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Declining Cancer Death Rates in Perspective

Cancer survivor holds her daughter

Amidst the string of political scandals and turmoil about the southern border, you may have missed an important piece of good news: the death rate from cancer in the United States has declined 27 percent since its peak in 1991. This drop translates into approximately 2.6 million fewer cancer deaths than would have been expected if death rates had remained at 1991 levels.

The data, published in the American Cancer Society’s journal, show a 48 percent decline in lung cancer death rates from 1990 to 2016, and a 40 percent decline in breast cancer death rates from 1989 to 2016. These and other findings are attributed to reductions in smoking and advances in early detection and treatment. The study also finds the difference in cancer death rates between black and white Americans has narrowed: the cancer death rate in 2016 was 14 percent higher in blacks than in whites, down from its peak of 33 percent higher in 1993.

While this progress is cause for hope, it must be taken in context with other findings from the study. Cancer is still the second-leading cause of death — 22 percent of deaths in the U.S. in 2016 were from cancer. In 2019, more than 1.7 million new cancer cases will be diagnosed, and rates of new liver cancers are rising faster than any other.

The study also finds that while racial disparities in cancer death rates are decreasing, socioeconomic disparities are increasing. The overall cancer death rate was approximately 20 percent higher among residents of the poorest counties compared with the most affluent counties from 2012 to 2016. This growing geographic health disparity reflects the national distribution of poverty.

Other public health data also convey a more sobering message. Life expectancy in the U.S. declined in 2017, to 78.6 years, from 78.7 years in 2016. This is the third consecutive year in which expected life span fell, and the longest sustained decline in a century.

The Centers for Disease Control and Prevention considers soaring death rates from drug abuse and suicide the driving forces behind the decline in life expectancy. The number of annual drug overdose deaths crossed 70,000 in 2017, up more than 10 percent from 63,632 in 2016. Of the drug overdose deaths in 2017, 47,600 involved opioids. And nearly 45,000 Americans age 10 or older took their own lives in 2016, a 1.5 percent increase from 2015.

Obesity is another public health crisis that may affect national life expectancy rates. Nearly 40 percent of American adults were obese in 2015–16, up from 34 percent in 2007–08. While obesity’s links to diseases like diabetes are well known, few may realize excess body weight leading to cancer causes about 7 percent of cancer-related deaths, or 40,000 deaths each year. The new cancer study finds that incidence rates continue to increase for cancers of the liver, thyroid, uterus, and pancreas, all of which are associated with obesity. These increases suggest that rising obesity could influence cancer death rates in the future.

Even as overall cancer death rates fall, public health crises like obesity and the opioid epidemic highlight the need for the U.S. health system to account for social factors that influence health. A growing body of research shows that factors like housing, access to food, and transportation are closely associated with health outcomes. Drug overdose is also associated with socioeconomic forces.

Cancer death rates are also colored by socioeconomics. Residents of the poorest counties experience a disproportionate burden of the most preventable cancers, in part because of because of state/territory differences in Medicaid expansion and other initiatives to improve access to health care. Addressing such social and public health issues should be an urgent priority to halt and perhaps reverse the disturbing trend of shorter life spans in the United States.

Publication Details

Publication Date: January 30, 2019
Citation:

Shanoor Seervai and David Blumenthal, "Declining Cancer Death Rates in Perspective," To the Point, Commonwealth Fund, Jan. 30, 2019. https://doi.org/10.26099/00bh-1b40

Experts

Shanoor Seervai
Senior Research Associate (President’s Office) and Communications Associate, The Commonwealth Fund
David Blumenthal, M.D.
President, The Commonwealth Fund