Cancer death rates have dropped by 33% since 1991, according to a new report from the American Cancer Society (ACS). However, despite this significant decline, racial disparities for certain cancers, including prostate, breast, and uterine, persist.

Cancer death rates are down

For the report, researchers analyzed data from the National Cancer Institute, CDC, and the North American Association of Cancer Registries. Data on cancer rates was taken through 2019, and data on federal mortality data was taken through 2020.

According to the researchers, U.S. cancer death rates saw a steady increase throughout the 20th century before peaking in 1991. Since then, improvements in preventive screenings and treatments, as well as a decline in smoking rates, have helped reduce the incidence of cancer and improve outcomes.

Over the last 30 years, cancer death rates in the United States have fallen by 33%—preventing roughly 3.8 million deaths overall. From 2019 to 2020, the cancer death rate continued to decrease by 1.5%.

The 33% decline in cancer mortality since 1991 is "truly formidable," said ACS CEO Karen Knudsen. "New revelations for prevention, for early detection and for treatment have resulted in true, meaningful gains in many of the 200 diseases that we call cancer."

The five-year survival rate for all cancers has increased from 49% in the mid-1970s to 68% for those who were diagnosed between 2012 and 2018.

Currently, the cancers with the highest rates of survival are thyroid (98%), prostate (97%), and melanoma (94%). The cancers with the lowest rates of survival are pancreas (12%), liver (21%), and esophagus (21%).

Despite this overall decline in cancer mortality, some cancers are seeing a rise in cases, including:

• Breast cancer, which has increased by 0.5% per year since the mid-2000s
• Uterine cancer, which has increased by around 1% per year since the mid-2000s among women 50 and older and by almost 2% since the mid-1990s among young women
• Prostate cancer, which increased by 3% per year between 2014 and 2019 after 20 years of decline

Disparities have worsened

The researchers found significant racial disparities in both incidence and mortality rates for these three types of cancer.

Although Black women are less likely to be diagnosed with uterine cancer than white women, they have the highest death rates from the disease. Black women are also 40% more likely to die from breast cancer even though they have a 4% lower incidence rate of the disease compared to white women.

Black men are also 70% more likely to have prostate cancer than white men, and they have a two-to-four-fold higher rate of prostate cancer mortality than all other racial and ethnic groups.

To address the rising rates of prostate cancer, ACS announced it was launching a new initiative, which will include research, patient support, and advocacy programs, to "reduce death rates from prostate cancer in all demographics and disparities for Black men by 2035."

According to Ernest Hawk, VP of cancer prevention and population sciences at the University of Texas MD Anderson Cancer Center, the new report highlights "important and consistent" advances against cancer, but "it's well past time for us to take health inequities seriously and make them a much greater national priority."

"Inequities in cancer risks, cancer care and cancer outcomes are intolerable, and we should not be complacent with these regular reminders of avoidable inequities," Hawk said. "With deliberate and devoted effort, I believe we can eliminate these disparities and make even greater progress to end cancer."

What will the future of cancer look like?

Currently, cancer is second-leading cause of death in the United States, behind heart disease. According to ACS estimates, almost 2 million people will be diagnosed with cancer in 2023, and more than 600,000 will die from the disease.

During the pandemic, many people delayed routine medical care, including cancer screenings. Because of this decline in screenings, some providers have reported a rise in advanced cancer cases, which could prevent patients and mortality.

So far, ACS researchers have not been able to track "that reduction in screening that we know we all observed across the country during the pandemic," Knudsen said. "This time next year, I believe our report will give some initial insight into what the impact was in the pandemic of cancer incidence and cancer mortality."

Going forward, health experts say that more needs to be done to detect cancer early to avoid more advanced diagnoses that are more difficult to treat.

"What you might see is that if there's less screening then there's likely to be less cancer diagnoses because you're not looking (for it)," said William Dahut, chief scientific officer for ACS. "That's really the concern, that we'll see cancer rates decrease initially ... Cancer rates will then recover but the people that present with cancer will have disease that we can't easily treat." (Wetsman/Miao, ABC News, 1/12; Howard, CNN, 1/12; Rodriguez, USA Today, 1/12; Abbott, Wall Street Journal, 1/12)