Understanding the burden of cancer survivorship also requires a quantitative appreciation of the incidence of cancer, the mortality of the disease, and the resulting number of accumulating survivors. The American Cancer Society publishes an annual summary of cancer statistics.14 Based on data from the National Cancer Institute and mortality data from the National Center for Health Statistics, it is estimated that in the United States for 2005, a total of 1,372,910 new cancer cases and 570,280 deaths are expected. Since 1999, cancer has surpassed heart disease as the leading cause of death for persons younger than 85 years. The estimated number of cancer cases in 2005 and the death rate, by various cancer sites, are shown in Figure 1, demonstrating which cancers are most common in incidence and those with the highest mortality.14 The incidence of prostate, lung, and colorectal cancer for men
and breast, lung, and colorectal cancer for women are by far the most frequent. These sites of disease also represent those with the highest mortality. Data based on tumor type and site are important because each can be associated with variable consequences based on the organ dysfunction, treatment adverse events, and long-term effects.
Figure 2 demonstrates graphically the annual age-adjusted cancer incidence and death rates from 1975 to 2001 noting substantial increase in incidence for the past two decades with a recent trend for decline.15 From 1993 through 2001, the overall annual cancer mortality rate fell by an average of 1.1% a year due to better screening, reduction in smoking in men and improved cancer therapy.
Treatment success and survival rates, similar to incidence, are heterogeneous when calculated for specific cancer site. For selected cancers, the annual age-adjusted cancer incidence rate for men and women are shown in Figure 3.14 As noted, for the two most common cancers, prostate cancer in men and breast cancer in women, the incidence continues to substantially increase. The age-adjusted death rates for various cancers are shown in Figures 4 and 5 for women and men respectively.14 As noted, the death rate for the common cancers, breast, colorectal, stomach, and prostate cancer are in decline. Remarkably, the death rate for lung cancer in men is also in decline leading to the overall diminished cancer mortality; unfortunately, a similar decline has not yet been observed for women.
The National Cancer Institute and the Centers for Disease Control, using the 1971 to 2001 incidence and death rate for the various cancers, estimated the number of persons living with cancer.16 As shown in Figure 6, the number of patients in the
United States ever diagnosed with cancer increased from 3.0 million (1.5% of the U.S. population) in 1971 to 9.8 million (3.5% of the U.S. population) in 2001. For 2001, an estimated 14% of these survivors had their cancer diagnosed at least 20 years previously. Worldwide, it is estimated that more than 25 million people are alive with a diagnosis of cancer.17 Adults are the preponderance of these survivors since childhood cancers (those diagnosed among children under the age of 15) account for less than 1% of all cancers diagnosed. It is estimated that more than 60% of all cancer survivors are greater than 65 years of age with less than 1% younger than 19 years of age.18 However, the overall success for the treatment of childhood cancer will lead to an increasing accumulation of young adults as survivors of childhood cancer. In adults, the preponderance of survivors are those with the most common neoplasms such as breast, prostate, and colorectal cancer.18 These data forecast that the number of patients with a diagnosis of cancer will continue to increase with the increasing cancer incidence in our enlarging aging population along with the further refinement of cancer therapy. It is understandable how the quantitative burden of cancer survivorship is currently substantial and anticipated to increase in the future.
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