Total Cancer Deaths Decline - Do I Care?

This was big news a few weeks back. According to the National Center for Health Statistics the total number of cancer deaths declined in 2003 for the first time since such statistics were kept in the 1930s. Do I care? Of course I do. I do find a few things disturbing about such a news story as I have seen it reported.

Medical professionals/researchers/informational web sites love to praise medical advancements and happy sounding statistics. I think with a class of diseases like cancer this is problematic. Did you notice the bold part of that last sentence? If you don't believe me that cancer is not a single disease, check the wikipedia definition. Cancer is not cancer is not cancer, so I'm not sure how much value there is at looking at statistics or big RAH! RAH! stories about overall cancer statistics. In fact, I have this little nagging thought in my head that perhaps it is harmful. If I see a story that says cancer deaths are declining and I think cancer is cancer is cancer, do I think our hotshot docs have cancer licked and now I no longer have to worry about it, fund it, etc? Maybe I do. And that is bad. Especially for the "rare" cancers.

Did you know that all pediatric cancers are considered "rare"? I'm not sure what the threshold for rare is, but CureSearch.org says this about incidence:

Nearly 30% of U.S. population is under the age of 20. In this age group:

  • Approximately 12,400 are diagnosed with cancer each year.
  • In 1998, about 2500 died of cancer.

About one in 300 boys and one in 333 girls will develop cancer before the age of 20. (The distribution of boys and girls diagnosed varies by type of childhood cancer.)

The incidence, or frequency that cancer is diagnosed, has risen since the 1970s for some types of childhood cancer, but rates have been fairly stable in more recent years.

Now there I go breaking my own rules. These are statistics based on a class of disease. Here are incidences by disease (sorry, the image isn't great):

It seems to me when we started our ordeal I saw lots of citing of an impressive long-term survival rate for pediatric cancer. Today as I was setting about to bitch and rant about that in pseudo-conjunction with my line of thought about careless and misleading cancer related news stories, I found such statistics much less prevalent and front and center. I think the CureSearch reorganization of COG materials has improved on this front and really structures things a lot more along the lines of individual disease.

There is some trickle down in research breakthroughs in high-profile disease. Incidence rate and total incidence seem to me (not based on research) to determine "high-profile". Some of the drugs, techniques, and methods used in treating common adult (or less rare pediatric cancers) can be used in more rare disease. This isn't always the case. Hell, I'm not even convinced that when we talk about neuroblastoma in one child and neuroblastoma in another that we are talking about the same disease.

So I've rambled a lot and that is good for me. I hope you got through this and could take something away from it. If I had to summarize, it is this: Don't believe the hype. Cancer is not one disease. There are some diseases that fall into the class that we have made huge strides in treating. There are others that we haven't touched the surface on. Something like 70% of children diagnosed with neuroblastoma have metastatic disease at diagnosis and are considered in the "high risk" category (prepare for a future rant on terminology such as "unfavorable outcome"). Most recent five year survival statistics for this group are 30%. We as a people can't find that to be acceptable and we can't be fooled by reports and news studies that lump all cancers together into thinking that we have made enough progress to stop being interested in curing "cancer".

1 comment:

matt dick said...

I have recently independently noted that when I was a kid, there was not such thing (in popular conversation) as "Bone Cancer", people got Cancer and died.

Now we have lots of varieties, which of course reflects our growing understanding. And maybe even now we are seeing a finer granularity in reporting and understanding of rates of individual kinds of cancer.

It's progress of a sort, and I find that at least a little encouraging.