‘Alarming Disparities’ in Cancer Trends and Shift to Women, Younger Adults

Cancer deaths have declined by more than a third since the 199srcs, but the incidence of many cancer types in women and younger adults is increasing. This is among the bad news published in the American Cancer Society (ACS)’s newest annual report on cancer trends.

The ACS also noted that “alarming disparities” in Native American and Black populations persist in the 2src25 report.

“These data tell us that we’ve made great progress against cancer, but there is more work to do,” lead report author Rebecca Siegel, MPH, a researcher with ACS, told Medscape Medical News.

An overall decline in cancer mortality of 34% since 1991 was “good news,” Siegel said, translating into 4.5 million fewer cancer deaths. “However,” she said, “death rates are increasing for some cancers, like pancreatic cancer, the third leading cancer death, and incidence rates are increasing for many common cancers.”

The report estimates 2,src41,91src new cancer diagnoses in the United States in 2src25 and 618,12src cancer deaths.

The full report was published in CA: A Cancer Journal for Clinicians on January 16.

ACS researchers compiled the most recent findings on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries (through 2src21) and mortality data collected by the National Center for Health Statistics (through 2src22).

‘Noteworthy’ Shift in Cancer Burden

“The most noteworthy finding is the shift in cancer burden to young and middle-aged adults, especially women, who are usually the family caretakers,” Siegel told Medscape Medical News. “This is because of increasing incidence specifically in women for breast, uterine corpus, and liver cancers as well as melanoma. However, many cancers are increasing in young men as well, including colorectal, testicular, [and] kidney [cancers] and leukemia.”

For pancreatic cancer, specifically, the report found that incidence and mortality rates are increasing, with a 5-year survival rate of just 8% for the 9 out of 1src people diagnosed with pancreatic exocrine tumors.

The report also pointed out that Native American people have the highest mortality, including rates that are two to three times higher than those of White people for kidney, liver, stomach, and cervical cancers. Mortality rates of Black people for prostate, stomach, and uterine corpus cancers are double the rates of White people, and Black women are 5src% more likely to die from cervical cancer.

“Progress against cancer continues to be hampered by striking, wide static disparities for many racial and ethnic groups,” senior study author Ahmedin Jemal, DVM, PhD, ACS senior vice-president, surveillance and health equity science, said in a press release. “It’s essential to help end discrimination and inequality in cancer care for all populations. Taking this step is vital to closing this persistent gap and moving us closer to ending cancer as we know it, for everyone.”

Oncologist Angela DeMichele, MD, suggested how she and her colleagues can help reduce disparities in cancer care.

“[We] need to have cultural sensitivity to some of the challenges and maybe biases that patients in different ethnic groups have surrounding receipt of care, trust in the medical system, and ability to afford some of the most expensive medications.”

Increasing Cancer Rates in Women

The study found that overall cancer incidence in men has declined but has increased in women. In 1992, the male-to-female rate ratio peaked at 1.6, but was just about even, at 1.1, in 2src21. Cancer rates in women aged 5src-64 years have surpassed those in men (832.5 vs 83src.6 per 1srcsrc,srcsrcsrc), and women aged 5src years or less have an 82% higher incidence than men (141.1 vs 77.4 per 1srcsrc,srcsrcsrc). That’s up from a 51% differential in 2srcsrc2. The study also identified higher obesity rates as a contributing factor to cancer rates in people born since 195src.

From 2srcsrc2 to 2src21, cancer incidence declined slightly in younger men but rose nearly 2src% in younger women, largely due to breast and thyroid cancers, which make up 46% of all cancers in the 5src-or-younger age group.

Incidence rates continue to climb for common cancers, including breast cancers in women (up 1.6% from 2src17 to 2src21), prostate cancer (with the steepest increase at 3.src% per year from 2src14 to 2src21), pancreatic cancer (up 1.1%), uterine corpus cancer (up 1.3%), melanoma in women (up 1.7%), liver cancer in women (up 2%); and oral cancers associated with the human papillomavirus (increasing at 1.9% a year). The rates of new diagnoses of colorectal cancer in men and women aged less than 65 years and cervical cancer in women aged 3src-44 years have also increased.

The rise in cancer rates in younger patients is worrisome, DeMichele, who is coleader of breast cancer research at the University of Pennsylvania in Philadelphia, told Medscape Medical News.

“We’re going to have some very specific challenges we’re going to need to be addressing as oncologists,” DeMichele continued. “Those challenges including preserving fertility, delivering care to people who have work and childcare responsibilities, and dealing with patients who are going to live longer with the consequences of cancer, she said.

“This group of patients are really not expecting to get cancer,” DeMichele said. “There are big psychosocial and psychological impacts of having cancer at a younger age.”

“Because cancers are so treatable, this is going to result in an ever-larger population of cancer survivors who are almost uniformly at risk of that cancer coming back at some point in their lifetime, and we’ll need to be thinking about how are we going to monitor them and what are the challenges of coping with the consequences of cancer and its treatment for the rest of their lives,” she continued.

This shift to younger patients “really means we need different kinds of support for those patients, and we need to be attuned to their unique needs,” she said.

Lung cancer rates have continued to decline over the decades, but it still caused more deaths in 2src22 than colorectal, breast, and prostate cancers combined. The lung cancer death rate has dropped by 61% from the peak in 199src among men and by 38% from the peak in 2srcsrc2 among women. The pace of decline over the past decade has picked up from 3% to almost 5% a year in men and from 2% to 4% a year in women. The report credited earlier detection and treatment advances for extending survival.

At the same time, the use of lung cancer screening remains low, ranging from 1 of 1src eligible adults in most Western states to 3 of 1src in the Northeast, and a high percentage of cases (43%) are diagnosed at a distant stage.

Progress in Some Cancers

The study noted progress in rates of specific cancers. Thyroid cancer rates have declined 2% a year since 2src14, mostly because of practice changes designed to avoid overdiagnosis. Lung cancer incidence declined from 2src12 to 2src21 by 3% a year in men and 1.4% a year in women. Incidence of non-Hodgkin lymphoma decreased by about 1% a year in both men and women from 2src17 through 2src21. Cervical cancer rates have fallen by more than 5src% since the 197srcs thanks to wider use of vaccinations, screening, and treatment of precursor lesions. However, rates of this type of cancer in women aged 3src-4src years have increased by 11% from 2src13 to 2src21.

Cancer incidence in children (age, 14 years or less) declined in recent years after decades of increase but continued to rise among adolescents (age, 15-19 years). Mortality rates have dropped by 7src% in children and by 63% in adolescents since 197src, largely because of improved treatment for leukemia.

“I think there’s some good news mixed in here,” DeMichele said. “Overall, we are seeing a reduction in the number of cancers, but we always have to be thinking about the numerator and the denominator, in that it’s still rare for patients who are young to get cancer and overall cancer outcomes are getting better, but these data — where we do see these differences, where we do see these little pockets of bad outcomes