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Stats Split On Progress Against Cancer : Shots : NPR

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Time to take a closer look at cancer figures. Matthias Kulka/Corbis hide caption

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Matthias Kulka/Corbis

Time to take a closer look at cancer figures.

Time to take a closer look at cancer figures.

Matthias Kulka/Corbis

When someone asks whether we’re winning the war on cancer, the
discussion often veers into the world of numbers. And,
depending on which numbers you’re looking at, the answer can
either be yes or no.

Let’s start with the no.

The number of cancer deaths in this country is on the rise. It
climbed 4 percent between 2000 and 2011, the latest year in
official statistics. More than 577,000 people died of cancer in
2011. That’s almost a quarter of all deaths. Those aren’t just
personal tragedies – the figure represents a growing burden on
America.

“It’s hard to think of winning a war when more and more people
are going into the battlefield every day,” says Clifton Leaf,
author of The Truth
in Small Doses: Why We’re Losing the War on Cancer — and How to
Win It
.

Find other stories in the Living Cancer series at WNYC.org.

For most of the common types of cancer, there has only been
incremental progress in improving treatments – especially in
advanced cancers, where lives may only be prolonged for a few
years.

“If you look at the late-stage disease for those intractable
cancers, the deadly dozen or so, we really haven’t made
staggering progress,” Leaf says. He’s not dismissing the
importance of those small improvements, but “the question is
whether we’re using the right strategy to be where we want to
be a decade from now,” he says. “Those targeted medicines are
just nipping at the corners,”

As a result of the ever-growing numbers, there’s a need for
more doctors to treat the disease, more hospital beds in
oncology wards, and more money to pay the ever growing bills
for cancer treatment.

National Cancer Institute scientists
project
that the cost of treating cancer will reach $173
billion in 2020, which is a 39 percent increase over those
costs in 2010. That assumes a modest 2 percent inflation rate
for the cost of cancer treatment.

It doesn’t take into account the soaring costs of cancer drugs.
A commentary
in the journal Cancer finds that the price of new
chemotherapy drugs has jumped from under $10,000 a year in 2000
to more than $100,000 a year in 2012. And more expensive new
drugs are in the pipeline, portending higher prices.

But there’s another, more encouraging way to look at the war on
cancer. This is how the yes-we’re-winning camp does it. While
the number of cancer deaths grew by 4 percent between 2000 and
2011, the total U.S. population grew by 10 percent. That means
the proportion of Americans dying from cancer is actually
declining. What’s more, cancer is mostly a disease of older
people, and they are making up an increasing share of the
population. So if there were no progress in stopping cancer,
the number of cancer deaths would be climbing much faster than
it is.

Statisticians have a way to account for those dramatic changes
to the population. Instead of simply counting the number of
people who die of cancer, they look at the number of deaths as
a fraction of the population. That provides a rate rather than
a simple number. They correct for the aging of the population
with a process called age adjustment or age standardization.
(Robert Anderson and a colleague at the National Center for
Health Statistics explain this in detail in an old but still
pertinent article.)

Using that widely accepted technique, the death rate from
cancer actually declined 15 percent between 2000 and 2011. Yes,
the total number of deaths is up, but the
rate, measuring annual deaths as a proportion of the
population, is falling. Organizations like the American Cancer
Society point to those rates to
argue
that we’re making progress in the war on cancer.

It’s worth looking at the details behind this decline. Cancer
is not one disease, but more than 100, and each one has its own
story. About half of all cancer deaths are from just four
different types: lung, colon, breast and prostate.

Each has a different story:

  • Lung cancer rates are declining largely because millions of
    Americans have quit smoking.
  • Breast cancer incidence rates dropped sharply in 2002,
    after doctors stopped routinely prescribing hormones to
    postmenopausal women, and they have leveled off since. Early
    detection and treatment improvements are driving the recent
    decrease in breast cancer mortality.
  • Colon cancer death rates are also declining, in part
    because colonoscopy screening is finding polyps before they
    turn cancerous. Treatment has improved, too.
  • Prostate cancer death rates are declining largely because
    of improvements in treatment.

When Dr. William Nelson first started treating men with
prostate cancer early in his career, he says treatment would
help a bit, but “usually within a year or two, the disease
would roar back and threaten their life, and usually they
didn’t live very long.”

“Today it’s completely different,” he says. “If you look at men
with advanced prostate cancer, they often live a decade or
more.” And though surgery and radiation treatments can have
unpleasant side effects, the men aren’t suffering in pain as
used to be the case.

He says it’s a “night-and-day difference” from when he started
treating this disease, says
Nelson
, director of the Sidney Kimmel Comprehensive Cancer
Center at Johns Hopkins.

Together, mortality numbers and mortality rates are the most
robust ways to measure progress on the cancer front, but
scientists also sometimes present five-year survival rates.

The Centers for Disease Control and Prevention has recently
added that measure to its cancer statistics. Overall, CDC
concludes that 2 out of 3 people who are diagnosed with
invasive cancer are alive five years later. This varies widely
based on the type of cancer.

One shortcoming is that cancer is sometimes overdiagnosed, yet
these rates include people who survived cancers (such as some
cases of prostate cancer) that grow so slowly they were
unlikely to be fatal anyway. The approach also fails to account
for people who die of cancer more than five years after
diagnosis, so it’s not the strongest measure of progress
against cancer.

That said, the five-year survival rate has been gradually
improving. That means the number of people alive with cancer
continues to grow. The American Cancer Society estimates
that there are more than 14 million people living with cancer
in the U.S. right now. That, in turn, affects the cost of
caring for cancer throughout the country.

Those costs not only affect the patients and their families; it
also falls on taxpayers and people who buy health insurance.
They are indirectly paying for a lot of that care.

Our series is produced with member station WNYC, and
with

Ken Burns Presents: Cancer: The Emperor of All Maladies
,
which will air on PBS starting March 30. Check
your local listings for broadcast times.

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