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Cancer Deaths Are Down, Now the Rest of the Story

Cancer deaths in the US are down 20% since they peaked in 1991, a new American Cancer Association study reports.

That’s very good news, no matter how you assess the data. But it raises a question: how did this improvement happen? Are we developing cancer less frequently? Are new treatments better at beating it into remission? Or, are we surviving with it longer, managing it as a chronic disease?

Trick question – the answer is all three, and the third option stands to greatly alter the landscape of aging in the US and elsewhere.

First, yes, incidences are down for most common cancers, especially lung cancer. And although some improvements can be explained by changing behaviors (fewer people smoke), much of the overall decline in the cancer death rate, including that of colorectal, breast and prostate cancers, is due to improvements in detection and treatment. 

But although fewer people are dying of cancer, that doesn’t mean they’ve all been “cured.” Some types of cancer are becoming more like manageable, chronic conditions that doctors and patients keep at bay for years, even decades. That is, for an increasing number of people, cancer is becoming something less to die of than to live with.

Cancer, of course, isn’t the only chronic condition that tends to appear with age – other common culprits include heart disease and diabetes. And although life expectancies are on the rise, conditions like these change the equation: we’re not only living longer, but also living sicker.

For the economy as a whole, managing widespread, long-term sickness isn’t going to be cheap, regardless of whether government or individuals pay for it, although any innovation that allows workers with chronic issues to remain productive will be a mitigating factor. (Additionally, some companies will benefit. You may see dialysis centers and other, new types of chronic condition management and wellness-related businesses pop up around town, and not only in traditional medical centers, but next door to Starbucks and the gym.)

But paying for long-term treatment of older adults is only one of two huge challenges raised by the ACA study. The second, counter-intuitively, is all the people who are dying before they even reach old age.

Even though cancer deaths have decreased on average since 1991, not all ethnic and socioeconomic groups have benefited equally. In a particularly distressing case, African-American males are 33 percent more likely to die of cancer than white males; African-American females are 16 percent more likely to die. In an example that includes all causes of death, the life expectancy for white people without a high school diploma has actually shrunk since 1990.

A number of factors contribute to the relatively low life expectancies of some groups: poor individuals are less likely to receive medical treatment, for instance, affordability, discrimination and geography can also lead to lower levels of care. Meanwhile, diet and even genetic factors can play a role in causing one group to be especially prone to certain diseases.

That’s not to take away from the good news, however: life expectancy on the whole continues to rise, and the declining cancer death rate is tied to that success. “We truly are creating more birthdays,” said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society, in a press release. 

If we’re going to take an age-positive view of the future, in which each added birthday is, first and foremost, considered a good thing, then we need to act to make those added years better and more productive. One way is by coming up with new innovations to manage and eventually, I hope, prevent debilitating disease. The other is to share those extra years throughout society: by making effective medicine available to all, for instance, and, more importantly, by providing people early in life with the factors that seem to make a difference in longevity – such as a high school education.

 

MIT AgeLab's Lucas Yoquinto contributed to this article.

 

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