Cancer in 2017
In this section you will learn:
In the United States, the age-adjusted overall cancer death rate is decreasing.
The reduction in the U.S. cancer death rate from 1991 to 2014 translates into 2.1 million cancer deaths avoided.
In 2017, 600,920 people are expected to die from cancer in the United States, making it the second most common cause of death.
Not all segments of the U.S. population have benefited equally from advances against cancer.
It is projected that the number of new cancer cases diagnosed each year in the United States will almost double by 2030.
The cost of cancer is enormous, both in the United States and globally.
Research: Driving Progress Against Cancer
Research is the foundation of progress against the many diseases we call cancer. It improves survival and quality of life for people around the world because it is the driving force behind every advance across the clinical cancer care continuum and every legislative action designed to improve public health.
Each advance is the culmination of a complex, multifaceted process that takes many years of hard work by individuals from all segments of the biomedical research community (see sidebar on The Biomedical Research Community: Driving Progress Together).
Among the advances made across the clinical cancer care continuum from August 1, 2016, to July 31, 2017, are the nine new anticancer therapeutics approved for use by the U.S. Food and Drug Administration (FDA) (see Table 1). During this period, the FDA also approved a new optical imaging agent to help visualize cancerous tissue during surgery and new uses for eight previously approved anticancer therapeutics.
Advances such as those listed in Table 1 are helping drive down U.S. cancer death rates and increase the number of children and adults who survive a cancer diagnosis (2-4) (see Figure 1). In fact, the age-adjusted U.S. cancer death rate declined by 25 percent from 1991 to 2014, a reduction that translates into 2.1 million cancer deaths avoided (2). In addition, the U.S. 5-year relative survival rate for all cancers combined rose from 49 percent in the mid-1970s to 69 percent in 2013, which is the last year for which we have data (5).
The research that drives progress against cancer is made possible by investments from governments, philanthropic individuals and organizations, and the private sector the world over. In the United States, federal investments in biomedical research and government agencies conducting research, such as the FDA and the Centers for Disease Control and Prevention (CDC), are of particular importance. Most U.S. government investments in biomedical research are administered through the 27 institutes and centers of the National Institutes of Health (NIH). The largest component of the NIH is the National Cancer Institute (NCI), which is the federal government’s principal agency for cancer research and training.
Cancer: An Ongoing Challenge
Although we have made incredible progress against cancer, this collection of diseases continues to be an immense public health challenge worldwide (see sidebar on Cancer: A Global Challenge). In the United States, it is predicted that 600,920 people will die from some type of cancer in 2017 (2) (see Table 2). This makes cancer the second most common cause of death in the United States after heart disease.
Variable Progress between Types of Cancer and Stages of Diagnosis
Among the challenges we face is that the advances we have made have not been uniform for all types and stages of cancer. For example, while the death rates for many of the most commonly diagnosed cancers in the United States—including breast, colorectal, lung, and prostate cancer—have been declining for more than a decade, those for other forms of cancer—most notably brain, liver, and uterine cancer—have been increasing (3). In addition, patients diagnosed when the disease is at an early stage, before it has spread to other parts of the body, have a much higher likelihood of long-term survival than those diagnosed when the disease has spread to distant sites, an occurrence known as metastasis (3).
Given these challenges, 5-year relative survival rates for U.S. patients vary widely depending on both the type of cancer diagnosed and the stage at diagnosis (2, 3) (see Figure 2).
Disparities in Progress for Distinct Population Groups
Cancer health disparities are some of the most pressing challenges posed by cancer that we face in the United States today.
According to the NCI, cancer health disparities are adverse differences in cancer measures such as number of new cases, number of existing cases, cancer-related health complications, number of deaths, survivorship and quality of life after cancer treatment, burden of cancer or related health conditions, screening rates, and stage at diagnosis that exist between certain segments of the population (8) (see sidebar on What Are Cancer Health Disparities?, and the sidebar on U.S. Cancer Health Disparities).
There are many complex and interrelated factors that contribute to U.S. cancer health disparities, which makes it difficult to isolate and study the relative contribution of each (see sidebar on Why Do Cancer Health Disparities Exist?). However, given that a significant proportion of the U.S. population falls into one or more risk categories, it is important that research into these specific issues continues. One area of intensive research investigation is furthering our understanding of the contribution of biological factors such as genetics to the adverse outcomes for certain U.S. populations. Only with new insights obtained through research and through the inclusion of all segments of the U.S. population in clinical trials will we develop and implement interventions that will eliminate cancer for all.
A Growing Challenge
The public health challenge posed by cancer is predicted to grow considerably in the coming decades unless we develop and effectively implement more effective strategies for cancer prevention, early detection, and treatment (7).
In the United States alone, the number of new cancer cases diagnosed each year is expected to almost double by 2030, when it is anticipated that it will reach 2.3 million (2, 7). This is largely because cancer is primarily a disease of aging, 53 percent of U.S. cancer diagnoses occur among those age 65 and older (16), and this segment of the U.S. population is expected to grow from 49.2 million in 2016 to 74.1 million in 2030 (17, 18). Also, contributing to the projected increase in the number of U.S. cancer cases are continued use of cigarettes by 15 percent of U.S. adults (19) and high rates of obesity and physical inactivity, which are both linked to some common types of cancer (20).
The United States is not unique in this regard (see sidebar on Cancer: A Global Challenge). Thus, it is imperative that the global biomedical research community work together to drive down cancer incidence and mortality.
Cancer: A Costly Disease
Research: A Vital Investment
Cancer exerts an immense toll, both as a result of the number of lives it affects each year and through its significant economic impact. The direct medical costs of cancer care are one measure of the financial impact of cancer, and in the United States alone, they are estimated to have been $87.6 billion in 2014, the last year for which these data are currently available (2). Although this number does not include the indirect costs of lost productivity due to cancer-related morbidity and mortality, it stands in stark contrast to the budget that the NIH received that same year, which was $30.1 billion, of which $4.9 billion went to the NCI.
With the number of cancer cases predicted to increase substantially in the next few decades, it is anticipated that the economic burden will rise sharply too (21). This underscores the urgent need for more research so that we can accelerate the pace of progress against cancer. Recent advances, some of which are highlighted in this report, were made as a direct result of the cumulative efforts of researchers from across the spectrum of research disciplines. Much of their work, as well as the federal regulatory agency that assures the safety and efficacy of medical devices and therapeutic advances—the FDA—is supported by funds from the federal government. While the consecutive $2 billion increases for the NIH budget in fiscal year (FY) 2016 and FY 2017 were a welcome boost, to maintain a vibrant cancer research enterprise it is imperative that Congress provide sustained, robust, and predictable increases in investments in the federal agencies that are vital for fueling progress against cancer, in particular the NIH, NCI, and FDA, in the years ahead.
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