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U.S. cancer death rate has dropped by a third since 1991
- impish9208 4y agohttps://archive.is/coMAR https://archive.is/coMAR
- paulpauper 4y agoThe problem is this is mostly due to screening, not progress at treating advanced cancer, although that has improved too.
- hooande 4y agoWhy is this a problem? The point of screening is to find and treat the most common forms cancer before they become advanced.
- nluken 4y agoI get what you're saying: it's a bit of an apples-to-oranges comparison since better screening means we're comparing cancers of different severities. I don't necessarily see that as a problem, though, since a lot of these earlier screened cancers would have become more advanced cancers down the line. If our testing were perfect such that we could detect all cancers early enough to stop, that would functionally be a cure, no?
- jagraff 4y agoThe thing we don't know is which early cancers actually progress to advanced cancer. It's possible that we detect more things that look like cancer, but that would not have ever progressed into full blown metastatic cancer (at least, not before the patient died of something else). So that could artificially make it look like we've gotten better at treating cancer, when actually we've just gotten better at detecting non-life-threatening cancer.
- chimeracoder 4y ago> So that could artificially make it look like we've gotten better at treating cancer, when actually we've just gotten better at detecting non-life-threatening cancer. No, because the death rate is measured at the population level, not at the incidence level. Fewer people are dying today of cancer than 30 years ago. The only way that detection bias could impact that outcome is if you make the argument that a large number of terminal cancer cases were going undetected in 1991 at the time of death.
- pasquinelli 4y ago> If our testing were perfect such that we could detect all cancers early enough to stop, that would functionally be a cure, no? no. being able to detect cancer doesn't mean people are getting tested twice a year for their whole life. for example, you wouldn't have routine cancer screenings for children, but sometimes they get cancer, and on those occasions it'd be nice to have better treatment options.
- nluken 4y ago> it'd be nice to have better treatment options. No disagreement with you there. By "perfect screening" I assumed a "perfect" patient set where problems brought up at annual checkups lead directly to tests which lead to detection, but perhaps that's a naïve assumption to the point of uselessness. Still, I think it's easy to write off screening advances as skewing the data set vs. actually saving lives, when they do in fact help people that otherwise could have been much sicker.
- tshaddox 4y agoWe wouldn’t normally even consider talking about these things as if they’re in any way mutually exclusive, would we? Like normally we would all understand that it’s good for cars to get safer and for trauma care to get better.
- kragen 4y agoif cancer screenings for children were painless, lower risk than the cancer, and cost five dollars, you would totally have routine cancer screenings for children i mean maybe not in the usa but in sane places
- timerol 4y agoThe "US Cancer Death Rate" talked about in the article is measured in deaths per 100,000 population, not deaths per detected cancer. So we are comparing apples to apples, but finding and treating cancers earlier could be helping to result in fewer deaths.
- londons_explore 4y agoOr it could simply mean that another cause of death has increased. Like heart disease/diabetes from ever increasing obesity rates. A person can't die twice, so if heart disease gets them first, then they won't die of cancer.
- chimeracoder 4y ago> Or it could simply mean that another cause of death has increased. Like heart disease/diabetes from ever increasing obesity rates. You could hardly have picked a worse counterexample. Deaths from heart disease have fallen dramatically over that time period, even faster than cancer deaths have dropped. Deaths from strokes - which at one point equalled deaths from all cancers combined - have fallen as well, although much of that drop occurred before the time period in question. Deaths from diabetes are actually quite few in number compared to heart disease and cancer. They've sort of plateaued over this time interval, which isn't good news, but hardly the alternate explanation for the reduction in cancer deaths. Now, there is one big cause of death which we haven't addressed: COVID-19, which causes about 3x the number of deaths as diabetes, and over half the number of deaths as all cancers combined. But that only began in 2020, and this data shows a decrease across the entire interval, so it's not relevant here.
- TylerE 4y agoDiabetes is almost never the direct cause of death, but it’s damn hard in the body. Hurts circulation, hurts your nerves, hurts your organs… and it can flare badly in reaction to some medications. So, the cause of death won’t be “diabetes”, it’ll be heart attack, stroke, chronic infection, something like that. Similar to AIDS in that it doesn’t kill you directly (not that we know that juvenile diabetes is a thing, and we routinely test for it), it just makes any other health challenge much dicier.
