Risk of Dying from Cancer Continues to Drop at an Accelerated Pace

The risk of dying from cancer in the United States has decreased over the past 28 years according to annual statistics reported by the American Cancer Society (ACS). The cancer death rate for men and women combined fell 32% from its peak in 1991 to 2019, the most recent year for which data were available.

Some of this drop appears to be related to an increase in the percentage of people with lung cancer who are living longer after diagnosis, partly because more people are being diagnosed at an early stage of the disease.  

Cancer continues to be the second most common cause of death in the US, after heart disease. A total of 1.9 million new cancer cases and 609,360 deaths from cancer are expected to occur in the US in 2022, which is about 1,670 deaths a day.

These statistics don’t include either basal cell or squamous cell skin cancers because US cancer registries are not required to collect information on these cancers. These numbers also do not account for the effect the COVID-19 pandemic has likely had on cancer diagnoses and deaths because they are projections based on reported cases through 2018 and deaths through 2019.

“Cancer Statistics, 2022,” published in the American Cancer Society’s journal CA: A Cancer Journal for Clinicians, provides the estimated numbers of new cancer cases and deaths expected in the US this year. The estimates are some of the most widely quoted cancer statistics in the world. The information is also available in a companion PDF report, Cancer Facts & Figures 2022 and is available on the interactive website, the Cancer Statistics Center.

Cancer death rate continues to drop

The 32% drop in cancer death rate between 1991 and 2019 translates to almost 3.5 million fewer cancer deaths during these years than what would have been expected if the death rate had not fallen. This success is largely because of fewer people smoking, which resulted in declines in lung and other smoking-related cancers.

Other factors that contributed to the reduced death rate include:

• Chemotherapy after surgery for breast and colon cancer
• Combination treatments for many cancers
• Prevention and/or early detection through screening for some cancers, including cancer in the breast, cervix, colon, prostate, rectum, and more recently, lung

The risk of death from cancer dropped by about 2% a year from 2015 through 2019 compared to 1% a year during the 1990s. Accelerating declines in the cancer death rate show the power of prevention, screening, early diagnosis, treatment, and our overall potential to move closer to a world without cancer.

The researchers note that improving upon the success of the reduced cancer death rate will require more investments from national, state, and local levels in two equally important areas:

• Cancer research that expands knowledge and advances treatment options
• Making sure that successful, targeted cancer control interventions are more broadly and equitably applied to all populations.

Progress in the early detection of lung cancer

The outlook is more promising than ever for lung cancer at all stages of disease. In recent years, more people with lung cancer are being diagnosed when the cancer is at an early stage and living longer as a result.

The rate of localized-stage disease diagnosis increased by 4.5% yearly from 2014 to 2018, while there were steep declines in advanced disease diagnoses. The result was an overall increase in 3-year survival rates. In 2004, 21 out of 100 people diagnosed with lung cancer were living 3 years after their diagnosis. By 2018, that number had risen to 31 out of 100 people.

Increased survival is also largely due to improvements in:

• Tests to diagnose lung cancer
• Video-assisted thoracoscopic surgery (VATS) 
• Updates to pathologic staging
• Drugs that target the most common gene mutations in lung cancer

“Improved lung cancer outcomes may also reflect increased access to care through the Affordable Care Act (ACA),” says Rebecca Siegel, MPH, lead author of Cancer Statistics, 2022, and Senior Scientific Director of Surveillance Research at ACS. “Plus, the ACS and USPSTF first recommended screening for lung cancer in 2013, so screening — even with low rates — still could have helped increase the diagnosis of localized-stage disease,” she says.

Here are some other statistics about lung cancer:

• Lung cancer still causes more than 350 deaths each day, which is the highest number of deaths for all types of cancer—more than breast, prostate, and pancreatic cancers combined. It causes 2.5 times more deaths than colorectal cancer, the second leading cause of death from cancer in the US.
• About 8 out of 10 (81%) deaths from lung cancer in 2022 are expected to be caused from smoking cigarettes. Both the amount and how long someone smokes increase risk of dying from lung cancer. People who smoke are about 25 times more likely to develop lung cancer than those who never smoked.
• Second-hand smoke causes almost 3% of new diagnoses of lung cancer and is expected to cause about 3% of deaths from it in 2022.
• After smoking, the next leading cause of lung cancer is exposure to radon gas, which is released from soil and can build up indoors.
  
• Nonsmoking-related deaths from lung cancer would rank as the 8^th leading cause of death from cancer if they were classified separately.

Stable progress against prostate and breast cancer

Prostate cancer. The risk of dying from prostate cancer decreased by about 50% from the mid-1990s to the mid-2010s due to improved treatment and earlier detection through screening with prostate specific antigen (PSA) testing, which helps find cancer when it is only in the prostate (localized). But in recent years, the risk of dying from prostate cancer is only decreasing by 0.6% a year. The cause for this slowing progress may be related to changes in screening guidelines.

