written by reader Cancer Care: Where Are We and Where Are We Headed?

By Michael Jorrin, "Doc Gumshoe", January 27, 2015

[ed note: Michael Jorrin is a longtime medical writer (not a doctor) who covers health and medical topics and trends for our readers, generally without an investment thesis. His words are his own, enjoy!]

In the Doc Gumshoe blog about cancer that appeared in June of 2013 (you can check it out here), I commented on the “bad rap” that cancer care gets, which I thought was due to a number of factors, not least that, although all kinds of eminent figures including several Presidents of the USA have declared “war on cancer,” cancer continues to kill upwards of half a million of us every year, so clearly we aren’t winning that war. Or, at least, that’s the perception of a considerable proportion of the public.

Let me state it clearly and unequivocally: Doc Gumshoe is not going to announce that we are winning the war on cancer. The war on cancer is most likely unwinnable – in fact, even defining it as a war on a single disease entity is a big mistake and a set-up for disappointment and failure. However, if we look at cancer treatment as a continuous campaign on an immense number of fronts, we find that we’re doing surprisingly well on quite a lot of these fronts. More on that later, but here, for a start, are some recent statistics:

The National Cancer Institute (NCI) estimates for 2014 are 1,665,540 new cancer cases and 585,720 cancer deaths. This represents an increase of 26,630 new cases and 8,530 deaths over the 2012 estimates.

But the NCI also compiles what are known as SEER statistics (Surveillance, Epidemiology, and End Results). These are estimates, but they are generally regarded as highly accurate, based on a number of regional registries. The current SEER registry includes data on about 28% of the entire US population, which is a robust statistical sample. According to SEER data, cancer deaths per 100,000 population peaked in 1991 at 215.1, and have been declining annually since then. The SEER estimate for 2011 (most recent year available for SEER) was 168.7 deaths per 100,000 population, a decline of 46.4 deaths per 100,000 population. Based on the SEER data, this would imply an overall decline of about 26% in the cancer death rate. Yes, a decline!

The discrepancy between the NCI’s estimate that there will be an increase of 8,530 cancer deaths from 2012 to 2014 with the SEER statistics, which are not yet available past 2011 is largely explained by the fact that US population grew by about 5 million between 2011 and 2014, and at the rate of 168.7 deaths per 100,000 that would account for 8,435 cancer deaths – almost exactly the same as NCI’s estimated increase for 2014 over 2012.

But enough of this fiddling around with statistics. What seems solid and reliable about the SEER statistics is the 26% decline in the rate of cancer deaths (the rate – not the total number of deaths!) in the 20 year period from 1991 to 2011. This would imply that if the cancer mortality rate as of 1991 had continued unabated, another 100,000 or so people in the US would have died of cancer. Let’s chalk that up as definite progress, if not a major victory.

However, another factor that deserves consideration when we think about cancer mortality is the zero-sum aspect of the relationship between cancer and cardiovascular mortality. Death rates from that particular killer are down sharply. The American Heart Association calculates that if the CVD mortality rate had remained at its 1963 peak of 307.4 per 100,000 population, 621,000 additional CVD deaths would have taken place annually from about 1996 onward – that’s about 12 million people. But those folks who escape dying of heart disease don’t live forever – instead, they survive to succumb to something else, frequently the big C.

A similar relationship prevails globally. Countries with the highest life-expectancy also tend to have higher rates of cancer mortality, while those with lower life-expectancy have much lower rates of cancer mortality. The simple, brutal, explanation is that something else kills them first, such as infectious diseases. Most of Africa, India, and South-East Asia have much lower cancer death rates than Europe and North America. An exception to this link between lower life expectancy and lower cancer death rates is Russia, which has both lower life expectancy rates and much higher cancer mortality. This is likely due t