Steady reductions in smoking combined with advances in cancer prevention, early detection, and treatment have resulted in a 23% drop in the cancer death rate since its peak in 1991. The drop translates to more than 1.7 million cancer deaths averted through 2012. The findings are included in Cancer Statistics, 2016, the American Cancer Society’s latest annual report on cancer incidence, mortality, and survival. It is published early online in CA: A Cancer Journal for Clinicians.

Every year, the American Cancer Society estimates new cancer cases and deaths in the U.S. for the current year and compiles the most recent data on cancer incidence, mortality, and survival. The report estimates there will be 1,685,210 new cancer cases and 595,690 cancer deaths in the United States in 2016.

Overall cancer incidence is stable in women and declining by 3.1% per year in men (from 2009-2012), with one-half of the drop in men due to recent rapid declines in prostate cancer diagnoses as PSA testing decreases.

Cancer mortality continues to decline; over the past decade of data, the rate dropped by 1.8% per year in men and 1.4% per year in women. The decline in cancer death rates over the past two decades is driven by continued decreases in death rates for the four major cancer sites: lung, breast, prostate, and colon/rectum.

Death rates for female breast cancer have declined 36% from peak rates in 1989, while deaths from prostate and colorectal cancers have each dropped about 50% from their peak, a result of improvements in early detection and treatment. Lung cancer death rates declined 38% between 1990 and 2012 among males and 13% between 2002 and 2012 among females due to reduced tobacco use.

The report also features an analysis of leading causes of death by state and finds that, even as cancer remains the second leading cause of death nationwide, steep drops in deaths from heart disease have made cancer the leading cause of death in 21 states: Alaska, Arizona, Colorado, Delaware, Florida, Georgia, Idaho, Kansas, Maine, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, Oregon, South Carolina, Vermont, Virginia, and Washington. In addition, cancer is the leading cause of death among adults ages 40 to 79, and among both Hispanics and Asian/Pacific Islanders (APIs), who together make up one-quarter of the U.S. population. Heart disease remains the top cause of death overall in the United States.  In 2012, there were 599,711 (24%) deaths from heart disease, compared to 582,623 (23%) deaths from cancer.

“We’re gratified to see cancer death rates continuing to drop. But the fact that cancer is nonetheless becoming the top cause of death in many populations is a strong reminder that the fight is not over,” said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society. “Cancer is in fact a group of more than 100 diseases, some amenable to treatment; some stubbornly resistant. So while the average American’s chances of dying from the disease are significantly lower now than they have been for previous generations, it continues to be all-too-often the reason for shortened lives, and too much pain and suffering.”

Other findings from the report:

• Among children and adolescents (aged birth-19 years), brain cancer has surpassed leukemia as the leading cause of cancer death, a result of more rapid therapeutic advances against leukemia.
• Thyroid cancer continues to be the most rapidly increasing cancer (>5% per year in both men and women), partially due to overdiagnosis because of the increased use of advanced imaging techniques.
• Colorectal cancer incidence and death rates declined by about 3% per year in both men and women from 2003 through 2012, with momentum gaining in the most recent years. However, rates increased by 1.8% per year from 1992 through 2012 in men and women aged younger than 50 years, among whom screening is not recommended for those at average risk.
• In contrast to stable or declining trends for most cancers, incidence rates increased from 2003 to 2012 among both men and women for some leukemia subtypes and for cancers of the tongue, tonsil, small intestine, liver, pancreas, kidney, renal pelvis, and thyroid.
• In addition, incidence rates increased in men for melanoma; myeloma; and cancers of the breast, testis, and oropharynx. Among women, incidence rates increased for cancers of the anus, vulva, and uterine corpus.
• Recent declines in incidence for melanoma and liver cancer among young adults may portend a reduction in the burden of these cancers in future generations.
• Death rates from cancer have dropped from a peak of 215.1 per 100,000 in 1991 to 166.4 in 2012. The decline is larger in men (28% since 1990) than in women (19% since 1991).
• Breast cancer is the leading cause of cancer death in women aged 20 to 59 years, while lung cancer is the cause of cancer death in women 60 and older. Among men, leukemia is the leading cause of cancer death for those aged 20 to 39 years, whereas lung cancer ranks first among men 40 and older.

Incidence data comes from the National Cancer Institute (Surveillance, Epidemiology, and End Results [SEER] Program), the Centers for Disease Control and Prevention (National Program of Cancer Registries), and the North American Association of Central Cancer Registries. Mortality data comes from the National Center for Health Statistics.