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5 Questions: George Fisher on the two-year decline in U.S. cancer deaths

 
George Fisher
  George Fisher, MD, PhD

Last week, a report by the American Cancer Society showed that the number of cancer deaths in the United States had dropped for the second consecutive year.There were 369 fewer deaths from 2002 to 2003, followed by 3,014 fewer deaths from 2003 to 2004. The largest drop was in colon cancer, with significant drops also reported in breast and prostate cancers. To better understand what this trend means, science writer Amy Adams spoke with cancer specialist George Fisher, MD, PhD, associate professor of medicine (oncology).

1. With two consecutive years of decreases in cancer deaths, is it too early to say that we're winning the war on cancer?

Fisher: I think these statistics show that the war is winnable. With trends going the other direction for many years, people felt the war wasn't being fought. These statistics don't include improvements in treatment during the past five years. I think in future years the trend will continue and these newer treatments will result in even fewer cancer deaths.

2. The most significant drops were in colorectal, breast and prostate cancer. Why would those particular types of cancer decrease?

Fisher: These are all cancers with effective screening tests to detect the cancer early. When we catch cancers at an early stage, they respond better to treatment. Uterine cancer (primarily cervical) has fallen from being the top cause of cancer death in women in 1930 to the sixth-leading cause of cancer death today. That speaks to the value of the regular Pap smear to detect pre-cancerous cervical cells and eliminate them before they develop into an invasive cancer. If we could apply that same standard to all cancers where we know there are effective screening tests, we'd see the cancer death rates fall even more. We also have a lot of work to do to find new markers for those cancers where good diagnostics don't already exist, such as pancreatic, ovarian and stomach cancer.

3. With shrinking research and health-care dollars, should the emphasis be put on developing better cancer treatments or on preventive health strategies?

Fisher: A lot of the highest risk cancers are ones that are increased by smoking. I don't want to shortchange the progress we've made on treating cancer. However, I think we'd see an even bigger decrease with an increased focus on prevention, especially preventing smoking. Weight and diet are also clearly associated with cancer risk, but there's no doubt that the highest risk factor is smoking. If we had the political will to take on smoking, I think we'd have a major impact on cancer incidence and mortality. Of course, it's important to show that those prevention dollars are spent in ways that can demonstrate a change in behavior.

4. Children are much less likely to die from their cancers now than they were 30 years ago. What do you think accounts for that decrease?

Fisher: Most kids are treated at major cancer centers, so they get cutting-edge care. It speaks to the benefits of major academic medical centers. Also, 50 percent of kids participate in clinical trials. Fewer than 5 percent of adults are in clinical trials. If you had a choice of receiving treatment that will be standard five years from now or the treatment that was standard 10 years ago, which would you choose? Childhood cancers are also biologically different than adult cancers and are more amenable to treatment.

5. Although the deaths from cancer overall are down, the decreases don't hold up for all racial groups. What can be done to get rid of these disparities?

Fisher: The biggest factor that explains racial discrepancy is access to care, prevention and screening. We're also just beginning to understand genetic factors that underlie cancer risk. Certainly programs that reach out to underserved communities will improve the outcomes for those populations, as will a better understanding of the unique biology of tumors in different populations.

Posted: 02/08/07

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