Monday, January 9, 2012

Cancer Rates Continue Falling

My wife sometimes notes, with wry incredulity, that economists seem to feel as if they have a more-informed opinion than non-economists on every topic. Thus, I smiled when ran across this press release last week: American Cancer Society report finds continued progress in reducing cancer mortality." As they report: "The American Cancer Society's annual cancer statistics report shows that between 2004 and 2008, overall cancer incidence rates declined by 0.6% per year in men and were stable in women, while cancer death rates decreased by 1.8% per year in men and by 1.6% per year in women. The report, Cancer Statistics 2012, published online ahead of print in CA: A Cancer Journal for Clinicians says over the past 10 years of available data (1999-2008), cancer death rates have declined in men and women of every racial/ethnic group with the exception of American Indians/Alaska Natives, among whom rates have remained stable. The reduction in overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of more than a million total deaths from cancer during that time period."

Of course, economists also believe that we have useful contributions to make to  the debate over reducing cancer. (Cue wife and children, rolling their eyes.)  In the Fall 2008 issue of my own Journal of Economic Perspectives, David M. Cutler wrote: "Are We Finally Winning the War on Cancer?" The article is freely available to anyone, like all issues of the JEP from the current issue back to 1994, courtesy of the American Economic Association. Here's the abstract:

"President Nixon declared what came to be known as the "war on cancer" in 1971 in his State of the Union address. At first the war on cancer went poorly: despite a substantial increase in resources, age-adjusted cancer mortality increased by 8 percent between 1971 and 1990, twice the increase from 1950 through 1971. However, between 1990 and 2004, age-adjusted cancer mortality fell by 13 percent. This drop translates into an increase in life expectancy at birth of half a year--roughly a quarter of the two-year increase in life expectancy over this time period and a third of the increase in life expectancy at age 45. The decline brings cancer mortality to its lowest level in 60 years. In the war on cancer, optimism has replaced pessimism. In this paper, I evaluate the reasons for the reduction in cancer mortality. I highlight three factors as leading to improved survival. Most important is cancer screening: mammography for breast cancer and colonoscopy for colorectal cancer. These technologies have had the largest impact on survival, at relatively moderate cost. Second in importance are personal behaviors, especially the reduction in smoking. Tobacco-related mortality reduction is among the major factors associated with better health, likely at a cost worth paying. Third in importance, and more controversial, are treatment changes. Improvements in surgery, radiation, and chemotherapy have contributed to improved survival for a number of cancers, but at high cost. The major challenge for cancer care in the future is likely to be the balancing act between what we are able to do and what it makes sense to pay for."