Cancer Deaths Are Dropping in the U.S. — Here’s Why

Last month, the American Cancer Society reported some encouraging news: In the past 30 years or so, cancer mortality rates have dropped — by a lot. Between 1991 and 2019, cancer deaths decreased by 33 percent, representing an estimated 3.8 million lives saved. So what’s behind this change?

A significant reason is the improvement of early cancer detection and prevention. We talk a lot about the importance of cancer screening, with good reason: When cancer is caught early, it’s often easier to treat or cure. We’ve also gotten better at treating cancer, even in its most advanced forms. Until recently, few options have existed for patients with late-stage cancers that don’t respond to traditional chemotherapy or radiation treatments. Here, we explore some of the new and improved tools that are helping to change that.

Targeted Therapy

Decades after their introduction, chemotherapy and radiation remain the most common treatments against cancer, and they continue to improve. While these treatments aim to kill cancer cells directly, normal cells can get caught in the crossfire, causing adverse side effects like fatigue or nausea. But a new type of treatment called targeted therapy has improved how precisely we can eliminate the bad cells while avoiding the good ones. Targeted therapies take on cancer by disrupting the processes that help cancer cells thrive. They work behind the scenes to sabotage day-to-day operations like blood supply to the tumor or cancer cells’ ability to repair themselves.

In recent years, targeted therapy has proven especially beneficial in certain types of advanced breast cancer. Some of these patients have too much of a protein called HER2, which essentially tells cancer cells to grow. Targeted therapy treatments attach themselves to that protein, so it can no longer receive or spread that dangerous message. In one study, the risk of death fell by 20 percent in patients who received both chemo and a targeted therapy drug (trastuzumab) compared to chemo alone.

Immunotherapy

The immune system’s job is to find and destroy abnormal cells that could cause harm to the body, such as viruses and bacteria. But did you know that the immune system helps fight off cancer, too? Enter immunotherapy, which focuses on enhancing the patient’s immune system in its efforts to battle cancer.

To avoid going overboard, immune cells rely on “immune checkpoints” to know what to attack and what to leave alone. Think of an immune checkpoint as a “Do Not Enter” sign on the surface of a healthy cell. The normal cell is telling the immune system, “Everything’s good in here. We don’t need your services today!” Unfortunately, some cancers evade detection by putting up immune checkpoints of their own. One group of immunotherapy drugs, called immune checkpoint inhibitors (ICIs), help prevent this, which unleashes a stronger immune response against the cancer cells.

ICIs have significantly improved options for patients with many types of cancer. One example is the treatment for the most common type of lung cancer. One study found that immunotherapies increased the two-year survival rate in lung cancer patients younger than 55 by 12.6 percent.

While findings like this are encouraging, it’s not uncommon for some advanced cancer patients to respond well to therapy while others do not. One type of test is helping inform doctors about which treatments may be appropriate for a given patient.

Beyond DNA

Cancers are caused by unique genetic mutations that change how the body’s cells grow and spread, but which mutations are present varies from patient to patient. For decades, genomic tests that “read” a tumor’s DNA have helped doctors personalize treatment. But DNA does not reveal everything. Increasingly, doctors fill in the gaps with help from another source: RNA.

As the “blueprint” for human development and function, DNA gets credit for making us who we are. But RNA finishes the job: It works to build the molecules that DNA describes, effectively bringing the blueprint to life. Cancer-causing mutations can be found by looking at DNA and RNA.

A new generation of genomic tests can “read” both in a process called comprehensive genomic profiling, or CGP. This provides more intel into a tumor’s inner workings and expands the treatment options that doctors can offer, including targeted and immunotherapy treatments. One new test, called the OncoExTra test, takes it one step further by helping patients take advantage of experimental treatments by providing a list of clinical trials they may be eligible for based on their genomic results.

As is often the case with leading-edge tools and treatments, CGP’s impact in the fight against cancer will be determined by its availability. Dr. Rick Baehner, Chief Medical Officer of Precision Oncology at Exact Sciences, puts it this way: “Targeted and immunotherapies have made remarkable differences in improving patient outcomes by extending the survival or even stopping cancer progression. Unfortunately, there are still many patients with advanced or metastatic cancer who do not have access to comprehensive genomic profiling to see if they are eligible for these new therapies. To help more patients, we must reduce disparities in access to CGP.”

Despite evidence that fewer people are dying from cancer overall (and living longer, and healthier, with the disease), most U.S. adults still see cancer as a death sentence. But as emerging tools and treatments improve and become more available, that perception may change —  and provide cancer patients with new reasons to hope.

This information is provided for educational purposes only and is not clinical, diagnostic, or treatment advice for any particular patient. Exact Sciences does not recommend or endorse any particular course of treatment or medical choice.