Americans' overall death rate from cancer continues to fall -- but rising rates of certain cancers and ongoing racial disparities linger.
Those are among the findings of an annual report to the nation from several major cancer organizations.
The good news includes an accelerating decline in the overall cancer death rate, among both women and men, and across racial and ethnic groups.
In particular, deaths from lung cancer and melanoma are dropping more rapidly.
The progress against lung cancer can be credited to both a decline in smoking and to treatment advances, said report author Dr. Farhad Islami, of the American Cancer Society.
Similarly, he said, doctors now have better treatments for advanced melanoma, the deadliest form of skin cancer. They include drugs that help the immune system battle the disease.
The trends with some other common cancers were somewhat less positive: For both colon and breast cancers, where deaths have long been falling, the decrease has slowed down in recent years.
Those cancers can be caught early through routine screening, and treatments for both have improved over the years.
But trends in screening may help explain why colon cancer deaths are dipping more slowly now: Between 2000 and 2010, Islami said, there was a substantial increase in the number of Americans getting recommended screening tests.
But since 2010, he said, there have been only small improvements.
At the same time, colon cancer incidence has risen among Americans younger than 50 -- a trend that may be largely related to obesity, Islami said.
As for the slowed decline in breast cancer deaths, the reasons are not clear. But the incidence of the cancer is climbing -- which, Islami said, may also be related to obesity, as well as factors like sedentary lifestyle and delayed childbirth.
The report -- published July 8 in the Journal of the National Cancer Institute -- draws on federal cancer surveillance data and vital statistics for 2001 through 2018.
On the broad level, cancer deaths fell at increasing clip over those years: Among women, the death rate declined 1.4% per year from 2001 to 2015, then sped up to 2.1% per year from 2015 to 2018. For men, those figures were 1.8% and 2.3%, respectively.
Rapid declines in lung cancer deaths were one reason: Among men, for example, that rate was decreasing by 2% per year in the early 2000s, then accelerated to 5.7% per year between 2015 and 2018.
New treatments are also a big reason, said Dr. Jacob Sands, a medical oncologist and volunteer spokesman for the American Lung Association (ALA).
"There's been a revolution of new therapies that work much better than chemotherapy," said Sands, who was not involved in the report.
They include "targeted" drugs that zero in on specific genetic anomalies in certain lung tumors, as well as therapies that enhance the immune response to the cancer.
Experts also recommend lung cancer screening -- done annually by CT scan -- for certain smokers and formers smokers, starting at age 50.
Unfortunately, only a small percentage of Americans who qualify actually get screened. If all candidates were screened, Sands said, that would have a "dramatic impact" on deaths.
Screening can catch lung tumors when they are still curable by surgery alone, Sands pointed out.
"But our medical system is under-identifying and under-referring people for screening," he said.
He recommended that smokers and former smokers visit the ALA's "Saved by the Scan" page to find out if they qualify for screening.
The report identified another big area where the U.S. can do better: bridging the racial gap in cancer deaths.
While deaths generally declined across racial and ethnic groups, disparities remained. Black women, for instance, have a similar incidence of breast cancer as white women -- but are still 40% more likely to die.
Islami said that ongoing efforts to boost cancer screenings among underserved Americans are vital, but not enough on their own.
"People also need access to timely treatment, and to quality treatment," he said.
Then there's prevention of cancer in the first place, where a healthy lifestyle is critical. Islami said an estimated half of all cancer deaths in the United States are related to modifiable factors -- like smoking, obesity and lack of exercise.
But there again, he noted, low-income Americans face obstacles. "Many people can't afford to go to a gym, or don't have safe places to go for a walk," he said.
Policies to create public spaces for exercise or make healthy food accessible are needed, too, Islami said.
The U.S. National Cancer Institute has more on cancer causes and prevention.
SOURCES: Farhad Islami, MD, PhD, scientific director, cancer disparity research, American Cancer Society, Atlanta; Jacob Sands, MD, medical oncologist, Dana-Farber Cancer Institute, Boston, and volunteer spokesman, American Lung Association, Chicago; Journal of the National Cancer Institute, online, July 8, 2021