- xupybd 4y agoScreening, the HPV vaccine and dropping rates of smoking. It would be nice if we could stop advanced cancers but at least we're getting better at prevention. I lost my dad to cancer last year. It's a horrible disease. I really had no idea how horrific it is. My dad had a year longer than his initial prognosis thanks to new immunotherapy drugs.
- JKCalhoun 4y ago> The decline in smoking rates in the U.S., better early detection and innovative treatments including immunotherapy drugs have driven a drop in death rates since 1991, the report said, averting an estimated 3.8 million cancer deaths in that time. Yes. I expected to find that the decline in smoking has also lead to the decline in fatal cancer — and there it is. Still a good thing.
- cokeandpepsi 4y agoit's crazy how fast smoking died out in the US even 10 years ago it felt people were puffing away all over the place
- caeril 4y agoIndeed. Now we just need to do the same for overeating.
- melling 4y agoThat’s not a problem, it’s the key to curing cancers, according to Craig Venter @15:40 early detection is the way to eliminate cancer: https://youtu.be/iUqgTYbkHP8 https://youtu.be/iUqgTYbkHP8 https://youtu.be/iUqgTYbkHP8?t=15m37s https://youtu.be/iUqgTYbkHP8?t=15m37s The reason people die from pancreatic cancer when they get it is because we can’t detect it early.
- ZainRiz 4y ago"problem" is a bit of a strong word, but when someone says "Cancer Death Rate Dropped" dropping people assume "Cancer Rate Dropped", which is not at all the same thing The article provides no numbers about cancer rate dropping. Yet the false association between the two ideas is so strong that even the authors themselves seem to theorize that the cancer rate itself is dropping because people don't smoke as often now. Conflating those two concepts seems like a Very Bad Idea
- Retric 4y agoThe % of the US population that dies every year from cancer has dramatically reduced. The % the US population that is detected to have cancer is up dramatically. The rate of people getting cancer in the US is a different question, but presumably it’s been increasing due to the aging population independent of other causes. https://www.statista.com/statistics/241494/median-age-of-the-us-population/ https://www.statista.com/statistics/241494/median-age-of-the...
- Wowfunhappy 4y agoI think this would only matter if some of the additional detected cancer would have gone away on its own. Correct me if I'm wrong, but I think that's impossible. It's different for e.g. Flu, where more testing = more detection of an illness that would not necessarily have become serious, had it gone undetected.
- stonemetal12 4y ago>detected cancer would have gone away on its own. Correct me if I'm wrong, but I think that's impossible. What if they detect a slow growing cancer that wouldn't have become a problem before you hit the age of 150? Not every cancer is aggressively trying to eat its host whole.
- msla 4y agoThere have been some wonderful advances in cancer therapy, such as immunotherapy. For example, Rituxan (rituximab) only dates to 1997, but it's already in a number of chemotherapy protocols, leading to a clear improvement in survival rates in previously difficult-to-treat cancers such as aggressive non-Hodgkin's lymphoma. https://en.wikipedia.org/wiki/Rituximab https://en.wikipedia.org/wiki/Rituximab https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398399/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398399/ Flashier, and something I've already talked about, is CAR T-cell therapy, the first generations of which were approved in 2017. This therapy has definite risks of severe side-effects, but it can result in complete remission of cancers that have survived multiple lines of chemotherapy, as happened with me. https://en.wikipedia.org/wiki/CAR_T_cell https://en.wikipedia.org/wiki/CAR_T_cell Immunotherapy isn't just promising, it's here, and, because of it, so am I, but even more exciting is that it gives us more avenues of research to build off of known-useful therapies.
- Hackbraten 4y agoCongrats for your success!
- jorvi 4y ago> For example, Rituxan (rituximab) only dates to 1997 It is kind of scary to me that drugs these days have such long regulatory lead times that a drug developed in 1997 is just now being entered into treatment regimens. I understand why that is (the Thalidomide tragedy stuff and like that), but I also clearly remember reading an article ~10 years back that asked why cancer treatment seemingly hadn’t made any leapfrogs since the ~70s, and the answer was back then they could aggressively iterate on treatments.
