Declining cancer mortality in the United States

BACKGROUND: The overall age-adjusted cancer mortality rate had been increasing in the United States for as long as such statistics have been kept. This trend was reversed and a decline in cancer mortality began in 1991. METHODS: Vital statistics of the United States provided annual age-adjusted mortality rates for all forms of cancer and for lung carcinoma. Information from the Surveillance, Epidemiology, and End Results Program was also used to evaluate the effects on mortality of declining 5-year cancer case fatality. RESULTS: The overall age-adjusted cancer mortality rate declined in each succeeding year from 1990 to 1995 for a total reduction of about 3.1%. A major reduction occurred in lung carcinoma, which declined by 3.9%. Other smoking-related cancers declined by about 2%. The 5-year case fatality declined by approximately 0.5% per year from 1950-1954 to 1986-1991 for forms of cancer for which lead-time bias could be largely excluded. CONCLUSIONS: Both cancer prevention activities, especially those directed against smoking, and improvements in medical care have produced an appreciable reduction in cancer mortality in the United States. The nature of these changes suggests that the now ongoing decline will be sustained for the immediately foreseeable future.