Introduction

The nation's investment in cancer research is making a difference.

• Many people are adopting good health habits that reduce the chances of getting cancer.
• The U.S. cancer death rate began to drop for the first time in 1994.
• Many people who have had cancer live longer, and enjoy a better quality of life, than was possible years ago.

Yet cancer remains a major public health problem—one that profoundly affects the more than 1 million people diagnosed each year, as well as their families and friends.

• The decline in incidence rates of all new cancers combined has slowed with evidence of a recent rise after adjusting for delayed reporting.
• Overall, declining death rates have slowed.
• Not all cancer death rates are going down. For example, the death rate for lung cancer in females has continued to rise.
• The rates of cancer of the liver and esophagus have continued to rise, as have the rates of new cases of melanoma.
• The burden of some types of cancer weighs more heavily on some groups than others. The rates of both new cases and deaths from cancer vary by socioeconomic status, sex, and racial and ethnic group, as well as by cancer site.
• The economic burden of cancer also is taking its toll. As our nation's population grows and ages, more people will get cancer. Meanwhile, the costs of cancer diagnosis and treatment are on the rise. The combination of these trends will accelerate the overall national costs of cancer treatment.

Why a Progress Report Is Needed

For the past 32 years, our country has vigorously fought the devastating effects of cancer. Now it is time to see how far we have come. The Cancer Progress Report - 2003 Update is the second in a series of reports describing the nation's progress against cancer through research and related efforts. The report is based on the most recent data from the National Cancer Institute, the Centers for Disease Control and Prevention, other Federal agencies, professional groups, and cancer researchers.

The Cancer Progress Report - 2003 Update was designed to help the nation review past efforts and plan future ones. The public can use the report to better understand the nature and results of strategies to fight cancer. Researchers, clinicians, and public health providers can focus on the gaps and opportunities identified in the report, paving the way toward future progress against cancer. Policymakers can use the report to evaluate our progress relative to our investment in cancer research discovery, program development, and service delivery.

What's in the Report

The Cancer Progress Report - 2003 Update includes key measures of progress along the cancer continuum.

• Prevention. The measures in this section cover behaviors that can help people prevent cancer—the most important of which is avoiding tobacco. This section also covers exposures to chemicals in the environment.
• Early Detection. Screening tests provide ways to find cancers early, when there is the best chance for cure. This section describes the proportion and types of people using recommended screening tests.
• Diagnosis. We can learn much about progress against cancer by looking at the rates of new cancer cases (incidence) and of cancers diagnosed at late stages. This section describes both.
• Treatment. Few treatment measures have been tracked at a national level. This section explains the current status of treatment measures and describes the kinds of measures that are emerging from ongoing research and monitoring activities.
• Life After Cancer. Trends in the proportion of cancer patients alive 5 years after their diagnosis and the costs of cancer care are addressed in this section.
• End of Life. This section includes the rate of deaths (mortality) from cancer and the estimated number of years of life lost (person-years of life lost) due to cancer.

Where possible, the Cancer Progress Report - 2003 Update shows changes in these data over time (trends). All trends have been evaluated statistically and are significant, unless stable or otherwise specified. When there were sufficient numbers of data points in a series (i.e. 5 or more), the trend graphs were made using a statistical method that illustrates changes in direction, instead of merely connecting one data point to the next. This report also shows whether the trends are "rising" or "falling" using standard definitions and tests of the statistical significance of the trend (Appendix D). For some measures, differences in the cancer burden among some U.S. racial and ethnic groups also are presented.

Most of the measures in this report are identical to those in Healthy People 2010, a comprehensive set of 10-year health objectives for the nation sponsored by the U.S. Department of Health and Human Services. This enabled us to show the nation's progress relative to Healthy People cancer-related targets for 2010.

How Data Were Selected

In selecting measures that would be meaningful to readers of this report, we relied on those measures based on scientific evidence and long-term national, rather than State or local, data collection efforts. The report includes more measures for prevention than for other segments of the continuum because more data on trends are available in that area. Some measures such as "quality of life" were not included in this report, even though they are important in assessing the cancer burden, because there simply is no consensus currently on how to best track these measures.

The data in the Cancer Progress Report - 2003 Update comes from a variety of systems and surveys with different collection techniques and reporting times, so time periods may vary. Where possible, 1990 was used as the starting point or baseline against which to measure how well the nation is progressing toward the Healthy People 2010 targets.

Cancer Progress Report - 2003 Update, National Cancer Institute, Bethesda,MD, February 2004, http://progressreport.cancer.gov/.

All material in this report is in the public domain and may be reproduced orcopied without permission; citation as to source, however, is appreciated.

Page last modified: 2/19/2004