755 | +15.1 | - 61.7 |
| childhood | 6,600 | 1,787 | +28.4 | - 58.7 |
| leukemia | 26,400 | 17,440 | +2.6 | - 1.8 |
| lung | 154,000 | 129,866 | +256.9 | +245.0 |
| skin | 25,800 | 5,912 | +283.8 | +147.2 |
| breast | 130,000 | 40,896 | +58.3 | +3.6 |
| prostate | 96,000 | 27,863 | +97.3 | +10.9 |
| kidney | 21,900 | 9,332 | +101.0 | +28.9 |
| lymphoma | 29,900 | 16,269 | +153.1 | +100.0 |
| All types (excluding lung) | 811,000 | 347,028 | +27.4 | - 19.0 |
| All types | 965,000 | 476,894 | +42.2 | +7.0 |
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