A new report out Monday shows that cancer deaths are continuing to fall. That’s the good news.
The bad news is that there are two increasingly common causes of cancer: obesity, and the human papillomavirus or HPV. Some experts predict a new epidemic of head and neck cancer caused by HPV as baby boomers who are already infected start to develop it. For the younger generation, there’s a vaccine that prevents HPV, yet U.S. kids are not getting it at anywhere near the recommended rates.
And the report also says that policymakers are doing far too little to fight obesity, which underlies a third of cancer cases.
Cancer death rates went down every year by 1.8 percent among children and men and by 1.4 percent among women from 2000 through 2009, according to the report from the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute and the North American Association of Central Cancer Registries.
And rates of cancer diagnosis fell just slightly among men, stayed stable for women and went up by a scant 0.6 percent per year for children aged up to 14, says the report, published in the Journal of the National Cancer Institute.
“The fact that people are not dying of cancer is clear evidence of progress,” said Dr. Otis Brawley of the American Cancer Society. “But could have a much lower death rate from cancer if we simply got serious about doing all the things that work.”
Cancer is the No. 2 killer of Americans, after heart disease.
“Over the next 10 years, a combination of high caloric intake and low physical activity is going to surpass tobacco as a cause of cancer deaths,” Brawley told NBC News. “We are not saying anything about that. That is a huge, huge cancer prevention effort that we haven’t gotten off the ground.”
Many reports suggest that poor diet, a lack of exercise and obesity underlie about a third of U.S. cancers, including breast, colon and pancreatic cancer. Polls show Americans are barely aware of this and are far more worried about chemicals and pollution, which cause fewer than 5 percent of cancer cases, according to Dr. Graham Colditz of the Washington University School of Medicine in St. Louis, an expert in the causes of cancer.
Smoking causes another third of cancers and it’s the dramatic fall in smoking – from about 40 percent of the population in the 1960s to just about 20 percent now – that’s fueled much of the drop in cancer deaths, Brawley says. And Brawley, who is known for his plainspoken approach on cancer causes, testing and treatment, says states and the federal government aren’t doing enough to further lower smoking rates, either.
Utah and California have smoking rates of 10 percent, while Missouri and Kentucky have rates of 30 percent, Brawley noted. Utah’s majority Mormon population largely shuns smoking and the low rates there are most likely cultural. “But in California they did some amazing work with advertisements,” Brawley said. “I wish we were doing that all across the country.”
Diet and exercise are harder to tackle, Brawley noted.
“It is socially unacceptable to smoke in many areas of the United States now,” he said. “I am not a skinny guy and I am cognizant of the problem that people have with food. This is something society needs to tackle instead of blaming the individual.”
American families now have multiple cars, and many neighborhoods lack sidewalks, Brawley pointed out. And more people than ever eat at fast-food restaurants daily.
Besides obesity, the report points to another potential growing cause of cancer – HPV. The report finds that two cancers on the rise, head and neck cancer and anal cancer, are caused by HPV. “HPV-associated cancers accounted for 3.3 percent of all cancer cases among women and 2 percent of the total cancer cases among men diagnosed in 2009,” the report reads. That adds up to 21,000 women and more than 13,000 men diagnosed with these cancers.
“We are seeing a large number of patients with HPV-associated head and neck cancer and these patients are relatively young, are typically non-smokers and quite often have children," says Dr. Robert Haddad, chief of head and neck oncology at the Dana-Farber Cancer Institute in Boston.
“In a way its good news; in a way it’s bad news,” says Dr. Joel Epstein of the City of Hope cancer center in Duarte, Calif.
The good news is that head and neck cancer caused by HPV is much easier to treat than head and neck cancer caused by smoking and excessive alcohol use. Epstein estimates that 75 percent of head and neck cancers caused by HPV can be cured, as opposed to just 25 percent of those linked to smoking.
“Cure rates are higher and the implication is we might be able to change the kinds of head and neck cancer treatments,” Epstein told NBC News.
Current surgery, radiation and chemotherapy treatments for head and neck cancer can be very harsh, leading to lifelong suffering for survivors who can have damage to their tongues, gums, teeth and their ability to taste and even eat food. So any improvement in treatments would benefit thousands of patients.
Even better, the HPV vaccine can prevent the changes that lead to cancer – although it’s not been proven to reduce the risk of head and neck cancer yet. It does greatly reduce the risk of cervical cancer, which is almost always caused by HPV.
But the vaccine does not appear to protect people who are already infected, and there is a whole generation of Americans who have been infected with HPV, which is passed sexually, and who risk developing the slow-growing forms of cancer it causes. These include not only cervical cancer but 90 percent of anal cancers, 60 percent of many mouth, tonsils and throat cancers and 40 percent of cancers of the vagina, vulva and penis.
Federal officials recommend that girls aged 11 to 17 get three doses of HPV vaccine, but fewer than a third have. The report finds that 32 percent of girls aged 13 to 17 had gotten all three doses in 2010. Only about 1.4 percent of boys have had the shots. Expert advisers to the federal government say it’s worthwhile getting boys vaccinated, too, but states are not requiring it.
“Coverage was statistically significantly lower among the uninsured and in some Southern states,” the report adds. In Alabama and Mississippi just 20 percent of girls were fully vaccinated – and these are states where cervical cancer rates are the highest, and where the fewest women get Pap smears, which detect the changes that can lead to cancer, the report notes.
Only Virginia and Washington D.C. currently require the HPV vaccine for girls to enroll in middle and high school but such requirements could increase vaccination rates, the report says.
“Increasing current vaccination coverage levels among boys could eventually curb the growing burden of anal cancers, especially among men who have sex with men and possibly the burden of oropharyngeal (head and neck) cancers,” it adds.