CANCER SURVIVORSHIP: OVERVIEW
Since the passage of the National Cancer Act of 1971, major advances have been achieved in virtually every area of cancer research. As a result of early detection and better treatment of cancer, there are now nearly 10 million cancer survivors in the United States, a population that is expected to increase dramatically as the U.S. population ages and progress against cancer continues. However, the end of cancer treatment is not the end of the cancer experience. For the nearly 10 million Americans living with a history of cancer, life after cancer treatment brings diverse and often unexpected challenges, which may be influenced by the survivor’s age at the time of diagnosis, the type and severity of both the cancer and its treatment, financial and geographic access to follow-up care, employment and educational needs, and language differences. Two recent reports address cancer survivorship in the United States. A Centers for Disease Control and Prevention (CDC) report, titled Cancer Survivorship – United States 1971-2001, found that the number of cancer survivors in the United States has more than tripled in the past three decades. Living Beyond Cancer: Finding a New Balance, the 2003-2004 Annual Report of the President’s Cancer Panel, an advisory group to the President of the United States, is the first to take a life-span approach to describing cancer survivorship issues, focusing particularly on the post-treatment period.
Survivorship in the United States
The number of people living with cancer in the United States has increased dramatically— from 3 million (1.5% of the population) in 1971 to 9.8 million (3.5% of the population) in 2001. Estimated Number* of Living Persons Who Have
Ever Received a Cancer Diagnosis – United States, 1971-2001
8 9
Number (millions)
0 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001
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Year
*Estimated by applying U.S. populations to SEER-9 and historical Connecticut registry data. Tumor Registry data are adjusted to represent all cancer survivors. January 1 populations were based on average mid-year population estimates from the U.S. Census Bureau. Source: CDC, MMWR 2004; 53(24).
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Approximately 14% of the 9.8 million cancer survivors were diagnosed more than 20 years ago. Today, 64% of adults diagnosed with cancer will be alive five years after diagnosis, up from 50% in the 1970s. The increase is greatest among those ages 50 to 85, in whom relative fiveyear survival increased from 43% to 64% in the last 25 years—an average annual percent increase of 1.9%. (Embargoed: See graph on page 2) Nearly 75% of childhood cancer survivors (those diagnosed under age 15) will be alive after 10 years. Their five-year relative survival increased from 58% in 1975 to 82% in 2000—an average annual percent increase of 1.7%.
Embargoed until Thursday, December 2, 9:30 am
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Cancer survivors ages 50 to 85 represent 70% of all patients with cancer and their survival improvement rate exceeds that achieved in children. The most common types of cancer among survivors are female breast (22%), prostate (17%), colorectal (11%), and gynecologic (10%). The current average age of male and female cancer survivors are 69 and 64, respectively. Sixty percent of survivors are currently over age 65.
Five-Year Survival Rates for Breast, Prostate, Colorectal, and Cervical Cancer 1950-1954 vs. 1995-2000
120%
99%
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Progress Against Cancer
There has been important progress against cancer over the last 50 years as a result of improvements in cancer screening and early detection, and the development of better treatments. In particular, the five-year survival rates for some of the most common cancers have increased.
100% Patient Survival Rate 80%
60%
89%
1950-1954 1995-2000
74% 64% 59%
60%
43%
40% 20% 0% Breast Prostate
37%
Colorectal
Cervical
Cancer Type
Source: National Cancer Institute, Five-year relative survival rates, 1950-2000
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Screening and Early Detection – A substantial proportion of the increase in survival rates can be attributed to improved screening—such as mammography for breast cancer, PSA testing for prostate cancer, Pap smear for cervical cancer, and colonoscopy for colorectal cancer—allowing more cancers to be detected at earlier, more curable stages. Improvements in Chemotherapy – Improvements in chemotherapy regimens during the last 30 years have contributed to the increase in survival rates among adults and are responsible for a large proportion of the increased survival observed among children with cancer. Most these children participate in clinical trials. These lessons can and should be applied to adults with cancer. Currently, only 5% of adults with cancer participate in clinical trials. Treatment of Side Effects – Increased survival is also due to more effective management of side effects. Drugs such as filgrastim (Neupogen), which boosts white blood cell counts, and epoetin (Epogen), which boosts red blood cell counts, make it easier for patients to tolerate chemotherapy, and allow doctors to administer higher, more effective doses of anticancer drugs. Targeted Therapies – Advances in highly targeted therapies—which are more specific and less toxic than standard chemotherapy—have the potential to increase survival rates by slowing disease progression while preserving healthy tissue. Examples include imatinib (Gleevec) for gastrointestinal stromal tumors and chronic myelogenous leukemia, gefitinib (Iressa) for lung cancer, and bevacizumab (Avastin) for metastatic colorectal cancer. Some of these drugs, such as Gleevec, are available in pill form and can be self-administered.
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Prostate Cancer: An Example of Success
Five-year survival rates for prostate cancer have dramatically increased—from 43% in 1950 to 99% in 2000—providing a clear example of success in the field.
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Early diagnosis due to widespread use of blood testing for PSA, a marker of prostate cancer growth, as well as digital rectal examination, are partly responsible for this success. Therapy has improved as well. Men diagnosed with prostate cancer are usually treated with more effective, highly localized therapy for early cancers, such as intensitymodulated radiation therapy, or multimodality therapy for more advanced cancers, including combinations of hormonal therapy, chemotherapy, and/or radiation therapy. Quality of life in prostate cancer survivors has also improved. Advances in nerve-sparing surgical techniques and the advent of drugs for erectile dysfunction have allowed better control of the side effects of surgery, such as impotence.
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References
Cancer Survivorship – United States, 1971-2001. MMWR 2004;53(24):526-529. National Cancer Institute Cancer Survivorship Research. Available at: http://survivorship.cancer.gov. Accessed November 19, 2004. National Cancer Institute SEER (Surveillance, Epidemiology, and End Results) Data. Available at: http://seer.cancer.gov. Accessed November 19, 2004. President’s Cancer Panel 2003 Annual Report. Living beyond cancer: finding a new balance.
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