- msla 4y agoI think you misunderstood: I said it dates to 1997 because that's when it was first approved for use in America. It's not that new in cancer therapy, with R-CHOP (the CHOP protocol plus Rituxan) apparently being introduced in the early 2000s: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9036549/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9036549/
- codegeek 4y agoI wouldn't use the word "problem" but to explain it better, cancer rate itself has not dropped necessarily but due to early detection, number of deaths from cancer has dropped. We still have a long way to go to actual be able to cure cancers especially in advanced stages. Still a good win but more work to do.
- smt88 4y agoIt's mostly due to the reduction in smoking, not screening. Screening helps, but it often extends lifespan and healthspan rather than preventing a death.
- vikingerik 4y agoAvoiding cancer in the first place matters too. Lung cancer is a lot less common, now that nobody smokes any more. The rate of lung cancer deaths for men has halved since 1991, which itself accounts for half of the overall decline.
- myroon5 4y agoMore vaccines seems like one of the most straightforward future mitigations since viruses like Hepatitis/HPV/mono/HIV/herpes/etc cause almost a fifth of cancer cases: https://en.wikipedia.org/wiki/Oncovirus https://en.wikipedia.org/wiki/Oncovirus
- docdendrite 4y agoThat is a dubious claim. While links between HPV and cervical cancer are quite strong and well-defined, the associations with the other viruses you cite are only correlative. Also, Hep C, HIV and herpes have no vaccine, so unclear what your statement is referring to anyway? What has contributed to a drop in cancer mortality would be advances in treatment (like targeted therapies and immunoncology), better image/blood/genetic screening practices, and certainly the decreased popularity of smoking.
- wahern 4y ago> While links between HPV and cervical cancer are quite strong and well-defined, the associations with the other viruses you cite are only correlative. HPV is merely correlative, as well. That's basically how all endogenous cancers work. With Epstein-Barr Virus the association is quite strong, though the incidence of EBV-induced cancers doesn't seem to be quite as large as HPV--~1% vs 2-3%.
- docdendrite 4y agoHPV isn't correlative, it's causative. Additional co-transformation factors may be required, but it is well understood that E6 and E7 proteins directly lead to tumorigenesis. EBV pathogenic mechanisms are more autocrine and therefore a muddier picture, hence correlative.
- vineyardmike 4y ago> the associations with the other viruses you cite are only correlative. Also, Hep C, HIV and herpes have no vaccine And poster's own link doesn't claim some of the viruses are actually an oncovirus. That said, I don't think that pushing vaccines (either in research or into arms) for the listed diseases would be bad.
- robotnikman 4y agofuck cancer
- babypuncher 4y agoI'd rather not
- yamanawabi 4y agoI did a ride with the Fireflies West (http://www.fireflieswest.com http://www.fireflieswest.com) cycling/fundraiser group this past year, and that was our motto. Indeed, fuck cancer.
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- fexecve 4y agoNow remove lung cancer and see if the numbers have changed that much.
- andirk 4y agoBecause of smoking?
- 43534534625456 4y agoOut of curiosity, I chose one cancer from the article: breast cancer. Deaths declined from a peak of 33 to 19.1 per 100k women, whereas smoking only seems to increase your risk modestly: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698948/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698948/ > The HR (reference group was never smokers) was 1.14 (95% CI 1.03–1.25; P = 0.010) for ever smokers, 1.24 (95% CI 1.08–1.43; P = 0.002) for starting smoking at ages < 17 years, and 1.23 (1.07–1.41; P = 0.004) for starting smoking 1–4 years after menarche. However smoking rates have gone down massively since the '50s: https://news.gallup.com/poll/237908/smoking-rate-hits-new-low.aspx https://news.gallup.com/poll/237908/smoking-rate-hits-new-lo... https://www.researchgate.net/figure/Trends-in-the-prevalence-of-cigarette-smoking-among-adults-by-race-and-gender-in-the-US_fig2_236894547 https://www.researchgate.net/figure/Trends-in-the-prevalence... Also something that absolutely does seem to raise your risk of breast cancer is chest x-rays: https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-021-01456-1 https://breast-cancer-research.biomedcentral.com/articles/10... > Ever/never chest X-ray exposure increases BC risk 2-fold regardless of age at first exposure and, by up to 5-fold when carrying 3 or more rare variants in a DNA repair gene. Digital x-rays have largely replaced film, and they can reduce radiation exposure by 80-90%. So I'm not sure one way or the other.
