In a recent article, we assessed the US cancer program by analyzing the overall incidence and mortality rates of all cancers combined, over 1975–2006.1 This study uses the same framework to analyze 24 specific types of cancer in three parts, and in alphabetical order. Part 1 of the study assessed cancers from bladder to kidney, over 1975–2007, and was published in the Aug./Sept. 2011 issue of the Townsend Letter. Part 2 of the study, presented in this issue, assesses seven cancers during the same time period: Leukemia, liver, lung, melanoma, mesothelioma, myeloma, and non-Hodgkin’s lymphoma. Part 3, to be published in a future issue of this journal, will cover the remaining types of cancer.
The data were primarily obtained from the SEER-9 (Surveillance Epidemiology and End Results) database of the National Cancer Institute (NCI). SEER-9 provides data from nine geographic areas: Connecticut, Hawaii, Iowa, Utah, New Mexico, Detroit, Atlanta, Seattle, and San Francisco. This geographic group constitutes approximately 10% of the US population. The US cancer mortality data are obtained by NCI from the Centers for Disease Control and Prevention (CDC) and are incorporated into the SEER database. Data on the US population were obtained from the US Bureau of the Census, Statistical Abstract of the United States.
SEER provides both incidence and mortality rates of cancers in age-adjusted form (to remove the effects of age on cancer incidence and mortality). Those data are calculated numbers of incidence and mortality by holding constant the age distribution of the US population to that of a given year (presently, the year is 2000). Thus, an incidence rate of 20 for a particular cancer means that 20 people per 100,000 population were expected to have been diagnosed with that cancer if the population of the US was the same as in year 2000. Consequently, an increase in the incidence rate indicates a real increase in cancer cases/cancer impact. The same applies to the mortality rates.
The incidence rates are also adjusted by SEER for delays in the reporting of cancer cases. These adjustments (including age adjustments) were described and discussed in our previous article in the Townsend Letter (Aug/Sept 2010).
The assessment is based on a long time period (1975–2007), which provides results that are more comprehensive and thus more reliable than those based on shorter time periods. The statistics used for the analysis are presented in chart form. For each cancer during the analysis period, we +calculated: (1) the incidence rate – to include overall rates, and rates for males and females; (2) the number of Americans afflicted with a cancer; (3) the mortality rate – to include overall rates, and rates for males and females; and (4) the number of Americans who died from a cancer.
With regard to assessing the program of the NCI in preventing cancer, the criteria used were the incidence rate and the number of Americans afflicted by a cancer. A constant or increasing incidence rate over time, along with increased numbers of those afflicted, indicates a failure of the NCI program in the prevention of a cancer. If the incidence rate declines but the number of people afflicted increases, the prevention program is also deemed to be a failure. A declining incidence rate, along with a declining number of those diagnosed with a cancer, indicates success in the prevention of that cancer.
With regard to assessing the treatment side of the NCI program, the criteria used were the mortality rate and the numbers of Americans who died from a cancer. A constant or increasing mortality rate of a cancer over time, along with increased numbers of deaths, indicates a failure of the NCI program in the treatment of that cancer. If the mortality rate declines over time but the number of deaths increase, the program for the treatment of that cancer is shown to also be a failure. If the mortality rate, however, declines over time and the number of deaths decline, this indicates success in the treatment of that cancer.
The overall incidence rate of leukemia, shown in Chart 1, increased over the analysis period from 12.8 (per 100,000) in 1975 to 14 (per 100,000) in 2007. Moreover, males had an incidence rate that was significantly higher than the females. In 1975, the incidence rate of males was 16.9, while that of the females was 10. By 2007, the rate of males had risen to 18.3, while that of the females had increased to 10.8. Even if the incidence rate of leukemia had stayed the same over time, it would still indicate a failing program of prevention. Consequently, even a relatively small increase in the incidence rate is a definitive sign of failure in prevention.
The other negative development of this cancer is that the number of Americans afflicted with leukemia increased steadily and significantly over time, as observed in Chart 2. In 1975, the number of people diagnosed with leukemia was 27,601 and this climbed markedly to 42,270 in 2007. The total number of people diagnosed with leukemia during the analysis period totaled a significant 1.1 million.
