Cancer death rate drama

Townsend Letter for Doctors and Patients, May, 2007 by Ralph W. Moss

The US cancer death rate declined by one-half of one percent between 2003 and 2004 ... and the world went wild. In fact, on January 17, 2007, President Bush paid a rare visit to the National Institutes of Health (NIH) in Bethesda, Maryland to bask in the reflected glory of this alleged turning point in the war on cancer. "Progress is being made," Bush claimed, after attending a roundtable discussion with cancer scientists. "We're spending about $28.6 billion here at the NIH, which was doubled from 15 years ago." However, the President failed to mention the equally significant fact that his administration has cut the National Cancer Institute's (NCI) budget by approximately $72 million between fiscal years 2005 and 2007.

Bush called the decline in cancer deaths "the steepest drop ever recorded." While technically true, this statement gives the unmistakable--and misleading--impression that the decline in the number of deaths was both dramatic and precipitous. This is not the case at all. As the respected weekly Cancer Letter trenchantly pointed out, the number of cancer deaths had either risen or remained the same, on a year-by-year basis, for over 70 years since record-keeping began. Meanwhile, the widely trumpeted decline in US cancer deaths amounted to only a few thousand--a fraction of a percentage point of the overall toll taken by cancer in 2004. And in 2003, the fall was even smaller, amounting to less than four hundred fewer deaths. Yet on the announcement of that minuscule drop, scientists also made a self-congratulatory mountain out of a statistical molehill.

This year, the leaders of the cancer war, accompanied by legions of enablers in the mainstream media, seemed to lose all sense of proportion. This was "big news," they intoned, "very exciting"; we've "finally turned the corner"; it is "highly gratifying"; "no fluke"; and so on. John R. Seffrin, PhD, chief executive officer of the American Cancer Society (ACS), said, "The hard work towards preventing cancer, catching it early, and making treatment more effective is paying dramatic, lifesaving dividends." Wow! That's a heavy burden of unwarranted assumptions to place on the shoulders of such a small change in mortality statistics.

Dr. Ahmedin Jemal, the epidemiologist who prepared the report for the ACS, declared that the decline "is not only continuing, but the decrease [in 2004] is much larger" [than that recorded for the previous year, 2003]. But "much larger" is a relative term. According to the figures released by the ACS, there were 553,888 US deaths from cancer in 2004. This compared somewhat favorably to the 556,902 cancer deaths in 2003. The 2004 figure thus represented a decline of 3,014 deaths, just over half of one percentage point. In 2003, by comparison, there were 557,271 deaths, just 369 fewer than 2002's total.

While any drop in cancer mortality is certainly good news, we have to ask whether the small declines recorded in these two successive years represent some decisive turning point in the war on cancer (as nearly everyone has unquestioningly assumed), or whether the drop may simply be a statistical glitch in an otherwise unremittingly grim picture. Are we seeing "light at the end of the tunnel," as Larry Norton, MD, of Memorial Sloan-Kettering Cancer Center, New York, told Public Broadcasting System's Jim Lehrer, (1) or could it be the headlight of an approaching train?

Of course, politicians of all stripes were quick to seize the opportunity and exploit it to the full. However, it remains to be seen whether this tentative two-year trend (spanning the years 2002-2004) will be sustained into the present day. While I join in appreciating each and every extra life that is not lost to cancer, there are good reasons for skepticism about the self-congratulatory mood that has overtaken the oncology profession in the light of this news.

For example, one need look no further than the American Cancer Society's own recently released publication, 2007 Cancer Facts & Figures, an annual review that gives a good statistical projection for cancer incidence and mortality in the current year. For 2007, the ACS projects a cancer death figure of 559,650. But wait a minute. Isn't this figure actually 5,762 more deaths than those recorded for the year 2004, the year that triggered the recent Presidential celebration?

According to statistics given in consecutive editions of Cancer Facts & Figures, which are available online, US cancer deaths for the last five years were as follows: 2002: 557,650; 2003: 556,902 (a decline of 369 over previous year); 2004: 553,888 (a decline of 3,014 over previous year); 2005: 570,280 (an estimated increase of 16,392 over previous year); 2006: 564,830 (an estimated decline of 5,450 over previous year); 2007: 559,650 (an estimated decline of 5,180 over previous year).

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I came across only one publication that pointed out this discrepancy: the SeniorJournal.com, which tracks trends of interest to Baby Boomers (see below). The SeniorJournal.com's headline read: "Cancer Society Predicts Cancer Deaths to Increase in 2007 Despite Long Rate of Decline." This seems to me to be a more accurate and newsworthy way of reporting the story.