Making progress

	Mary C. Tierney Editorial Director

With the annual report card on America’s fight against cancer just out, we see once again that survival rates are up. Imaging, screening, better treatments and declines in smoking are having an impact.

Cancer incidence and deaths are on the decline in most areas, most dramatically in lung, prostate and colorectal cancers among men, and breast and colorectal cancers in women.

“Overall, cancer incidence rates for all racial/ethnic groups combined decreased by 0.7 percent per year during 1999-2006 for both sexes combined, by 1.3 percent per year during 2000-2006 for men, and by 0.5 percent per year during 1998-2006 for women,” according to the authors from the American Cancer Society, the CDC, the National Cancer Institute, and the North American Association of Central Cancer Registries. Broken down by cancer type, lung cancer accounted for nearly 30 percent of cancer deaths in 2006. Colorectal cancers accounted for 10 percent, breast cancer in females was about 7 percent and prostate cancer was about 5 percent.

So where’s the best news? In colorectal cancer, the focus of this year’s report, which has seen a 20 percent decline over the last decade. And the news is expected to get even better, with microanalysis within the report suggesting death rates could be cut by 36 percent by 2020 if “1995-2000 trends for risk factor prevalence, screening, and treatment continue.” (such as reductions in smoking and red meat consumption). That would mean colorectal cancer deaths in 2020 would be half that of 2000.

But the news was not all good. As men saw decreased rates of prostate, lung, oral, stomach, brain, and colorectal cancers, there was an uptick in cancers of the kidney, renal, liver, and esophagus and in leukemia, myeloma, and melanoma of the skin.

For women, declines were seen in cancer of the breast, colorectal, ovaries, cervix, uterus and mouth—yet increases continue in lung, thyroid, pancreas, bladder, and kidney cancers, as well as non-Hodgkin lymphoma, melanoma and leukemia.

Links have been clear for some time that screening mammography helps reduce breast cancer deaths. But as you’ll read on page 16, a threat to continued progress on that front could come from a reversal of 2002 recommendations by the U.S. Preventive Services Task Force (USPSTF) guidelines that now recommend against routine screening mammography in women aged 40 to 49 years and advocate screening only every two years for women aged 50 to 74 years. The breast imaging and radiology communities say the recommendations were based on bad science.

“Screening mammography represents one of the great medical achievements of our time,” said Stephen A. Feig, MD, professor of radiology at the University of California Irvine School of Medicine and president-elect of the American Society of Breast Disease. Annual screening has reduced mortality by 40 to 50 percent for women between the ages of 40 and 75, despite an increase in the disease, Feig noted. Screening is effective—and believers will push to continue it. The debate is far from over.