The overall mortality rate of leukemia declined slightly over the period of analysis – from 8.1 in 1975 to 7.0 in 2007 (Chart 3). This represents a decline of −0.45% (or 0.0045) per annum, a very small magnitude. Comparing the genders, one notes that once more, the males have a higher mortality rate than the females. In 1975, the mortality rate of the males was 11 while that of the females was 6, and in 2007, the rate of the males was 9.4 while that of the females was 5.3.
The very small decline in the mortality rate of leukemia and the increasing population over 1975–2007, resulted in increases in the number of Americans who lost their lives to this cancer. As observed in Chart 4, the number of deaths increased from 17,472 in 1975 to 21,120 in 2007. The total number of deaths from leukemia during 1975–2007 reached 659,574. The ratio of those who died from leukemia to those who were stricken with that cancer indicates that, on average, 58% of Americans diagnosed with leukemia will die from it. That is a grim statistic.
Cancer of the Liver and Intrahepatic Bile Duct (Invasive)
Data on liver cancer clearly show a dismally failing program, by NCI, in preventing this cancer. The overall incidence rate of liver cancer rose significantly over the analysis period, from 2.6 in 1975 to 7.2 in 2007 (Chart 5). With regard to gender, it is observed, once again, that the males had a substantially higher incidence rate of liver cancer than the females. In 1975, the incidence rate of males was 3.9, while that of the females was 1.6. Moreover, the rate of males increased faster over time than that of the females. By 2007, the incidence rate of males had risen to a remarkable 11.2, while that of the females had increased to 3.8.
Three questions arise from these statistics on liver cancer: (1) Why did the incidence rate of liver cancer increase over time? That is, why did the NCI program achieve worse results over time in the prevention of liver cancer? (2) Why did the males have a substantially higher incidence rate of liver cancer than the females? (3) Why did the incidence rate of the males increase faster than the rate of the females? These issues need to be investigated further.
The number of Americans stricken with liver cancer, shown in Chart 6, rose rapidly from 5702 in 1975 to 21,844 in 2007. This represents an amazing 283% increase and proves that the NCI cancer program failed in preventing liver cancer. The total number of Americans afflicted with liver cancer during 1975-2007 was 378,311.
The mortality rate of liver cancer increased significantly, from 2.8 in 1975 to 5.4 in 2007, as shown in Chart 7. From 1975 to 1988, the mortality rate grew by 1.3% annually. Moreover, the situation worsened, and from 1988 to 2007, the mortality rate increased by 3.2% annually. With regard to gender, as in other cancers, the rate of the males surpasses that of the females. In 1975, the mortality rate of the males was 3.8, while that of the females was 2. By 2007, the rate for the males had climbed to 7.9 as compared with 3.2 for the females. The faster increase in the mortality rate of the males than of the females over time resulted in a widening gap between the two genders.
The rising mortality rate of liver cancer resulted in escalating numbers of Americans who lost their lives to that cancer. That number, shown in Chart 8, increased from 6,069 in 1975 to 16,202 in 2007. This represents a 167% increase. The total number of deaths from liver cancer during this period reached 332,421. This indicates that on average, 88% of Americans afflicted with liver cancer die from the disease; that is indeed a horrendous statistic, showing the abysmal failure of the NCI program in treating this cancer.
Cancer of the Lung and Bronchus (Invasive)
The overall incidence rate of lung cancer rose from 52 in 1975 to 61 in 2007, as seen in Chart 9. This indicates an increase of 17% over the analysis period. With regard to gender, the incidence rate of men was much higher than the rate of women. In 1975, the incidence rate of males was a remarkable 90, while the rate of females was 25; and by 2007, the rate of males had declined to 72 while that of females had risen to 53. Consequently,the gap between the two genders narrowed over time.
In 1975, the number of Americans diagnosed with lung cancer was 112,867, as observed in Chart 10. That high number increased rapidly over the years that followed, reaching 183,895 by 2007. As a result of these increases,the number of Americans diagnosed with lung cancer during the period of analysis totaleda shocking 5.4 million.