Despite the contribution of screening to a reduction in mortality, there was increasing evidence that PSA testing was causing undue harm through overdiagnosis and overtreatment of prostate cancer. As a result, the US Preventive Services Task Force (USPSTF) changed their screening guidelines.

In 2008, the USPSTF recommended against routine screening with PSA testing for men age 75 and older and in 2012 for all men, which led to fewer men being screened. 

At first, reduced PSA testing was followed by rapid declines in the diagnosis of prostate cancer. But from 2014 to 2018, the incidence rate for local-stage disease stayed stable, whereas incidence rates for regional-stage disease rose each year by 4% and by 6% for distant-stage disease. 

As a result, the proportion of prostate cancers diagnosed at a distant stage has more than doubled over the past 10 years, from 3.9% to 8.2%. 

ACS researchers note that “controversy remains about the underutilized potential of the PSA test” to reduce deaths from prostate cancer by detecting potentially fatal disease earlier.

“One study found that after the 2012 USPSTF guideline changes, there was a steeper drop in PSA testing in Black men than in White men,” says Siegel. “That’s concerning because early detection is especially important for Black men, who are twice as likely to die from prostate cancer as White men.” See the ACS Guidelines for Screening and Early Detection of Prostate Cancer.

Breast cancer. In females, breast cancer incidence rates have been slowly increasing by about 0.5% a year since the mid-2000s. This rise in diagnoses is due in part to more women having obesity, having fewer children, or having their first baby after age 30. Declines in breast cancer mortality have slowed in recent years, probably related to rising incidence as well as unchanged mammography rates.

Cancer disparities continue

Racial/ethnic, socioeconomic, and geographic disparities in cancer occurrence and outcomes largely show longstanding inequalities in wealth that make access to high-quality health care difficult for some people. These disparities can be attributed in large part to historical and persistent structural racism in the US experienced by all people of color.

Cancer disparities occur when barriers to high-quality cancer prevention, early detection, and treatment create differences in cancer occurrence and outcomes based on sociodemographic factors such as race, ethnicity, age, income, sexual orientation, gender identity, or the place where a person lives. Most inequities in wealth, education, and overall standard of living among people of color stem from historical and persistent structural racism and discriminatory practices.

The COVID-19 pandemic greatly reduced people’s ability to find available services for cancer prevention, early detection, and treatment. These delays in care will probably worsen cancer disparities given the unequal burden the pandemic is having on communities of color.

Here are examples of statistics showing these disparities:

• In 2019, 27% of men without a high school education smoked cigarettes compared to 6% of men with a college degree. This is partly due to tobacco companies specifically marketing in neighborhoods where many people have low incomes.
• Black women have a 41% higher breast cancer death rate than White women even though their incidence of breast cancer is 4% lower.
• Cancer survival rates are lower for Black people than for White people for almost every cancer type.
• American Indians and Alaska Natives (AIANs) have the highest liver cancer incidence of any major racial/ethnic group in the US. The risk of developing liver cancer among AIANs is more than double that in White people. (See 2022 Special Section on AIANs and Cancer.)

Cancer in children and adolescents

Cancer is the second most common cause of death among children ages 1 to 14 years in the US. Accidents are the most common cause.

• In 2022, it is estimated that 10,470 children will be diagnosed with cancer, and 1,050 will die from the disease.
• Although the cancer incidence rate among children has been increasing some since the mid-1970s, cancer death rates in children have declined by 71% since 1970, largely due to improvements in treatment and more children taking part in clinical trials.
• Leukemia remains the most common childhood cancer, accounting for 28% of all cancers in children. Death rates for leukemia went down by 84% from 1970 through 2019.
• Brain and other nervous system tumors are the second-most common type, accounting for 26% of all childhood cancers.

Cancer is the fourth most common cause of death among adolescents ages 15 to 19.

• In 2022, it is estimated that 5,480 adolescents will be diagnosed with cancer, and 550 will die from the disease.
• Similar to children, cancer incidence rates among adolescents have increased slightly for decades, while the cancer death rate declined by 61% from 1970 to 2019
• Brain and other nervous system tumors are the most common type, accounting for about 21% of cancers in adolescents, followed by lymphoma (19%).

Progress among adolescents has lagged somewhat behind children for complex reasons that include lower enrollment in clinical trials, differences in tumor biology and treatment protocols, as well as treatment tolerance and compliance.

Other highlights from the report

• According to ACS research, at least 42% of the projected new cancers are potentially avoidable. This includes 19% of cancers that are caused by smoking and at least 18% that are caused by a combination of excess body weight, drinking alcohol, poor nutrition, and physical inactivity.
• New combination immunotherapies for metastatic melanoma — a historically hard-to-treat cancer — have been a game changer for survival. In 2004, only 15 out of 100 people diagnosed with distant-stage melanoma were alive after 5 years. For those diagnosed during 2011 through 2017, since these new treatments have been available, twice as many — 30 out of 100 people — were alive after 5 years.
• The occurrence of liver cancer—one of the most fatal cancers—has finally stabilized. Just a few years ago, it was the most rapidly increasing cancer.