Facts & Figures 2020 Reports Largest One-year Drop in Cancer Mortality

The death rate from cancer in the US declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop ever recorded, according to annual statistics reporting from the American Cancer Society. The decline in deaths from lung cancer drove the record drop. Deaths fell from about 3% per year from 2008 - 2013 to 5% from 2013 - 2017 in men and from 2% to almost 4% in women. However, lung cancer is still the leading cause of cancer death.

The decline in the death rate over the past 26 years has been steady. Overall cancer death rates dropped by an average of 1.5% per year between 2008 and 2017. This translates to more than 2.9 million deaths avoided since 1991, when rates were at their highest. A total of 1,806,590 new cancer cases and 606,520 deaths are expected in the US in 2020, which is about 4,950 new cases and more than 1,600 deaths each day.

The numbers are reported in “Cancer Statistics, 2020,” published in the American Cancer Society’s peer-reviewed journal CA: A Cancer Journal for Clinicians. The annual report estimates the numbers of new cancer cases and deaths expected in the US each year. The estimates are some of the most widely quoted cancer statistics in the world. The information is also released in a companion report, Cancer Facts and Figures 2020, available on the interactive website, the Cancer Statistics Center.   

Major cancer types: Lung, breast, prostate, and colorectal cancer

The 26-year decline in overall cancer deaths is due to long-term drops in death rates in the 4 most common cancer types: lung, colorectal, breast, and prostate. Progress in reducing lung cancer deaths has improved due to declines in smoking and advances in early detection and treatment. However, progress in reducing colorectal, breast, and prostate cancers has slowed.

These 4 cancers also account for the greatest numbers of cancer deaths. Almost one-quarter of all cancer deaths are due to lung cancer, more than breast, prostate, and colorectal cancers combined.

• Lung cancer death rates declined by 51% from 1990 to 2017 among men and 26% from 2002 to 2017 among women. From 2013 to 2017, the rates of new lung cancer cases dropped by 5% per year in men and 4% per year in women. The differences reflect historical patterns in tobacco use, where women began smoking in large numbers many years later than men and were slower to quit. However, smoking patterns do not appear to explain the higher lung cancer rates being reported in women compared with men born around the 1960s.
• Breast cancer death rates declined 40% from 1989 to 2017 among women.
• Prostate cancer death rates declined 52% from 1993 to 2017 among men.
• Colorectal cancer death rates declined 53% from 1980 to 2017 among men and by 57% from 1969 to 2017 among women.

Advances in treatment

The steepest declines in cancer deaths occurred for melanoma skin cancer, due in part to the immunotherapy drugs Yervoy (ipilimumab) and Zelboraf (vemurafenib), which the FDA approved in 2011. The overall melanoma death rate dropped by 7% per year during 2013-2017 in people ages 20 to 64, 1% per year in people ages 50 to 64, and 5% to 6% in people 65 and older. Progress in the 65+ age group is especially significant, because rates before 2013 had been increasing.

“The accelerated drops in lung cancer mortality as well as in melanoma that we're seeing are likely due at least in part to advances in cancer treatment over the past decade, such as immunotherapy,” said William G. Cance, MD, chief medical and scientific officer for the American Cancer Society, in a statement. “They are a profound reminder of how rapidly this area of research is expanding, and now leading to real hope for cancer patients.”

Improvements in targeted therapies and other treatments have helped drive progress for some types of leukemia and lymphoma. For example, the 5-year relative survival rate for chronic myeloid leukemia increased from 22% in the mid-1970s to 70% for those diagnosed during 2009 through 2015, and most people treated with tyrosine kinase inhibitors now have nearly normal life expectancy.

Special section: Cancer in adolescents and young adults

Each year, American Cancer Society researchers include a special section in Cancer Facts & Figures highlighting an issue of cancer research or care. This year, the topic is cancer in adolescents and young adults (AYAs). In 2020, researchers expect there to be 89,500 new cancer cases and 9,270 cancer deaths among AYAs, ages 15 to 39 years old.

As more research focuses on these patients, we are learning more about how cancers in this age group develop and are best treated.

• AYAs are more likely to be diagnosed at a late stage because of delays in diagnosis due to the rarity of cancer in this age group, higher uninsured rates, and higher rates of aggressive disease.
• AYA patients have a high risk of long-term and late effects, including infertility, sexual dysfunction, heart problems, and future cancers.
• Adolescents (15- to 19-year-olds) have a unique mix of cancer types including childhood cancers (such as acute lymphocytic leukemia), adult cancers (such as thyroid cancer and melanoma skin cancer), and a higher risk of lymphoma. For example, Hodgkin lymphoma accounts for 13% of cancer cases in adolescents compared to 9% in ages 20-29 years and 3% in ages 30-39 years.
• In 2020, the most commonly diagnosed cancers will be thyroid, testicular, and melanoma skin cancer in ages 20-29 years and breast, thyroid, and melanoma in ages 30-39 years.
• Leukemia is the leading cause of cancer death in both males and females ages 15-29 years, while brain and breast cancers are the leading causes of death in males and females, respectively, ages 30-39 years. Although cervical cancer is highly preventable through the HPV vaccine and screening, it is the second-leading cause of cancer death among women ages 20-39 years.
• During 2007-2016, the steepest increases in thyroid cancer incidence rates occurred among adolescents, 4.9% per year among males and 4.1% per year among females.
• In adults ages 20-39 years, rates increased for cancers of the colorectum (3%-6% per year), endometrium (3%), kidney (3%), and breast (0.2%-2%), with more rapid increases among those in their 20s.

Other highlights from the report:

• The overall rate of new cancer cases in men stayed about the same through 2016 after dropping significantly from 2007 to 2014, due to slowing declines for colorectal cancer and stabilizing rates for prostate cancer. Researchers attribute a sharp drop in prostate cancer diagnoses from 2007 to 2014 to decreased PSA testing following US Preventive Services Task Force recommendations against routine use of the test because of growing concerns about overdiagnosis and overtreatment.
• The overall rate of new cancer cases in women has stayed about the same over the past few decades. While lung cancer cases have continued to decline, the drop in colorectal cancer cases has slowed and other common cancers in women have increased or stayed the same.
• Breast cancer incidence rates have gone up slightly, by about 0.3% per year, since 2004. This may be due in part to increased obesity rates and decreased fertility rates.
• Rates of new cases continue to increase for cancers of the kidney, pancreas, liver, and oral cavity and pharynx (among non-Hispanic whites) and melanoma skin cancer. Liver cancer is increasing fastest, by 2% to 3% annually during 2007 through 2016, although the pace has slowed from previous years.
• The 5-year relative survival rate for all cancers combined that were diagnosed during 2009 through 2015 was 67% overall, 68% in whites, and 62% in Blacks.
• Cancer survival has improved since the mid-1970s for all of the most common cancers except cervical and endometrial cancers. A lack of improvement in survival rates largely reflect a lack of major treatment advances for patients whose cancers have spread or have come back.

“Cancer Statistics 2020” can be viewed at cacancerjournal.com, while “Cancer Facts & Figures 2020” is available at cancer.org/statistics.