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Cancer deaths fall to lowest rate in decades as smoking declines

A cell culture laboratory at I-Mab Biopharma in Shanghai, Dec. 12, 2017. A growing number of Chinese pharmaceutical companies are trying to break into the United States, seeking regulatory approval to offer their treatments for cancer and other ailments. (Yuyang Liu/The New York Times Copyright 2018)

Fewer Americans are getting cancer, and more of those who do are surviving the disease, according to a new study.

In 2015, the most recent year with available data, cancer deaths dropped to 158.6 per 100,000 people, according to a report released Thursday by the American Cancer Society. That's 26 percent lower than in 1991, according to the report, or about 2.4 million fewer deaths over that period.

While a number of breakthrough, high-cost drugs have improved the outlook for people with some deadly cancers, the biggest cause of the decrease in deaths is that Americans are smoking less.

"It's the low-hanging fruit," said Ahmedin Jemal, the cancer group's vice president of surveillance and health services research. "We're going to continue to see this decline because of prevention, primarily reduction in smoking prevalence."

Jemal said that while innovative new treatments will likely affect the mortality rate, he expects preventative measures to have the strongest effect in the immediate future. The report found decreased smoking rates, and improved detection and treatment, have led to sharp declines in lung, breast, prostate and colorectal cancer deaths.

For most of the 20th century, cancer death rates rose as tobacco usage caused an increasing number of male deaths from lung cancer. However, in the early 1990s that trend reversed, according to the report. The Food and Drug Administration said last year it will take steps to bring the smoking rate down further, by cutting the amount of nicotine in cigarettes and other burnt tobacco products.

Since the cancer mortality rate peaked in 1991, it has fallen more sharply in men than in women. Lung-cancer death rates fell 45 percent among men between 1990 and 2015. For women, the death rate declined 19 percent between 2002 and 2015, according to the report.

"We can do more to accelerate the reduction in mortality rate" by cutting rates of smoking and obesity, said Jemal, the report's senior author. Obesity is a risk factor for some malignancies, including pancreatic cancer.

Other cancers have also become less lethal. The mortality rate for female breast cancer declined 39 percent between 1989 to 2015, and prostate cancer's death rate fell 52 percent between 1993 and 2015.

Increased detection of breast cancer at early stages through mammography and improved treatment are behind the drop in breast cancer, Jemal said.

Death rates from other cancers have increased in recent years, including uterine cancers, liver cancers and pancreatic cancer in men.

Wealth inequality has created significant gaps for cancer death rates between racial groups, because some groups have higher rates of smoking and obesity, or access to preventive care and treatment.

African Americans, American Indians and Alaska Natives all have cancer death rates higher than whites, while Asian Americans and Pacific Islanders have the lowest cancer incidence and mortality rates among racial groups tracked in the report.

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