Data on the mortality rate of lung cancer are shown in Chart 11. In 1975, the overall mortality rate was 42.6 and itincreased until 1989, when it peaked at 58. Subsequently, it began a gradual descent, reaching 50.7 in 2007. However, that rate was still noticeably higher than in 1975. With regard to gender, the mortality rate of males in 1975 was 74.5, very much higher than that of females, at 17.6. After 1991, the rate of the males began to decline, while that of females continued to rise. By 2007, the mortality rate of males had decreased to 65.2 while that of females had risen significantly to 40. Thus, the gap between the genders narrowed during the period of analysis.
The question arises as to why the mortality rates of lung cancer for the males were much higher than the rates of the females. Were the treatment protocols for lung cancer used for males and females not similar? If treatments were similar, why did the males have so much worse outcomes than the females? This needs to be investigated further.
Also, one wonders about which factors affected the rising mortality rates of females with lung cancer from 1975-2007. That is a very important point because a treatment program for cancer used during a time period – i.e., around 1975 – should at least provide the same outcomes in later years. One would think that changes in treatment protocols approved by the NCI/FDA would give better results on survival for cancer patients. That is not the case as seen in the rising mortality rates of the females.
The number of Americans who died annually from lung cancer increased tremendously over the analysis period, as shown in Chart 12. In 1975, the number of Americans who died from this cancer was 91,918, and by 2007 that number jumped 66% to reach 152,539. The total number of deaths from this cancer during the period of analysis was a shocking 4.6 million. That number in relation to the number of people afflicted by lung cancer (4.6 million deaths/5.4 million diagnosed) indicates that, on average, 85% of Americans diagnosed with the disease, will die from it – a horrible statistic.
Melanoma of the Skin (Invasive)
The incidence rate of melanoma of the skin increased rapidly over the analysis period. Data in Chart 13 show that while in 1975 the overall incidence rate was 7.9 (per 100,000), by 2007 it had climbed to 21.5. These numbers indicate a phenomenal 172%increase in the incidence rate over the analysis period. With regard to gender, over 1975–2007, the incidence rate of the males tripled from 8.5 to 26.9, while the rate of the females more than doubled, from 7.4 to 17.8. As observed in other cancers, the incidence rate of the males far exceeded the rate of the females over the analysis period. Moreover, as the incidencerate of males grew faster than for females,the gap between the two genders widened – with the incidence rate of males exceeding the rate of females by 9 points in 2007, compared with about 1 point in 1975.
The steadily increasing overall incidence rate of melanoma resulted in a stunning increase in the total number of Americans who contracted this cancer, as observed in Chart 14. The number of Americans diagnosed with melanoma rose from 17,040 in 1975 to 64,808 in 2007. That represents a remarkable 280% increase over the analysis period, or an 8.8% annual growth rate. The total number of Americans afflicted with this cancer during the analysis period totaled an extraordinary 1.3 million.
Chart 15 presents the mortality rate of melanoma over 1975–2007. In 1975, the overall mortality rate was 2.1, and by 2007 it had increased to 2.7. Both genders unfortunately experienced increases in their mortality rates. The rate of the males rose from 2.6 in 1975 to 4.0 in 2007, while the rate of the females increased from 1.6 to 1.7. Consequently, the US cancer program failed both males and females in the treatment side. Moreover, the males experienced more of a worsening in their mortality rate over time than the females, resulting in a widening gap between the two groups.
The number of Americans who lost their lives to melanoma during 1975–2007 is shown in Chart 16. The number of deaths rose substantially from 4471 people in 1975 to 8,056 in 2007. The total number of deaths from melanoma during the analysis period was 219,602. This indicates that, on average, 17% of those who contract melanoma will die from it.
Mesothelioma is a rather rare form of cancer found in the mesothelium, a protective sac that covers most of the internal organs of the body. It is by nature invasive; that is, it cannot be “in situ.” This is also true for other hematopoietic cancers such as leukemia. Mesothelioma also had an increasing incidence rate over time, as shown in Chart 17. In 1975, the overall incidence rate of this cancer was 0.6, and in 2007 it had reached 0.96. With regard to gender, the incidence rates of both males and females increased over time, and males had substantially higher incidence rates than females. The incidence rate of the males also increased more rapidly than the rate of the females. In 1975, the incidence rate of males was 1.0 while that of females was 0.3; and by 2007 the rate of the males had risen to 1.7, while for the females it was 0.4.