- arroz 4y agoDid it improve or did people stop getting diagnosed because it is too damn expensive?
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- moooo99 4y agoScreening is more widespread and so is general awareness for symptoms. This leads to earlier diagnosis which generally has a better outlook than later stages. Then there's also general progress in terms of surgical procedures as well as medication for treatment
- kgwgk 4y agoCancer death rates decline because people find that dying of cancer is too damn expensive?
- Gatsky 4y agoThis is great progress. Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM, small cell lung cancer, stomach and esophageal cancer, certain types of breast cancer. Advanced colorectal cancer also not great. The other aspect of this is that death can often be replaced with multiple years of a highly medicalised and sallow existence while receiving cancer therapy. Point being, we don’t want to lose site of the ultimate goal, which is preventing cancer as much as possible.
- kodah 4y agoProstate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, you'd find the beginnings of prostate cancer in all of them. It's a question of when, not if." I say this to highlight three things: - Physicians routinely ignore things they shouldn't. Be your own advocate and research the things your doctor tells you, especially the things they believe are just worth watching. - There is little to no awareness in the public over prostate cancer. - Surviving isn't always a good metric. In my dad's case, surviving was a promise for a slow and miserable death.
- omniglottal 4y agoKnowing something must be checked, while your primary refuses to check it, what is one's recourse in the US?
- HPsquared 4y agoIs this "cancer deaths per person per year", or "cancer deaths per detected cancer"?
- mdp2021 4y agoYes it is a theoretical mess. The article manages to conflate in the same sentence: > The decline in smoking rates in the U.S., better early detection and innovative treatments including immunotherapy drugs have driven a drop in death rates since 1991 which mixes all meanings together (smoke → cases ; detection → fatality ...). So it's just "decreased number of deaths". (Well, on the other hand, it makes sense that more factors impact such "final" result.) From the CDC: > In the past 20 years, from 2001 to 2020, cancer death rates went down 27%, from 196.5 to 144.1 deaths per 100,000 population https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-deaths/index.htm https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-de...
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- tee_0 4y agoCancer rates have exploded since 1970. I told this to someone and they arrogantly corrected me. But I just looked it up right there and they had confused death rates with cancer rates. Thanks be to god for smartphones. Diabetes, obesity, cancer, depression rates all exploded in unison starting around 1970. Why does everyone ignore the massive implications of this? It means there’s something we’re doing that is killing millions of people but everyone brushes that aside and supports treatments rather than figuring out what happened in 1970 that is actually causing it. There are a trillion pet theories but nobody wants to do research to figure out. Nobody advocates for this research. What the hell
- seanmcdirmid 4y agoCould it be that people started living long enough to develop these problems, or that the problems were just previously undercounted? There are a lot of fairly boring theories that are more likely than anything extravagant.
- zw7 4y agoCancer rates skyrocketed because we started screening for cancer. It's that simple.
- tee_0 4y agoAnd obesity skyrocketed because nobody knew the difference between a fat person and a skinny person before 1970? We knew what cancer was before 1970. We certainly knew what diabetes was. The simple fact is that people started getting sicker in the 70s. For a very long time people have been going to the doctor when they feel sick. Oliver Cromwell consulted with doctors and was convinced that he was very ill. Later on we understand that he had bipolar disorder. When people feel sick they consult doctors and have been doing this for hundreds of years. An illness like diabetes presents very specific symptoms and doctors have been aware of diabetes for a very long time. The same is true for many kinds of cancer. And even mental illnesses as I have pointed out were recognized as medical ailments by people for hundreds of years. It wasn’t that we suddenly started diagnosing these things. Also, there are communities of people who do not develop heart disease or insulin resistance or depression or cancer. The common thread between every community like this is that they live outside of the modern world and do not eat modern foods. They live in an old way. This is well documented. Yet another insane data point that people somehow ignore. There are literally people out there who basically do not get cancer heart disease or diabetes and nobody seems to think it’s important to get to the bottom of this, people like you who leave snide comments and contribute nothing. A worthless parasite. So there are communities that live in the old way and do not get any of these diseases. We see that these diseases exploded for us around 1970. It couldn’t be more obvious.
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- jokethrowaway 4y agoI'd be interested in seeing cancer occurence rates over death rate. Sure, it's great we got good at keeping incredibly sick people alive, but it'd be better to avoid it in the first place.