In a study reported in a research letter in JAMA Oncology, Kratzer et al found that mortality from cancer overall has decreased significantly since the passage of the National Cancer Act in 1971, with reductions observed in 12 of the 15 cancer sites associated with the highest mortality rates in 1971.
As stated by the investigators, “The year 2021 marks the 50th anniversary of the National Cancer Act of 1971, which designated defeating cancer a national priority and allocated substantial resources to the National Cancer Institute…. [T]he National Cancer Institute’s annual budget increased 25-fold, from $227 million in 1971 to $1 billion in 1980 and $6.01 billion in 2019.”
Cancer mortality rates per 100,000 population (age-adjusted to the 2000 U.S. standard population) were obtained using SEER*Stat, version 8.3.9, as reported by the National Center for Health Statistics, for all cancers and the top 15 sites in 1971 (accounting for 81% of cancer deaths) for 1971 through 2019.
Key Findings
Compared to 1971, the mortality rate for all cancers combined was significantly lower in 2019 (rate ratio [RR] = 0.73, 95% confidence interval [CI] = 0.73–0.74).
Mortality rate ratios for 2019 vs 1971 were significantly reduced for 12 cancer sites, consisting of lung/bronchus (RR = 0.87), female breast (RR = 0.61), prostate (RR = 0.61), colon and rectal (RR = 0.44), ovarian (RR = 0.59), stomach (RR = 0.28), leukemia (RR = 0.69), cervical (RR = 0.31), non-Hodgkin lymphoma (RR = 0.89), urinary/bladder (RR = 0.73), oral cavity/pharyngeal (RR = 0.57), and kidney/renal pelvis (RR = 0.96). Rate ratios were significantly increased for three sites, consisting of pancreatic (RR = 1.03), brain/nervous system (RR = 1.08), and esophageal (RR = 1.08).
Mortality rates increased after 1971 and subsequently declined after reaching peak mortality years. For peak mortality rate years vs 2019, rate ratios were significantly reduced for all cancers (RR = 0.68), lung/bronchus (RR = 0.56), female breast (RR = 0.58), prostate (RR = 0.47), non-Hodgkin lymphoma (RR = 0.56), brain/nervous system (RR = 0.87), kidney/renal pelvis (RR = 0.79), and esophageal (RR = 0.86).
Overall cancer mortality was higher in 2019 vs 1971 for 845 (29%) of 2,930 U.S. counties, mostly in the South; the increase was statistically significant for 41 counties, reflecting sparse data.
The investigators stated, “The cancer mortality rate has reduced considerably since 1971 overall and for most cancer sites because of improvements in prevention, early detection, and treatment…. [T]hese findings demonstrate considerable progress in reducing cancer mortality in the wake of expanded investment following the passage of the National Cancer Act of 1971. Improving equity through investment in the social determinants of health and implementation research is critical to furthering the national cancer control agenda.”
Ahmedin Jemal, DVM, PhD, of the Surveillance & Health Equity Science Department, American Cancer Society, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the Surveillance & Health Equity Science Department of the American Cancer Society. For full disclosures of the study authors, visit jamanetwork.com.
