The American Cancer Society (ACS) recently published Cancer Statistics 2023, compiled from US incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. The ACS projects approximately 1.96 million new cancer cases in the US in 2023, or about 5,370 new cases diagnosed each day. Encouragingly, they reported a 33% overall reduction in cancer deaths since 1991 and an estimated 3.8 million deaths averted. This reduction reflects advances in treatment, as evidenced by rapid declines in mortality for leukemia, melanoma, and kidney cancer despite increasing incidence, as well as acceleracoted declines for lung cancer.
Overall, cancer is the second leading cause of death in US adults after heart disease and accounted for 18% of all deaths in 2020. However, for women aged 40–79 years and men aged 60–70 years, cancer is the leading cause of death. An estimated 609,820 US cancer deaths are projected for 2023, the equivalent of about 1,670 deaths per day. Although declining in incidence, lung cancer is the leading cause of cancer deaths in both men and women, nearly 2.5 times more than those who die from the second leading cause of cancer death—colorectal cancer. Cancer is also the second most common cause of death among children aged 1–14 years and fourth most common cause of death among adolescents.
The 5-year relative survival rate for all cancers combined has increased by nearly 20% since the mid-1970s. Survival rates are highest for patients with thyroid, prostate, or testicular cancers, and for those with melanoma. Conversely, survival is lowest for those with pancreatic, liver, and esophageal cancers. Improvements in survival have been most notable for hematologic malignancies, which the ACS attributes to improvements in treatment protocols, including development of targeted therapies. Additionally, new immunotherapies (eg, anti–CTLA-4 and anti–PD-1 checkpoint inhibitors, BRAF and MEK inhibitors) have had a significant impact on outcomes in melanoma.
For most cancers, incidence trends were more favorable in men compared with women. Overall, the lifetime probability of being diagnosed with invasive cancer is 1.8% lower for men than for women. Among men, prostate, lung and bronchus, and colorectal cancers account for almost half of all new cases and are the leading causes of cancer deaths, while for women, breast, lung, and colorectal cancers account for just over half of all new diagnoses and the highest rates of cancer deaths.
The data also highlight racial disparities. Although cancer incidence is highest among White people, survival rates are lower for Black individuals than for White individuals for all cancer types except pancreatic and kidney cancers (for which they are similar). Compared with White people, after adjusting for stage, sex, and age, the risk of cancer death is 51% higher in American Indian/Alaska Native people and 33% higher in Black people. The greatest differences in survival between Black patients and White patients are found in melanoma (20%) and cancers of the uterine corpus (20%), oral cavity and pharynx (18%), and the urinary bladder (13%). The ACS attributes racial disparities in cancer incidence and outcomes to longstanding inequalities in wealth, stemming from hundreds of years of structural racism that have altered the balance of social determinants of health.
High level
The authors warn that although mortality rates are declining, future progress may be offset by increased incidence of breast, prostate, and uterine corpus cancers, which also have the largest racial disparities in outcomes. Survival has not improved over the past 40 years for women with uterine malignancies, reflecting a lack of major treatment advances. More specifically, uterine corpus cancer is the fourth most commonly diagnosed cancer in women, yet there is little research activity in this tumor type. Distinct molecular subtypes have recently been identified, suggesting opportunities for targeted therapies to have a large impact since almost half of early-stage, recurrent endometrial cancers have targetable molecular alterations. Researchers and life science companies are encouraged to consider this area for future innovations.
Ground level
The decrease in cancer deaths reported by the ACS reflects the many advances in treatment since 1991. Clinicians should continue to monitor data and new drug approvals to ensure they are offering the most effective therapies available to patients. There are numerous therapeutics in development, including immunotherapies, which have recently shown promise in other tumor types such as cutaneous squamous cell carcinoma, non-small cell lung cancer, and renal cell carcinoma.
