Positive Yet Unequal Trends

The American Cancer Society recently reported a second consecutive year of very positive data regarding cancer survival. Although the latest data may have been affected by pandemic-associated delays, the trend in the data indicates that the overall death rate from cancer in the United States continues to decline. The death rate from cancer has fallen 31% from 1991 to 2018, with an estimated 2.9 million fewer cancer deaths during that interval than would have occurred if death rates had remained at their peak level (based on five-year age-specific, sex-specific, and population-based data). Multiple factors have contributed to this improvement in cancer survival. For example, notable improvements in treatments for childhood cancers have resulted in overall survival increasing from 30% in the 1960s to greater than 80% in most high-income countries in 2020. In addition, vaccines against human papillomavirus are reducing cervical cancer risk, enhancement in breast cancer diagnosis and treatment have led to marked survival gains, and targeted therapies (e.g., immune checkpoint inhibitors) for malignant melanoma have increased long-term survival by 50% in some cases. However, other cancer types, such as pancreatic and brain, have seen lower levels of improvement.