VEJAY STEEDE
Earlier this year, the American Cancer Society (ASC) published a report entitled “Cancer Statistics, 2021.” The article was published by Rebecca Seigel, MPH, and colleagues, in CA: A Cancer Journal for Clinicians, and highlighted a record drop in cancer mortality rates in the United States for the second straight year. A consumer version of the report was also produced, Cancer Facts & Figures 2021.
This is obviously a very auspicious development, but questions like the effect that the onset of the COVID-19 pandemic has had on cancer rates still linger. What does this all mean for Bermuda? Let’s chat.
The American Society of Clinical Oncology (ASCO) offered their take on the record drop in an article published in the ASCO Post in January of this year as well. Their analysis of the statistics made special mention of the impact of COVID-19 on cancer mortality; specifically, the difficulty in determining any impact at this stage:
“The report estimated that in the United States in 2021, almost 1.9 million (1,898,160) new cancer cases will be diagnosed, and 608,570 Americans will die from cancer. These projections are based on currently available incidence and mortality data through 2017 and 2018, respectively, and thus do not account for the impact of the COVID-19 pandemic on cancer diagnoses or deaths.
“The impact of COVID-19 on cancer diagnoses and outcomes at the population level will be unknown for several years because of the time necessary for data collection, compilation, quality control, and dissemination,” said Rebecca Siegel, MPH, lead author of the report. “We anticipate that disruptions in access to cancer care in 2020 will lead to downstream increases in advanced-stage diagnoses that may impede progress in reducing cancer mortality rates in the years to come.” (ASCO Post, 2021)
Highlighting the falling cancer mortality rates, the ASCO Post noted:
“Progress in reducing mortality has slowed for other leading causes of death in the United States, but accelerated for cancer, which is the second-leading cause. An estimated 3.2 million cancer deaths have been averted from 1991 through 2018 due to reductions in smoking, earlier detection, and improvements in treatment, which are reflected in long-term declines in mortality for the four leading cancers: lung, breast, colorectal, and prostate.”
Several reasons were highlighted as significant in the record decrease: measures such as improvements in lung cancer treatment, a sharp decline in smoking throughout society, improved awareness and prevention measures, and improved access to advanced treatment.
Doctor Christopher Fosker, MBChB BSc MRCP FRCR, Medical Director at the Bermuda Cancer and Health Centre, and a resident oncologist for the Bermuda Hospitals Board describes how the current international cancer mortality trends relate to Bermuda:
“In terms of the local situation, unfortunately, we don’t have data to compare ourselves to the ACS analysis. A review to assess our trends in cancer mortality is under way but has been significantly slowed by COVID-19. Our anticipation is we should be seeing a similar improvement as most of the reasons the ACS use to explain the improvement are also true here; increased access to care, improved early diagnosis, access to advanced treatment.
“This is great for Bermuda (that we can keep up with those changes) but the real deficiency in Bermuda is the systemic collection and analysis of data to help us continue to improve and provide reassurance that we are up to date with our care. This deficiency is being addressed at present with the development of a National Cancer Control Plan. This project is being run by Bermuda Cancer and Health while being funded by the Bermuda Health Council.”
On the other side of the pond, the trend is very similar. In a report published by the European Society for Medical Oncology (ESMO) in February, a longstanding decline in cancer mortality within the European Union is highlighted in detail.
“The present analysis updates the cancer mortality predictions to 2021, confirming and further quantifying the persistent declines in total cancer mortality for both sexes in Europe, and in several specific cancer sites. The proportionally highest declines (>10%) were predicted in stomach cancer and leukaemias in both sexes and in lung and bladder cancer in men. In addition, other major cancer sites, including colorectum, prostate, breast and ovary, showed appreciable favourable trends. However, in the EU27 there were no substantial changes in pancreatic cancer mortality, apart for some fall in young men, confirming its status as a major public health concern in Europe.”
ESMO goes on to break down the trends in the United Kingdom, and how they compare to those in the EU.
“Following Brexit, we presented the UK separately as in previous reports, but we did not include it in the EU aggregate (EU27 as of 2020). Lung cancer patterns in the UK are closer to those seen in the USA than those in the EU27. Male lung cancer rates are more than 25% lower in the UK than in the EU27, because of earlier and larger decreases in smoking prevalence in UK men.
“This is also reflected in a lower predicted total cancer mortality rate in the UK. The decreases in smoking prevalence in subsequent cohorts of European men explain the predicted fall in lung cancer mortality in the EU27.”
The focus on lung cancer is not by accident here, as lung cancer is the most commonly diagnosed cancer globally, and it’s refreshing to see that the widespread preventative measures and treatment advances are taking their toll on this deadly scourge’s campaign.
ASCO highlights the advances in lung cancer treatment specifically: “Lung cancer is the most common cause of cancer death, accounting for more deaths than breast, prostate, and colorectal cancers combined. Sluggish progress against these latter cancers in recent years contrasts with accelerating reductions in the death rate for lung cancer, from 2.4% annually during 2009–2013 to 5% annually during 2014–2018. As a result, lung cancer accounted for almost half (46%) of the overall decline in cancer mortality in the past 5 years and spurred a record single-year drop (2.4% from 2017 to 2018) for the second year in a row.
“Recent rapid reductions in lung cancer mortality reflect better treatment for the most common subtype of the disease, non–small cell lung cancer (NSCLC). Two-year relative survival for NSCLC has increased from 34% for patients diagnosed during 2009 through 2010 to 42% for those diagnosed during 2015 through 2016, including absolute gains of 5% to 6% for every stage of diagnosis. Two-year survival for small cell lung cancer remained at 14% to 15% during this time period.”
With the consistent drive to screen for preventable cancers, as well as cancers that can be eliminated if they are detected early enough, such as prostate and cervical cancers, the fight against this blight is progressing, logically; but this trend is not necessarily global. In Africa, for example, cancer is still classified as an “emerging health problem” and it has been suggested that by 2030, there will be a 70% increase in new cancer cases due to population growth and aging (Frontiers in Oncology, 2021). Western advances, of course, will be readily available to select tiers of African society, but until cancer of all kinds is defeated at all levels of society, humanity must remain vigilant.
