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#222 - Cancer -- Part 1: Losing The Battle Against Cancer, 26-Feb-1991

A new report from the U.S. National Cancer Institute makes it clear
that we are losing the battle against cancer in the sense that more and
more of us are getting it. In the U.S., the incidence rate for all
cancers except three (stomach, rectum, and cervix) has risen steadily
since 1950; see Table 1. (Incidence rate means the number of people
each year diagnosed with a new cancer per 100,000 population.) These
are age-adjusted data, which rules out the explanation that "people are
living longer so they're getting more cancer." At the same time that
the incidence rate for 14 types of cancer has risen during the last 37
years, the death rate (the number of people each year dying of a cancer
per 100,000 population) for 11 types of cancer has fallen while the
death rate for only 6 types of cancer has risen; see Table 1. Some
government officials, and some medical doctors want to put a good face
on this and declare it a kind of victory to have more and more of us
living with a cancer that we have to fight, sometimes for the rest of
our lives. As the NEW YORK TIMES said recently (Feb. 4, 1991, pgs. 1,
B6) there's a "Changing View of Cancer: Something to Live With." The
TIMES story opens with a vignette of what it means to live with cancer:

"Margaretta Young was a Charlotte, N.C., teacher when she felt a tiny
lump in her breast on Easter weekend in 1963. Since then, doctors have
found tumors in her bones, liver, brain, parathyroid, and stomach.

"Mrs. Young has had seven operations, 30 sessions of radiation therapy,
and 17 years of weekly chemotherapy. She is not cured, and after 28
years of cancer and treatment, she is weakened, scarred, and often in
pain." But she is alive, the TIMES points out, and she says she still
enjoys the life she is hanging on to.

The TIMES speaks of "real advances in treatment" for cancer, but goes
on to describe the harsh reality that cancer patients face: "Most
cancer patients say they are constantly aware of their disease,
sometimes because of tangible reminders like having to take a pill
every day, feeling pain, or dressing to cover up scars or prostheses.
Many have serious side effects from treatment, including sterility,
nausea, profound exhaustion or organ failure.

"And almost all cancer patients say there are emotional reminders, too,
in the form of a new sense of mortality, added fear of the future, and
a sense of somehow being apart from those who have never had cancer.
Each new ache or pain, they say, brings with it a special terror that
their cancer is growing or spreading....

"The expanded arsenal of cancer treatments, which still mostly involve
some form of surgery, radiation, or chemotherapy, can be brutal,
causing side effects that may be as severe a burden as the disease. So
many patients with incurable cancers are faced with decisions about
just how much they are willing to go through to stay alive for a few
more years.... 'Some people feel we're prolonging living, others that
we're prolonging death,'" says Dr. John Rowe, president of the Mount
Sinai Medical Center in New York.

The new report from the National Cancer Institute (NCI) says, "Each
race and sex group [in the U.S.] showed statistically significant
increases in the overall incidence of cancer between 1973 and
1987." (Pg. I.1 of the NCI report, which is cited in our last
paragraph, below.) In this overall negative trend, there are scattered
bits of good news; for example, in the period, 1983-1987, the incidence
of lung cancer among men declined 0.6% per year--no doubt related to
changing patterns of tobacco use (pg. I.1). (However, among white
females, both the lung cancer incidence rate and death rate more than
doubled between 1973 and 1987 [pgs. I.7-I.8]--again a reflection of
tobacco use: yes, you have "come a long way, baby" as the cigarette ads
like to proclaim.)

Since 1980, the incidence of breast cancer among U.S. women has
increased "rather dramatically" from 84.8 per 100,000 to 111.9 per
100,000--a 32% increase. (NCI, pg. I.2.) Better screening by
mammography partly explains the change, but "these increases are a
major concern" says NCI (pg. I.9). The incidence of malignant melanoma-
-an aggressive and deadly form of skin cancer--increased 78.8% among
whites during the period 1973-1987.

The incidence of cancer of the colon and rectum increased slowly, 1973-
1987, from 46 per 100,000 to 49. However it increased more rapidly
among men (from 53.2 to 60.4). (Pgs. II.12, II.13).

Cancer of the prostate gland "has become the number one cancer for
men," says NCI (pg. I.11). Prostate cancer incidence increased 46%
between 1973 and 1987; it affects black men (132.0 per 100,000) much
more than white men (88 per 100,000) (pg. I.11).

Between 1973 and 1987, the incidence of non-Hodgkin's lymphoma
increased 50.9%; only malignant melanoma and female lunger cancer
increased faster during the period (pg. I.11). Cancer of the testicles
increased 37% during 1973-1987; the death rate from this cause dropped
60% during the period (pg. I.14.)

The incidence of urinary bladder cancer is rising at about 1% per year
among white males but at more than twice that rate among black males.
(Pg. I.14). The death rate among both groups is dropping.

Brain cancer increased slowly from 1973 to 1980; then "around 1980 the
incidence of brain cancer began increasing at an alarming rate among
people 65 and older with an increase of more than 3% per year," says
NCI (pg. I.14). Survival rates for this cancer are "dismal," says NCI.
An estimated 15,600 new brain cancers were diagnosed in 1990.

Incidence of cancer among children increased 6.1% during the period
1973-1987; the death rate dropped dramatically, however (36% overall,
and 50% or more for four cancers). (Pg. I.15)

Get: Lynn A. Gloeckler Ries and others, editors. CANCER STATISTICS
REVIEW 1973-1987 [National Institutes of Health Publication No. 90-
2789]. Bethesda, MD: National Cancer Institute (NCI), 1990. Free from
Office of Cancer Communications, NCI, Building 31, Room 10A24,
Bethesda, MD 20892; phone (301) 496-6641.

Table 1 -- U.S. Cancer Incidence and Deaths in 1987, and the Percent
Change in Rates of Incidence and Death per 100,000 U.S. Population,
1950-1987.

Cancer Incidence Deaths Percent Percent type in 1987 in 1987 change
in change in . ncidence, deaths, . 1950-1987 1950-1987 --------
--------------------------------------------------------------- stomach
24,600 13,740 -72.6 -75.3 rectum 43,000 7,638 -12.5 -65.9 cervix
12,800 4,423 -78.5 -73.0 colon 102,000 49,613 +24.9 -3.1 ovaries
19,000 11,838 +0.6 -0.5 larynx 12,100 3,670 +57.3 -8.1 testicles
5,500 422 +97.3 -64.5 bladder 45,500 9,589 +52.5 -35.3 Hodgkin's
7,300 1,755 +15.1 -61.7 childhood 6,600 1,787 +28.4 -58.7 leukemia
26,400 17,440 +2.6 -1.8 lung 154,000 129,866 +256.9 +245.0 skin
25,800 5,912 +283.8 +147.2 breast 130,000 40,896 +58.3 +3.6 prostate
96,000 27,863 +97.3 +10.9 kidney 21,900 9,332 +101.0 +28.9 lymphoma
29,900 16,269 +153.1 +100.0 . All types 811,000 347,028 +27.4 -19.0
excluding lung . All types 965,000 476,894 +42.2 +7.0 .

--Peter Montague, Ph.D.

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Descriptor terms: nci; cancer; bone cancer; liver cancer; brain cancer;
parathyroid cancer; stomach cancer; new york times; race; gender;
breast cancer; melanoma; colon cancer; rectal cancer; prostate cancer;
lung cancer; bladder cancer; brain cancer; childhood cancer; hodgkin's
disease; kidney cancer; ovarian cancer; cervical cancer; larynx cancer;
testicular cancer; lymphoma; skin cancer; john rowe; death statistics;
disease; studies; health effects;