
U.S. cancer death rate drops by largest annual margin ever, report says - apsec112
https://www.statnews.com/2020/01/08/u-s-cancer-death-rate-drops-by-largest-annual-margin-ever-report-says/
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aaavl2821
The most effective drugs for lung cancer approved in the last few years are
PD-1 and PD-L1 inhibitors. The leading drug is mercks pembrolizumab

Here are some of the most widely cited studies of pembro in lung cancer that
illustrate its clinical benefit:

Open label pembro vs chemo in first line non small cell lung cancer:
[https://www.nejm.org/doi/full/10.1056/NEJMoa1606774](https://www.nejm.org/doi/full/10.1056/NEJMoa1606774)

Development of PD-L1 biomarkers in 495 patient phase 1 study:
[https://www.nejm.org/doi/full/10.1056/nejmoa1501824](https://www.nejm.org/doi/full/10.1056/nejmoa1501824)

Pembro + chemo in lung cancer:
[https://www.nejm.org/doi/full/10.1056/NEJMoa1801005](https://www.nejm.org/doi/full/10.1056/NEJMoa1801005)

Pembro + docetaxel for previously treated lung cancer:
[https://mdanderson.elsevierpure.com/en/publications/pembroli...](https://mdanderson.elsevierpure.com/en/publications/pembrolizumab-
versus-docetaxel-for-previously-treated-pd-l1-posit)

~~~
semi-extrinsic
Fun fact: you can identify these drugs as Monoclonal AntiBodies due to the
suffix -mab.

This category has been incredibly successful against a wide variety of
debilitating illnesses like autoimmune, cancer etc. My doctor told me that
surgery for arthritis is a dying specialisation in medicine, because the new
drugs like infliximab are so effective.

The discovery of how to produce them got the Nobel Prize in Medicine in 1984,
and the more recent discovery of how to tailor them via directed evolution got
the Nobel Prize in Chemistry in 2018.

~~~
acidburnNSA
Apparently that's true for rheumatoid arthritis but osteoarthritis still gets
a lot of surgery.

Source: my SO the MD.

~~~
ekianjo
There is no cure for osteoarthritis because it is purely mechanical
degradation of joints with aging. You get a lot of pain as your joints
disappear. Most of the treatments are symptomatic (strong painkillers) or
surgery (replacing joints with prosthetic ones). Very different from RA as a
condition.

~~~
loceng
There is a solution for osteoarthritis, joint degeneration - it's by injecting
your bone marrow, stem cells into the joint. A company in the US, Regenexx,
has been doing research on stem cell treatments for 18 years now. Other places
in the world have been doing stem cell research for 30+ years, it just hasn't
become mainstream or widespread yet - so the knowledge isn't distributed well
yet.

~~~
dm319
The evidence isn't strong for it either. The randomised controlled trials have
very small n-numbers, are unblinded, have subjective primary outcomes. Needs a
big trial to convince people it works.

~~~
loceng
You can see before and after MRI imaging of areas with injury and then healed.
Obviously we have to define the process of what is being talked about when
saying "stem cell treatment" and determining degeneration level of tissues,
along with health of the individual - and therefore the health and potency of
their own stem cells, are other factors to consider.

I'd say the bigger issue is filtering out the bad-greedy actors who jump into
this space, who are piggybacking on the excitement generated from of word of
mouth from patients who have benefit greatly - from clinics who have protocols
they follow for what they know works and what won't work.

I have been getting stem cell treatments from a clinic in the US for a few
years now to treat many different areas of injury (limited number of areas
they can treat due to limited amount of fluid they have to use after
aspiration and post-processing) and from my own experience, and that of
speaking with other patients in waiting rooms (and even hotel lobby) who have
returned for additional treatments - it certainly works, heals, regenerates
tissues with the right protocol and condition. The most painful injection spot
I had was a ruptured, torn disk, in my low back - I am doing that area again
on the 16th of this month, as part of a number of areas, because it helped
permanently reduce radiating pain from that area greatly; I plan to do an MRI
of area a few months after this next treatment to have post imaging.

