THE MOSS REPORTS: PLAYING WITH NUMBERS, CONTINUED

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THE MOSS REPORTS Newsletter (02/26/06)

 

 

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Ralph W. Moss, Ph.D. Weekly CancerDecisions.com

Newsletter #225 02/26/06

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THE MOSS REPORTS – CANCER DECISIONS NEWSLETTER

 

 

 

 

 

PLAYING WITH NUMBERS, CONTINUED

 

 

Last week we began a discussion of the alleged improvement in cancer statistics

in the US, and showed that the small changes in cancer mortality rates that have

been recorded may have been due the overdiagnosis of pseudo-disease and

underdiagnosis of occult (hidden) cancer. We conclude this week with a

consideration of the American Cancer Society's projections for 2006.

 

 

 

Cancer Facts and Figures

 

 

The statistical report on the absolute decline in cancer deaths

coincided with publication of the American Cancer Society's 2006

Cancer Facts and Figures. This is a very useful compendium of cancer

statistics. This year's issue, together with several back issues, are

available at the ACS Web site, www.cancer.org. It is instructive to

look at the projected deaths for 2006 for the various categories of

cancer and then compare them to the 2005 figures.

 

Table 1

Changes in US Cancer Mortality, 2005-2006 (projected)

Type of Cancer 2005 Deaths 2006 Deaths Change

1. Oral cavity 7,320 7,430 +110

2. Digestive system 136,060 136,180 +120

3. Respiratory system 168,140 167,050 -1,090

4. Bones & joints 1,210 1,260 +50

5. Soft tissue 3,490 3,500 +50

6. Skin 10,590 10,710 +120

7. Breast 40,870 41,430 +560

8. Genital system 59,920 56,060 -3,860

9. Urinary system 26,590 26,670 +80

10. Eye & orbit 230 230

--

11. Brain & nerv. sys. 12,760 12,820 +60

12. Endocrine sys. 2,370 2,290 -80

13. Lymphoma 20,610 20,330 -280

14. Multiple myeloma 11,300 11,310 +10

15. Leukemia 22,570 22,280 -290

16. Other or unspec. 46,250 45,280 -970

 

Total

570,280 564,830 -5,420

 

Source: Cancer Facts & Figures 2005 and 2006, available at www.cancer.org

 

 

If ACS's projections for 2005-2006 are correct, more major diagnostic

categories will actually register an increase in the absolute number

of cancer deaths than will see a decrease. (In the HTML version of

this newsletter, decreases are highlighted in red). True, the total

number of cancer deaths will decrease by 5,420. But that is mainly

because the number of deaths from cancers of the respiratory system

will decline by 1,090 and cancers of the genital system will decline

by 3,860. Thus, these two types of cancer will account for 4,950 less

deaths, which is 91.3 percent of the entire projected decline. So let

us look more specifically at where that decline is taking place.

 

 

Table 2

Changes in US Respiratory Cancer Mortality, 2005-2006 (projected)

 

 

Type of Resp.Cancer Sex 2005 Deaths 2006 Deaths Change

Larynx M 2,960 2,950 -10

Larynx F 810 790 -20

Lung & bronchus M 90,490 90,330 -160

Lung & bronchus F 73,020 72,130 -890

Other respiratory M 540 540 ---

Other respiratory F 320 310 -10

Total 168,140 167,050 -1,090

 

Source: Cancer Facts & Figures 2005 and 2006, available at www.cancer.org

 

 

While all the subcategories of respiratory cancers show a decline in deaths,

the greatest reduction is in lung and bronchus cancer among women. This decline

of 890 deaths is still only about 1.2 percent of the female lung cancer death

total. But even so, it represents a favorable trend, paralleling the earlier

sustained decline in lung cancer deaths among men. It is not hard to predict

where this decline is coming from - reduced smoking. The ACS itself admits:

" These trends in lung cancer mortality reflect decreased smoking rates over the

past thirty years " (ACS, 2006 Cancer Facts & Figures, p.16), thereby

undercutting the self-congratulatory message of ACS officials that the decline

in deaths results in part from improved screening, early diagnosis and

treatment.

 

What about the decline in mortality from cancers of the genitourinary system?

