Cancer mortality rates continue to decrease, but at a slower pace

James V. Lacey Jr., PhD, MPH

My first reaction to these data was relief, because it looks like the pandemic caused some brief disruptions but didn’t completely halt or reverse some encouraging recent trends in cancer incidence and mortality.

For both men and women, cancer mortality rates continue to fall, as they have since 2001. A key part of that drop is lower lung cancer mortality, especially among men but also among women. This is a clear success that should remind the cancer community that when community-based prevention — earlier detection, improved treatments and broader access to care — each do their part, good things happen.

For every cancer site, and for every population subgroup, there are interesting nuggets in the detailed year-by-year rates.

Since 2018, mortality rates fell for every race/ethnicity group — but since 2017, incidence rates among women increased in every race/ethnicity group.

The report shows higher incidence of female cancers that are associated with obesity, especially breast cancer, uterine cancer and colorectal cancers. Obesity is well on its way to overtaking tobacco as the most important modifiable risk factor for cancer, and these data show why: smoking-related cancer rates are falling while obesity-related cancer rates are rising. There’s an urgent need to develop a comprehensive and coordinated strategy to reduce the burden of obesity-related cancers.

The detailed data on cancer rates during the first few months of the pandemic are both fascinating and reassuring. The month-by-month data show that by late summer 2020, overall incidence rates had returned to the same level as in previous years. And monthly rates in 2021 were also in line with the prepandemic rates.

For the most part, the drop in numbers of new cancers being diagnosed when the pandemic first hit was unprecedented but, thankfully, short-lived. One worst-case scenario also appears to have been avoided: Delayed diagnoses led to higher percentages of cases being diagnosed at late stages, but except for prostate and cervical cancers, that adverse stage shift also seems limited to 2020.

[Negoita, Cronin] and colleagues discuss these issues with great clarity, and they correctly remind us that even the short-term underdiagnosis of cancers in 2020 will influence mortality rates for years to come.

My final reaction to this report was gratitude. We should all be immensely thankful for the federal agencies that cooperated to generate these important data, especially the CDC and the NCI, as well as their partners in the state cancer registries and the medical professionals in our communities. [Their] day-in and day-out dedication to reporting and tracking cancers among us establishes the foundation for continuing to make progress is reducing the burden of this disease.

Disclosures: Lacey reports no relevant financial disclosures.

Dale Shepard, MD, PhD

I was not surprised to see the decrease in incidence in 2020. I was a little surprised it didn’t carry into 2021, because we were not really back to “normal” in 2021.

I was happy to see that things like mortality trends, for the most part, continued to decrease as we expected and also that we didn’t see an increase in mortality during that 2020-2021 period.

When you think about cancer, you have three components: screening, diagnosis and treatment. There was great potential to have people not getting adequate care in all three areas during the pandemic. I don’t think the decreased incidence is surprising because there wasn’t a focus from health care providers on screening or even diagnosis.

From a treatment standpoint, I was really surprised, at least early in 2020, how many people had metastatic disease and needed treatment but wouldn’t come in for treatment because they were afraid they would get a virus. It was fear of the unknown that possibly kept them from treating something they knew about. It was pretty interesting psychology.

I was happy that we didn’t see a bump in mortality when their reporting ended, but that was only 2022. What’s the next 5-year block going to look like? Were tumors already there? Was it that we didn’t find things we should have and now it’s going to show up later? Or, when it shows up, is it going to be worse? I don’t think we’ve gone out far enough to know that.

It’s hard to know what [the slowing mortality rate] means. It’s kind of multifactorial. Overall mortality is going down, which is pretty consistent with what they showed here, because there is less use of tobacco, better treatments, things like that. But mortality is not improving in patients with obesity-related tumors or in women and young women like it is for the general population.

We’re looking at the effects during this period of time and looking at the data about the pandemic and its effects on cancer. I think in many ways it just points to the fact that medical conditions don’t live in isolation. We have to figure out the best ways, even in a pandemic, to pay attention to other things that are important, like cancer.

There are still 600,000 people who die of cancer every year, whether or not there’s a pandemic. Everything we can do to maintain diagnoses, make sure we keep up with screening [is important]. The decreased incidence in 2020 points to the fact that there has to be education on the part of patients and on the part of health care providers to pay attention to these things.

One thing that was missing, and it may be hard to capture, is that I don’t think we truly understand why there was decreased incidence. I think they were looking for things like state policies and whether things in the health care system changed these numbers. I think there was this component about people’s perceptions of safety of health care during that time, both on the provider part and the patient part.

Can we learn anything that can help with an education effort if this were to ever happen again?

Disclosures: Shepard reports no relevant financial disclosures.