Cancer mortality has decreased over time, but the contributions of different interventions across the cancer control continuum to averting cancer deaths have not been systematically evaluated across major cancer sites.
To quantify the contributions of prevention, screening (to remove precursors [interception] or early detection), and treatment to cumulative number of cancer deaths averted from 1975 to 2020 for breast, cervical, colorectal, lung, and prostate cancers.
In this model-based study using population-level cancer mortality data, outputs from published models developed by the Cancer Intervention and Surveillance Modeling Network were extended to quantify cancer deaths averted through 2020. Model inputs were based on national data on risk factors, cancer incidence, cancer survival, and mortality due to other causes, and dissemination and effects of prevention, screening (for interception and early detection), and treatment. Simulated or modeled data using parameters derived from multiple birth cohorts of the US population were used.
Primary prevention via smoking reduction (lung), screening for interception (cervix and colorectal) or early detection (breast, cervix, colorectal, and prostate), and therapy (breast, colorectal, lung, and prostate).
The estimated cumulative number of cancer deaths averted with interventions vs no advances.
An estimated 5.94 million cancer deaths were averted for breast, cervical, colorectal, lung, and prostate cancers combined. Cancer prevention and screening efforts averted 8 of 10 of these deaths (4.75 million averted deaths). The contribution of each intervention varied by cancer site. Screening accounted for 25% of breast cancer deaths averted. Averted cervical cancer deaths were nearly completely averted through screening and removal of cancer precursors as treatment advances were modest during the study period. Averted colorectal cancer deaths were averted because of screening and removal of precancerous polyps or early detection in 79% and treatment advances in 21%. Most lung cancer deaths were avoided by smoking reduction (98%) because screening uptake was low and treatment largely palliative before 2014. Screening contributed to 56% of averted prostate cancer deaths.
Over the past 45 years, cancer prevention and screening accounted for most cancer deaths averted for these causes; however, their contribution varied by cancer site according to these models using population-level cancer mortality data. Despite progress, efforts to reduce the US cancer burden will require increased dissemination of effective interventions and new technologies and discoveries.
JAMA oncology. 2024 Dec 05 [Epub ahead of print]
Katrina A B Goddard, Eric J Feuer, Jeanne S Mandelblatt, Rafael Meza, Theodore R Holford, Jihyoun Jeon, Iris Lansdorp-Vogelaar, Roman Gulati, Natasha K Stout, Nadia Howlader, Amy B Knudsen, Daniel Miller, Jennifer L Caswell-Jin, Clyde B Schechter, Ruth Etzioni, Amy Trentham-Dietz, Allison W Kurian, Sylvia K Plevritis, John M Hampton, Sarah Stein, Liyang P Sun, Asad Umar, Philip E Castle
Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., Georgetown Lombardi Institute for Cancer and Aging Research and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC., Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada., Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut., Department of Epidemiology, University of Michigan, Ann Arbor., Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands., Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington., Institute for Technology Assessment, Massachusetts General Hospital, Boston., Information Management Services Inc, Calverton, Maryland., Department of Medicine, Stanford University School of Medicine, Stanford, California., Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York., Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison School of Medicine and Public Health., Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California., Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts., Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.