Cancer Picture Continues to Get Brighter (CME/CE)

FG_AUTHORS: MedPage Today

Overall cancer death rates continue to fall for both men and women and across major ethnic and racial groups, according to the annual Status of Cancer report.

Cancer incidence also decreased overall in men and stabilized in women, according to Ahmedin Jemal, DVM, PhD, of the American Cancer Society in Atlanta, and colleagues involved in the yearly update.

But Jemal and colleagues reported that the burden of cancers associated with human papillomavirus (HPV) continues to rise, with marked disparities by socioeconomic and racial/ethnic status.

The "Annual Report to the Nation on the Status of Cancer, 1975–2009" appears online in the Journal of the National Cancer Institute. The report is prepared by researchers from the American Cancer Society, the CDC, the National Cancer Institute, and the North American Association of Central Cancer Registries.

From 2000 through 2009, overall cancer mortality fell by 1.8% a year among men, 1.4% annually among women, and 1.8% a year among children under 14, the researchers found.

During that decade, death rates among men fell for 10 of the 17 most common cancers -- lung, prostate, colorectal, leukemia, non-Hodgkin lymphoma (NHL), kidney, stomach, myeloma, oral cavity and pharynx, and larynx. However, death rates increased for melanoma of the skin and cancers of the pancreas and liver.

At the same time, mortality among women declined for 15 of the 18 most common cancers -- lung, breast, colorectal, ovary, leukemia, NHL, brain/nervous system, myeloma, kidney, stomach, cervix, bladder, esophagus, oral cavity and pharynx, and gallbladder. But it rose for cancers of the pancreas, liver, and uterus.

Overall cancer incidence fell by just 0.6% a year among men, was stable among women, and increased by 0.6% a year among children under 14, the authors reported.

During that time, incidence among men dropped for five of the 17 most common cancers -- prostate, lung, colorectal, stomach, and larynx – but increased for kidney, pancreas, liver, and thyroid cancers, as well as for melanoma of the skin and myeloma.

Among women, incidence fell for seven of the 18 most common cancers -- lung, colorectal, bladder, cervix, oral cavity and pharynx, ovary, and stomach – while rising for seven others: thyroid, melanoma of the skin, kidney, pancreas, leukemia, liver, and uterus.

Incidence was stable for the remaining top cancers, including breast cancer in women and NHL in men and women.

HPV-associated cancers accounted for 3.3% of all cancers among women in 2009 and 2% of those among men, Jemal and colleagues reported.

From 2000 to 2009, incidence of HPV-associated cancer of the oropharynx rose among white men and women, as did the rate of anal cancer among whites and blacks of both sexes, and cancer of the vulva among white and black women.

On the other hand, cervical cancer incidence over that period fell for women in all racial and ethnic groups, except American Indians and Alaskan natives.

The incidence of vaginal cancer fell, but only among black women, while rates of penile cancer remained unchanged among men in all racial and ethnic groups, the researchers found.

A snapshot of incidence rates in 2005 through 2009 showed that incidence rates for HPV-associated oropharyngeal cancers were highest among white and black men at 8.5 and 7.9 per 100,000 respectively. Among women, whites and blacks also led but at rates of 1.9 and 1.8 per 100,000 respectively.

Incidence rates for anal (2.6 per 100,000) and vulvar cancer (2.5 per 100,000) were highest among white women. Among men, blacks had the highest rate of anal cancer at 2.1 per 100,000.

Incidence rates for vaginal cancer were highest among black women at 0.8 per 100,000.

Finally, incidence rates for cervical cancer were highest among Hispanic women, at 14.4 per 100,000, followed by blacks at 12.6 per 100,000.

Jemal and colleagues also found that cervical cancer rates were elevated among women living in poor areas, compared with those in better-off neighborhoods, with similar disparities seen for men with HPV-associated anal cancers.

In 2010, 32% of girls, ages 13 to 17, had been given three doses of the HPV vaccine, and coverage was statistically significantly lower among the uninsured and in some Southern states such as Alabama (20%).

The findings concerning HPV-associated cancers are "strikingly different" from the overall trend, with increasing incidence and marked disparities across social and economic classes and racial and ethnic groups, commented Marc Brisson, PhD, of the Hôpital Saint-Sacrement in Québec city, and colleagues.

The differences are important given the "tremendous promise of reducing the overall burden of HPV-related diseases and inequalities" offered by recently approved vaccines, they argued in an accompanying editorial.

An important implication of the findings is the need to find ways of reaching vulnerable populations with HPV vaccines, Brisson and colleagues wrote.

"To fulfill the full potential of HPV vaccines," they argued, "vaccination coverage must be high not only at the population-level but also within the populations with the greatest need."

The study had support from the American Cancer Society, the CDC, the National Cancer Institute, the NIH, and the North American Association of Central Cancer Registries. No potential conflicts were reported.

The editorial authors had support from the Canada Research Chairs program and the Canadian Institutes of Health Research. Brisson reported financial links with GlaxoSmithKline and Merck Frosst.

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