Overall cancer mortality decreases, but regional disparities persist

Good news for the FDA and HHS marketing departments: The PSAs are working.

Overall cancer mortality in the United States decreased by about 20 percent from 1980 to 2014, but it varied widely at the county level, according to a study conducted by the University of Washington’s Institute for Health Metrics and Evaluation (IMHE).

“For most cancers you can find counties where the mortality rate actually increased,” said Laura Dwyer-Lindgren, a researcher at the IMHE and an author on the study. “It shows there’s all these counties who had success in reducing mortality rates, but at the same time there’s others who are getting worse and worse.”

These increases are largely a combination of lackluster screening, low access to care, and risk profiles for certain areas of the country. For example, while the U.S. will never return to the steep rates of tobacco smoking experienced during the post-war period, respiratory cancer mortality increased in Kentucky and West Virginia, who have the highest rates of cigarette smoking in the country. In addition, the increased use of cigars and smokeless tobacco is another barrier to reducing respiratory cancer mortality, according to the study.

Obesity is a major risk factor for cancers across the board, not to mention the non-oncological health problems it causes. It may be a primary force for change in mortality rates from county to county, and new public education efforts to fight obesity are needed, wrote the authors. While Americans have reduced their consumption of sugary beverages, their diet remains poor when compared to other developed countries, driven by the unhealthiness and ubiquity of fast food.

Many of these risk factors converge in the Southern U.S., particularly in the Mississippi Delta.

“That area tends to be worse off for a wide range of outcomes,” said Dwyer-Lindgren. “It’s a perfect storm of health outcomes that cause disadvantage.”

In addition, liver cancer was highlighted for more research by the authors, due to the peculiar distribution of changes in the mortality rate.

“If you look at the area where liver cancer is increasing most, it’s not necessarily in the areas of the country with the highest drinking rates,” said Dwyer-Lindgren, referring to the increase in mortality on the West Coast. “Alcohol is part of the story, but it’s probably not the whole story.”

Some cancers including colon, rectum, stomach, breast, and prostate experienced a decline in mortality across the U.S. These cancers tend to have strong screening cultures, long lead times, or an abundance of public education material encouraging preventative care. Study authors pointed to this style of prevention and treatment as the template for successful cancer care, with testicular cancer achieving an impressive five-year survival rate of 96 percent.