The number of Americans diagnosed with mesothelioma rose from 1361 in 1975 to 2896 in 2007, as seen in Chart 18. The total number of Americans diagnosed with mesothelioma during the analysis period was 83,902.
Data on mortality of mesothelioma are not available for 1975–2007. That cancer cannot be identified as the cause of death in versions of ICD (International Classification of Diseases) prior to version 10. So SEER can only identify deaths from mesothelioma for 1999 and beyond – according to information from SEER staff.
Myeloma is a cancer that begins in plasma cells, a type of white blood cell. Over time, these abnormal plasma cells (myeloma cells) collect in the bone marrow, damaging the solid part of the bone. The overall incidence rate of myeloma, shown in Chart 19, rose from 4.91 in 1975 to 5.97 in 2007; this represents a 20% increase. With regard to gender, once more the males had significantly higher incidence rates than the females. The incidence rate of males in 1975 was 6.4, while the rate of females was 3.9. Over time, the situation for both genders worsened so that by 2007, the incidence rate of males had risen to 7.8 while the rate of females had reached 4.6.
The number of Americans afflicted by myeloma also increased substantially over time, from 10,604 in 1975 to 18,012 in 2007, as seen in Chart 20. That is a notable 70% increase. The total number of Americans afflicted with myeloma during the analysis period reached 474,101.
With regard to mortality, the US cancer program is again shown to have been a failure in treating patients with myeloma. The overall mortality rate of this cancer rose from 2.9 in 1975 to 3.5 in 2007 (Chart 21). With regard to gender, the males once again had a higher mortality rate (3.7) than the females (2.4) in 1975. Moreover, the mortality rate of males rose faster than that of the females, to reach 4.4 by 2007, while the rate of females increased to 2.8.
The number of Americans who lost their lives to this cancer also increased substantially over time – from 6,350 in 1975 to 10,469 in 2007, as seen in Chart 22. The total number of deaths from myeloma during the analysis period was 305,693. This indicates that on average, 64% of Americans afflicted by this cancer will die from it – a grim statistic.
Non-Hodgkin’s lymphoma is a cancer that begins in the cells of the immune system. It occurs when a lymphocyte becomes abnormal and multiplies, weakening the lymphatic system, which is part of the immune system. In Chart 23, one observes a big increase in the incidence rate of non-Hodgkin’s lymphoma over the analysis period. In 1975, the overall incidence rate was 11, and by 2007, it had climbed 91% to 21. The failure of the US program in preventing non-Hodgkin’s lymphoma affected both men and women, as the incidence rate of both genders increased significantly over the analysis period. Men once more had a higher incidence rate than women (13 versus 10 in 1975), and that difference increased over the analysis period (26 for men versus 17 for women, in 2007).
Moreover, the rapidly increasing incidence rate resulted in ever-rising numbers of Americans being afflicted by non-Hodgkin’s lymphoma over the analysis period, as seen in Chart 24. The number afflicted with this cancer was 23,887 in 1975 and climbed significantly to 63,028 by 2007. The number of Americans afflicted with non-Hodgkin’s lymphoma during the period of analysis totaled a significant 1.5 million.
Data on the mortality rate of non-Hodgkin’s lymphoma also indicate a failing US cancer program in treating this cancer. The overall mortality rate increased from 5.6 in 1975 to 6.5 in 2007 (Chart 25). The mortality rate peaked at 8.9 in 1997, after which year, it declined. However, in 2007, that mortality rate was 6.5, still higher than in 1975. This implies that if the treatment protocol used in 1975 for non-Hodgkin’s lymphoma was kept the same over time, the results on treating this cancer would have been much better – that is, they would have been the same as in 1975. That, in turn, would have reduced the number of Americans who lost their lives to this cancer over the analysis period.
The mortality rate of both men and women also increased during 1975-2007. In 1975, the mortality rate of the males was 7, while that for the females was 4.7 and by 2007, the rate had reached 8.3 for the males and 5.2 for the females. One again observes that the mortality rate of the males was higher and grew faster than that of the females, over time.
Again, one wonders why the mortality rate of men is substantially higher and increased faster than the rate of women over time. If the same treatment protocol was applied to both men and women, why should the men have worse results than the women? One would expect the results to be more or less the same for both genders.
