Cancer in 2018
In this section, you will learn:
In the United States, the age-adjusted overall cancer death rate has been decreasing since the 1990s, with the reduction from 1991 to 2015 translating into almost 2.4 million cancer deaths avoided.
Not all segments of the U.S. population have benefited equally from advances against cancer.
It is predicted that the number of new cancer cases diagnosed each year in the United States will increase in the coming decades, rising from 1.735 million in 2018 to 2.387 million in 2035.
The cost of cancer is enormous, both in the United States and globally.
Research: Driving Progress Against Cancer
Research improves survival and quality of life for people around the world because it spurs the development of new and better ways to prevent, detect, diagnose, treat, and cure some of the many diseases we call cancer.
Every advance against cancer is the result of many years of hard work by individuals from all segments of the biomedical research community (see sidebar on The Biomedical Research Community: Driving Progress Together).
Among the advances are the new anticancer therapeutics approved for use by the U.S. Food and Drug Administration (FDA). From Aug. 1, 2017, to July 31, 2018, the FDA approved 14 new anticancer therapeutics (see Table 1). During this period, the uses of 11 previously approved anticancer therapeutics were expanded by the FDA to include additional types of cancer.
Advances such as those listed in Table 1 are helping drive down U.S. cancer death rates and increase the number of children and adults who survive a cancer diagnosis (see Figure 1) (2-4). In fact, the age-adjusted U.S. cancer death rate declined by 26 percent from 1991 to 2015, a reduction that translates into almost 2.4 million cancer deaths avoided (2). In addition, the U.S. 5-year relative survival rate for all cancers combined rose from 49 percent in the mid-1970s to 69 percent in 2014, which is the last year for which we have data (3).
The research that drives progress against cancer is made possible by investments from governments, philanthropic individuals and organizations, and the private sector the world over. In the United States, most federal investments in biomedical research are administered through the 27 institutes and centers of the National Institutes of Health (NIH). The largest of these institutes and centers is the National Cancer Institute (NCI), which is the federal government’s principal agency for cancer research and training. Cancer research also is funded through the congressionally directed medical research program at the Department of Defense. For research investments to yield dividends in the form of new medical products and community-based programs to improve public health, we also need strong federal investment in agencies such as the FDA and the Centers for Disease Control and Prevention (CDC).
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Cancer: An Ongoing Challenge
Although we have made incredible progress against cancer, this collection of diseases continues to be an enormous public health challenge worldwide (see sidebar on Cancer: A Global Challenge). The magnitude of this challenge is illustrated by the fact that cancer accounted for 8.9 million or 16 percent of the 54.7 million deaths that occurred around the world in 2016, meaning that it accounted for one in every six deaths (5).
In the United States, cancer accounts for a greater proportion of deaths than it does worldwide. In 2016, it accounted for 598,038 of the 2.7 million deaths, which is 22 percent of deaths (9).
Variable Progress Between Types of Cancer and Stages of Diagnosis
Among the challenges we face is that the advances we have made have not been uniform for all types of cancer. For example, while death rates for the four most commonly diagnosed cancers in the United States—breast, colorectal, lung, and prostate cancer—have been declining for more than a decade, those for other forms of cancer—most notably brain, liver, and uterine cancer—have been increasing in recent years (2).
In addition, advances have not been uniform for all stages of a given type of cancer. Patients diagnosed when cancer is at an early stage, before it has spread to other parts of the body, have a much higher likelihood of long-term survival than those diagnosed when the disease has spread to distant sites, an occurrence known as metastasis (10).
Given these challenges, 5-year relative survival rates for U.S. patients vary widely depending on both the type of cancer diagnosed and the stage at diagnosis (2,10).
Disparities in Progress for Distinct Population Groups
Cancer health disparities pose another pressing challenge both globally and nationally.
The NCI defines cancer health disparities as adverse differences in cancer measures such as number of new cases, number of deaths, cancer-related health complications, survivorship and quality of life after cancer treatment, burden of cancer or related health conditions, screening rates, and stage at diagnosis that exist among certain segments of the population (11) (see sidebar on What Are Cancer Health Disparities? and the sidebar on U.S. Cancer Health Disparities).
There are many complex and interrelated factors that contribute to U.S. cancer health disparities, which makes it difficult to isolate and study the relative contribution of each (see sidebar on Why Do Cancer Health Disparities Exist?). However, given that a significant proportion of the U.S. population falls into one or more risk categories, it is important that research into these specific issues continues. One area of intensive research investigation is furthering our understanding of the contribution of biological factors such as genetics to the adverse outcomes for certain U.S. populations. Only with new insights obtained through research and through the inclusion of all segments of the U.S. population in clinical trials will we develop and implement interventions that will eliminate cancer for all.
The Growing Cancer Burden
The public health challenge posed by cancer is predicted to grow considerably around the world in the coming decades unless we develop and effectively implement more effective strategies for cancer prevention, early detection, and treatment (see sidebar on Cancer: A Global Challenge).
In the United States, it is predicted that 1,735,350 new cases of cancer will be diagnosed in 2018 and that 609,640 people will die from some type of the disease (10) (see Table 2). These numbers are anticipated to rise significantly by 2035 (7). This is largely because cancer is primarily a disease of aging—53 percent of U.S. cancer diagnoses occur among those age 65 and older (3)—and this segment of the U.S. population is expected to grow from 52.5 million in 2018 to 78 million in 2035 (19). Also contributing to the projected increase in the number of U.S. cancer cases are continued use of cigarettes by 14 percent of U.S. adults (20) and high rates of obesity and physical inactivity, which are both linked to some common types of cancer (21).
Given the growing challenge presented by cancer, it is imperative that individuals from all segments of the biomedical research community work together to drive down cancer incidence and mortality.
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Cancer: A Costly Disease.
Research: A Vital Investment
The immense global toll of cancer is felt through both the number of lives it affects each year and its economic impact. One study estimated that the direct costs related to the prevention and treatment of cancer, and the economic value of lives lost and disability caused, cost the world approximately $1.16 trillion in 2010 (22).
In the United States, the direct medical costs of cancer care are estimated to have been $80.2 billion in 2015, the most recent year for which these data are available (10). It is important to note that this number does not include the indirect costs of lost productivity due to cancer-related morbidity and mortality.
The costs of cancer care alone stand in stark contrast to the amount of money the federal government invests across all areas of biomedical research. In 2015, the same year that the direct medical costs of cancer care were $80.2 billion, the NIH budget was just $30.36 billion, of which $4.93 billion went to the NCI.
With the number of cancer cases projected to increase in the coming decades, we can be certain that both the direct and indirect costs will also escalate.
The rising personal and economic burden of cancer underscores the urgent need for more research so that we can accelerate the pace of progress against cancer. Recent advances, some of which are highlighted in this report, were made as a direct result of the cumulative efforts of researchers from across the spectrum of research disciplines. Much of their work, as well as the federal regulatory agency that assures the safety and efficacy of medical devices and therapeutic advances—the FDA—is supported by funds from the federal government. The consecutive multibillion dollar increases for the NIH budget in fiscal year (FY) 2016, FY 2017, and FY 2018 have helped (see Figure 19). To keep up with the pace of scientific innovation, it is imperative, however, that Congress continue to provide sustained, robust, and predictable increases in investments in the federal agencies that are vital for fueling progress against cancer, in particular the NIH, NCI, FDA, and CDC, in the years ahead (see The AACR Call to Action).
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