The latest trends in cancer incidence in the United States show both good news and bad news, as highlighted in the latest annual report from the American Cancer Society (ACS).

The good news is an “astounding” 65% drop in cervical cancer incidence among women in their early 20s, the first cohort to have access to the human papillomavirus (HPV) vaccine, noted ACS chief executive officer Karen E. Knudsen, MBA, PhD.

The bad news is an alarming 3% annual increase in prostate cancer incidence from 2014-2019 after two decades of declining incidence.

“Most concerning is that this [prostate cancer] increase was driven by the diagnosis of advanced disease” Knudsen said, noting that the highest incidence and death rates were among black men. This increase in late-stage disease diagnoses has also been highlighted by others, as reported by Medscape Medical News.   

This uptick in prostate cancer has prompted a new ACS initiative called IMPACT: Improving Mortality from Prostate Cancer Together, to “mobilize resources across advocacy, patient support and research,” she announced.

ACS chief scientific officer William Dahut, MD, explained that “IMPACT will fund bold new cancer research programs that connect the laboratory, the clinic, and the community…to help discern who is most at risk for prostate cancer, and how to prevent it.”

Overall Cancer Deaths and Incidence

The cervical cancer and prostate cancer rates represent outliers at opposite ends of the spectrum. Overall, the data show a 33% decline in cancer mortality since 1991, which equates to an estimated 3.8 million cancer deaths averted, according to the report, titled Cancer Statistics, 2023.

Notably, cancer deaths continued to decline after the beginning of the COVID-19 pandemic, with a 1.5% drop from 2019 to 2020.

The report was published online today in CA: A Cancer Journal for Clinicians. A consumer-friendly companion, Cancer Facts & Figures 2023, can be viewed at cancer.org.

Looking at population-based cancer occurrence and outcomes using incidence data from central cancer registries and mortality data from the CDC’s National Center for Health Statistics, the ACS projects there will be 1,958,310 new cancer cases and 609,820 cancer deaths in the United States in 2023.

Cancer incidence trends were mixed but were better among men than women. Lung cancer incidence from 2015-2019, for example, decreased by 2.6% for men and by 1.1% for women.

Breast and uterine corpus cancers, as well as liver cancer and melanoma, continued to increase in women, stabilized in men aged 50 years and older, and declined in younger men.

The ACS attributes the overall drop in cancer mortality to advances in treatment, particularly for leukemia, melanoma, and kidney cancer, and to accelerated declines for lung cancer.

Cervical Cancer: A Vaccine Success Story

The steep 65% decline in cervical cancer incidence in women aged 20-24 years from 2012-2019 — compared with a 20%–30% decline in pre-HPV vaccine cohorts over the prior decade — underscores the value of HPV vaccination and provides “clear population-level evidence that vaccination can reduce cancer incidence and provides optimism for expanding research toward the development of additional cancer prevention vaccines,” an ACS press release notes.

“The large drop in cervical cancer incidence is extremely exciting because this is the first group of women to receive the HPV vaccine, and it probably foreshadows steep reductions in other HPV-associated cancers,” Rebecca Siegel, MPH, lead author of the report and ACS senior scientific director, surveillance research, stated in the press release.

Knudsen noted that HPV vaccination rates are only about 32%, and although cervical cancer rates are still higher in unvaccinated women, the data show some evidence of a herd effect.

“Increased investment in strategies to harness the immune system in cancer prevention is warranted,” added senior author Ahmedin Jemal, DVM, PhD, president, surveillance and health equity science at the ACS.

Prostate Cancer: “A Significant Call to Arms”

As the most common malignancy diagnosed in men and the second leading cause of cancer deaths in men, prostate cancer has profound but disparate health and financial effects. About 200,000 prostate cancer diagnoses are expected in the United States this year, representing nearly a third of all cancers in men, Knudsen said.

Incidence rates are 70% higher in Black vs White men, and mortality rates in Black men are 2-4 times higher than those in every other racial and ethnic group, Dahut added. 

Cure rates for localized prostate cancer are excellent and survival is nearly 99%.

The problem, as outlined in the ACS report based on a 2022 study conducted by Knudsen and her colleagues, is that more prostate cancers are being detected at later stages when the 5-year survival is only about 32%, she explained. Since 2011, the diagnosis of advanced-stage disease has increased by 4%–5% annually, and the proportion of men diagnosed with distant-stage disease has doubled.

“We must catch these cancers early,” she said, calling the findings “a significant call to arms.” That’s where the IMPACT initiative comes in.

Making an IMPACT 

In addition to research focused on risk-based prevention strategies, the IMPACT initiative will also work to promote greater access to screening and quality care across communities, and to advance public policy that will address the US prostate cancer burden.

“ACS is committed to utilizing a tripartite strategy to reverse prostate cancer disparities and reduce death rates from prostate cancer in all demographics and disparities for Black men by 2035,” Knudsen said. The goals of the initiative “can only be accomplished with community partnerships, including standing shoulder to shoulder with trusted organizations that share our vision to meaningfully address disparities in prostate cancer.”

CA Cancer J Clin. Cancer Statistics, 2023. Published online January 12, 2023. Full text

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, MDedge and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at  [email protected]  or on Twitter:  @SW_MedReporter

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