The number of Americans who lost their lives to non-Hodgkin’s lymphoma increased significantly over time, as shown in Chart 26. In 1975, 12,000 Americans died from the disease and this number grew by over 100% to reach 24,235 in 1997; it then decreased to 19,672 in 2007. That number, however, was still much higher than in 1975. The total number of Americans who lost their lives to non-Hodgkin’s lymphoma during the period of analysis totaled 622,451. This indicates that on average, 42% of Americans diagnosed with non-Hodgkin’s lymphoma will die from it.
The analysis over 1975–2007 showed increasing incidence rates and rising numbers of those afflicted for 7 out of 7 cancers: leukemia, liver cancer, lung cancer, melanoma, mesothelioma, myeloma, and non-Hodgkin’s lymphoma. This indicates a failing US/NCI cancer program in the prevention of these cancers. Also, in all seven cancers, the incidence rates of males were significantly higher than those of the females, and increased faster over time.
Our study also found a failing US/NCI program in the treatment of 6 out of 6 cancers (mortality data are not available for mesothelioma), as indicated by rising or constant mortality rates and rising numbers of deaths, or declining mortality rates but rising numbers of deaths. These cancers are: liver, lung, melanoma, myeloma, non-Hodgkin’s lymphoma, and leukemia. In addition, mortality rates of males were greater than those of females for all cancers assessed, and they increased faster over time.
The NCI’s announcements of its involvement in “cancer prevention” are misleading and deceptive, since they give the public the perception that NCI actually works to prevent cancer, whereas in fact it does not. An effective national program in the prevention of cancer requires two necessary components: (1) discovery of the carcinogenic substances through research; and (2) regulatory authority to ban or control those carcinogens. In reality, NCI only carries out research on those issues, without the authority to regulate carcinogens. Without that power, it cannot enforce the prevention of cancer. The results of our analysis attest to that lack of cancer prevention. It would seem that the cancer prevention system of the US was designed to fail.
Increasing mortality rates over 1975–2007 of the six cancers also indicate a failing US/NCI program of cancer treatment. Currently, there are three basic conventional approaches to treating cancer, approved by NCI and the Food and Drug Administration (FDA): surgery, radiation, and chemotherapy. It is obvious that the use of those modalities has been a failure at cancer treatment for these six cancers. There are other “alternative” treatments available. However, the NCI has not encouraged research on those treatments. On the contrary, alternative cancer treatments have faced many obstacles from the federal or state governments, including the regulatory section of the FDA and state medical societies. These obstacles are revealed in Politics in Healing – the Suppression and Manipulation of American Medicine by D. Haley (2005). As we mentioned before, “It seems unthinkable that the US, which professes to champion freedom around the world, does not offer the same freedom to its people in their choice of cancer treatment.”2
The failures on both the prevention and treatment sides of cancer call for a basic restructuring of the NCI and the US cancer program. On the prevention side, these changes should include the creation of an agency that has both research capabilities and regulatory authority to control/ban carcinogens. On the treatment side, the government should provide funding for the testing of alternative cancer treatments. These suggested changes would require thoughtful planning and direct involvement by the federal government – that is, the president and Congress.
1. Apostolides AD, Apostolides IK. The US Cancer Program, 1975–2006: A Failure. Townsend Letter. Aug/Sept 2010; Part 1; Oct 2010; Part 2.
2. Apostolides AD, Apostolides IK. The US Cancer Program, 1975–2006: A Failure. Townsend Letter. Oct 2010; Part 2:59.
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Anthony D. Apostolides, PhD, received a doctoral degree in economics from the University of Oxford, UK, and an MA degree from the University of Pittsburgh. He has taught on health-care economics and related fields at the university level; and carried out research in health care economics and delivery. He was engaged in research at the UN, Economic Commission for Europe and The Conference Board. He also worked for the State of Maryland, Department of Health; and for the federal government. His publications include articles in peer-reviewed journals.
Ipatia K. Apostolides, BA, has a bachelor’s degree in biology from Case Western Reserve University and several years’ graduate coursework. She has worked in the cancer field for over 15 years – as a laboratory manager and data manager at the Cleveland Clinic, and as data manager at the Children’s Hospital Bone Marrow Transplant Center in Cincinnati. She was also supervisor in the PLCO study at Georgetown University. She has coauthored several medical articles related to cancer. firstname.lastname@example.org