Cancer Incidence decreases, Survival Improves

It’s wonderful to see benefits of public health interventions reflected in cancer statistics and outcomes.

“Cancer diagnosis rates decreased by an average of 0.8 percent each year from 1999 to 2005”

“The data may point to a real decline in the occurrence of some types of cancer, experts said. Alternatively, the decline may reflect inconsistent screening practices, causing some cancers that used to be detected to now go undiagnosed.”

“Breast Cancer incidence rates decreased by 2.2 percent annually from 1999 to 2005” Medicynical note: likely due to decrease in use of estrogen hormone replacement.

“The incidence of prostate cancer declined by 4.4 percent a year from 2001 to 2005, after annual increases of 2.1 percent a year for several years” Medicynical note: This may be a screening artifact.

“The incidence of lung cancer has been declining among men for many years but rising among women, though the increase is slowing, according to the report.”

“Women, unfortunately, got hooked on the smoking habit in the ’60s and ’70s,” Dr. Eheman said, “so there was a larger increase in smoking later on in time, and the prevention of smoking has been slower. The decrease in lung cancer that we hope will occur has not been happening yet.” Medicynical Note: The decline in lung cancer is almost certainly due to smoking cessation programs which seem to have been more effective amongst men than women.

There was a decline in death rates as well:

“Death rates from cancer fell an average of 1.8 percent each year from 2002 to 2005, according to the new report. Although last year’s report said death rates dropped an average of 2.1 percent each year from 2002 to 2004, a modest 1 percent decline in 2005 lowered the average percentage for the period.” Medicynical note: This death rate decline is almost entirely due to improved disease screening and early diagnosis. The earlier the diagnosis the better the outcome.

However, PSA testing has problems with both sensitivity and specificity. Colon cancer screening seems best done with colonoscopy which is labor intensive and very costly. To further improve we’ll need to develop screening technology that’s less costly more sensitive and more specific.

Treatment may contribute to the improvement but it’s benefit is small, and an order of magnitude more expensive than the prevention and early diagnosis strategy.

Other articles reporting these findings in the media point out the decline in government research funding over the past several years and make a plea for more government spending on medical research.

Medicynic certainly supports such funding but would point out that it’s been common practice to allow patenting of government funded research for the benefit of private companies, individual researchers, and research institutions. These patents allow monopoly pricing of medical advances for a generation. Such misuse of public funds needs to be stopped either by not allowing patenting of government funded advances which would encourage more active price competition and/or enforcing the reasonably pricing provision of Dole-Bayh legislation which facilitated the patenting of government sponsored advances.

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