 

 

Table 3

Changes in US Genitourinary Cancer Mortality, 2005-2006 (projected)

 

Type of Cancer Sex 2005 Deaths 2006 Deaths change

Uterine cervix F 3,710 3,700 -10

Uterine corpus F 7,310 7,350 +40

Ovary F 16,210 15,310 -90

Vulva F 870 880 +10

Vagina F 810 820 +10

Prostate M 30,350 27,350 -3,000

Testis M 390 370 -20

Penis/genitals M 270 280 -10

 

Total (male) M 31,010 28,000 -3,010

Total (female) F 28,910 28,060 -850

Grand total

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59,920 56,060 -3,860

 

Source: Cancer Facts & Figures 2005 and 2006, available at www.cancer.org

 

 

 

Again, we can see that many subcategories actually experienced increases in

cancer mortality. What accounted for the relatively large decline in

genitourinary cancer was a considerable reduction in the number of deaths from

prostate cancer, which accounts for over three-quarters of the overall decline.

The reason for this improvement is unknown. Again, it has been suggested that

the decline is due to improved screening and early diagnosis, through digital

rectal examinations (DRE) and prostate specific antigen (PSA) testing. However,

this is unlikely, in the light of the recent data showing no actual survival

benefit from either form of mass screening (Concato 2006). It may be due to

improved treatment, such as the wider use of complete androgen blockade therapy,

although I am unaware of any proof that this is so. Or, as I have suggested, it

could possibly be due to improvements in life style factors (including

supplement use) among men with the disease.

 

Conclusions

 

 

If the ACS figures given above are accurate, there does seem to be a slight

downward trend in the overall cancer mortality in the US. But the operative word

is " slight, " being a fraction of one percent of the total. Between 2005 and

2006, judging from projected figures, there will continue to be a decline in the

number of deaths, but this will also total a little less than one percent. Most

of that decline will be registered in two particular categories: lung cancer in

women and prostate cancer in men. The decline in female lung and bronchus cancer

can be ascribed to a beneficial decline in cigarette smoking over the past few

decades, which is now starting to have an impact on mortality rates. The reason

for the modest decline in prostate cancer deaths in men is uncertain. However,

to ascribe it to the increase in mass screening goes against the conclusions of

the recent large-scale study on PSA and DRE from Yale University (Concato 2006).

It may also be due to improvements in treatment (such as complete hormonal

blockade), to lifestyle changes (including food supplements), or to factors yet

unidentified.

 

To congratulate oneself for turning a corner in cancer deaths at this point is

both premature and hubristic. This is especially so as the Baby Boom generation

enters its golden years, a demographic trend which according to Dr. Jack Mandel,

chairman of epidemiology at Emory University's Rollins School of Public Health,

may lead to an increase in both cancer incidence and mortality.

 

 

References:

 

Concato J, Wells CK, Horwitz RI, et al. The effectiveness of screening for

prostate cancer: a nested case-control study. Arch Intern Med. 2006;166:38-43.

 

Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery

compared with surgery alone for adenocarcinoma of the stomach or

gastroesophageal junction. N Engl J Med. 2001;345: 725-730.

 

Schroder FG, Roobol MJ, Boeve ER, et al. Randomized, double-blind,

placebo-controlled crossover study in men with prostate cancer and rising PSA:

effectiveness of a dietary supplement. Eur Urol. 2005;48:922-930.

 

Seben, Larry. Cancer deaths decline, Valley News Dispatch, Feb. 10, 2006.

Available at:

http://pittsburghlive.com/x/tribune-review/trib/newssummary/s_422704.html

 

Welch HG, Black WC. Are deaths within 1 month of cancer-directed surgery

attributed to cancer? J Natl Cancer Inst. 2002 Jul 17;94(14):1066-70.

 

Welch, H. Gilbert. Should I Be Tested for Cancer? Berkeley: University of

California Press, 2004,

 

Welch HG, Schwartz LM, Woloshin S. Prostate-specific antigen levels in the

United States: implications of various definitions for abnormal. J Natl Cancer

Inst. 2005;97:1132-1137.

 

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IMPORTANT DISCLAIMER

 

The news and other items in this newsletter are intended for informational

purposes only. Nothing in this newsletter is intended to be a substitute for

professional medical advice.

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