ecancer deaths continue to decline due to advances in research, screening and treatment, according to the report. The nation’s cancer death rate was found to have dropped 32 percent from 1991 to 2019 — a reduction that translates into 3.5 million lives saved, Dr. David Cohn, interim chief executive and chief medical officer at the State Ohio University James Cancer Hospitalsaid in an interview.
To continue moving in the right direction and further reduce cancer mortality, oncologists must prioritize personalized cancer treatment and initiatives to address the social determinants of health, Dr. Cohn urged.
Several different factors are contributing to the nation’s declining cancer death rates—the first Dr. Cohn pointed to is the mitigation of risk factors through lifestyle changes, such as smoking cessation. For example, the report shows that 42% of US adults smoked cigarettes in 1965, but only 12.5% in 2020. Smoking tobacco increases the risk of developing not only lung cancer, but also 17 other types of cancer, including bladder, kidney and pancreatic and liver, according to the report.
Early screening is another key reason why cancer deaths are falling. Over the past decade, advanced cancer detection technology has created tests that can catch the disease in its earliest stages, before it has spread to multiple sites in the body. However, although many have benefited from early screening, not everyone can use these tests equally. Early screening often misses the nation’s uninsured population because they visit the doctor infrequently to avoid expensive bills, according to the report.
Technological advances in cancer screening are expected to continue in the coming years, as evidenced by FDA approvals for AI-based software to aid in the early detection and diagnosis of cancer, the report said. For example, Memorial Sloan Kettering spinout Paige received FDA clearance last year for its Cancer Detection Tool, which is the first artificial intelligence-based software approved by the FDA to identify cancerous lesions from prostate tissue slides, according to the report.
In addition, breakthroughs in treatment have contributed significantly to the reduction of cancer mortality in the country. One of the main reasons treatments are improving is that the medical community has gained a better understanding of the human genome, according to Dr. Kohn.
“As we’ve sequenced the human genome, we’ve begun to understand some of the molecular genetic changes that occur in cancer, and how those molecular changes interact with the environment,” he said. “If you understand that there are significant mutations in cancer, then you can develop drugs that target those specific mutations. We now have more targeted treatments that can improve the chances of not dying from cancer.
American oncologists must prioritize the availability of genomic testing to reduce cancer mortality, Dr. Cohn said. His team at the James Cancer Hospital is currently pursuing an initiative to ensure that medical oncologists across the state of Ohio have knowledge and access to genomic testing. These tests can lead to more personalized and effective cancer care, but patients who don’t live in urban centers still often don’t have access to this testing, he pointed out.
Advances in cancer treatment also include a greater focus on immunotherapy, which Dr. Cohn says has the potential to “change the entire paradigm of cancer treatment.” For him, mobilizing the body’s own immune system against cancer cells is the fourth pillar of cancer treatment, following the more traditional methods of treating cancer with chemotherapy drugs, damaging it with radiation and removing it with surgery.
Immunotherapy in oncology mainly refers to the use of immune checkpoint inhibitors, which are therapeutics that release the brakes on T cells. In 2011, the FDA approved only one checkpoint inhibitor, ipilimumab, which is used to prevent melanoma from coming back. There are currently nine FDA-approved checkpoint inhibitors, according to the report.
To ensure that cancer death rates continue to decline, the United States will need to address the obesity epidemic, Dr. Cohn said. He pointed out that obesity and lack of physical activity are risk factors that increase the risk of developing some of the few cancers that have an increasing incidence in the country, such as kidney and uterine cancer.
This is related to the social determinants of health, as many low-income Americans live in zip codes that lack of affordable healthy food options. Efforts to further reduce cancer mortality in the U.S. must focus on addressing these social determinants, Dr. Kohn said. Factors such as a patient’s ability to pay for their care and geographic distance from a cancer treatment center still play an important role in whether a patient will survive cancer, he said.
“The country has invested significantly to get to a place where we have better outcomes for those accessing care,” Dr Kohn said. “The next thing we need to do is increase access for people who are not currently receiving this level of care because the improved standard of care already exists.”
Photo: Public domain image from the National Cancer Institute