------
joe_the_user
Summary: The death rate from cancer has dropping slowly but surely each year
(at about %1.5-%16 rate). This last reported year was largest single
percentage drop in that process - 2%. That could also be phrased as 98% of the
deaths happened the previous year (2016) also happening that year (2017).
Half-full, half-empty, etc.

So it's a blip but an encouraging blip. At the same time, the headline makes
this sound much more extreme and excite.

~~~
wczekalski
Half-full - If the 2% rate is retained in 35 years the number of cancer deaths
will be halved. Considering that 87%[1] of cancer-related deaths happens after
50 it is a very hopeful outlook for young people

[1]: [https://ourworldindata.org/cancer](https://ourworldindata.org/cancer)

------
TurkishPoptart
Could it be that people are dying from opioid ODs, suicide, and other means
that tragically cut lives short? Cancer risk seems to be a function of time
and entropy. The longer someone lives, the more likely I suspect they'll
succumb to cancer eventually.

~~~
nostrademons
That was my first thought, but the article specifically addresses that. It's
due to improved treatments for lung cancer. Take lung cancer out of the data
and the death rate improved by 1.4% last year, which is basically the same as
the baseline 1.5%/year rate that cancer deaths have been dropping since 1991.
If it were due to the opioid epidemic, you also wouldn't see that sustained
drop over 3 decades - life expectancy in the U.S. has only been falling for 3
years.

~~~
ip26
Decommissioning coal plants & spinning up natural gas plants could
hypothetically help with lung cancer too.

~~~
hinkley
Long term, sure. Short term, you'd be looking at the link between air quality
levels and chronic diseases like COPD, asthma, and congestive heart failure.

That might show up as an increase in the number of living people with these
conditions.

------
pcurve
For those wondering about lack of e-cigarette mentioning, World Health Org
says e-cigarette doesn't help reduce lung cancer for now.

[https://www.reuters.com/article/us-health-tobacco/who-
says-e...](https://www.reuters.com/article/us-health-tobacco/who-says-e-
cigarettes-smoke-free-products-do-not-help-reduce-cancer-idUSKCN1UL29C)

~~~
agumonkey
This article is short.. I don't understand how e-cigarettes (granted the
liquid is not full of shitty chemicals) can not be an improvement. The
carcinogenic compounds were said to come from tobacco combustion byproducts.
Theoretically in e-cigarettes.. there's no combustion, only vaporization of
nicotine and the liquid. So what's the link ?

~~~
JeremyNT
One trouble with e-cigs that prevents them from being an unmitigated win is
that their aggressive marketing targeted towards children is highly effective
at getting new users addicted to nicotine. This is a reversal of the trend of
long term gradual decline in the use of tobacco-derived products (in developed
economies, anyway).

On the face of it this seems unrelated to lung cancer rates, but there's
concern in the public health community that some percentage of these users
will graduate to smoking tobacco over time.

I don't think we really know whether those concerns will be borne out, or
whether they'll counteract adults switching in time to save themselves.

~~~
t-writescode
I have trouble believing that people will actually switch from ecigs to actual
cigarettes. Adjustable nicotine flavored steam vs cough-inducing smoke with
possibly less nicotine?

I guess a cigarette is smaller and easier to use where there’s no electricity
source?

I guess a small percentage might migrate, though, as always happens with
anything where you _can_ migrate.

A small percentage would try regular cigarettes in the first place too. It
will be interesting to see if small subgroup of bigger, new subgroup is larger
than historical subgroup.

------
tempsy
It's hard to take this very seriously when the claim is that it's "only" due
to advances in the treatment of lung cancer. Given that lung cancer rates are
almost surely driven by smoking rates, and that the rate of adults who smoke
regularly has dropped significantly over the last couple decades, how could
the fact that there are fewer adult smokers not also be a significant factor
in declining lung cancer rates?

To claim this is only driven by treatment innovation and not public policy
changes is wildly misleading.

~~~
db48x
The rate has been declining for years, but this year the decline is larger
than expected. They're talking about that increase in the reduction of the
rate.

~~~
tempsy
What's your point? The YoY decline in smoking rates since 1970s is not linear.

This stat is effectively meaningless without accounting for the rate of the US
pop that develops lung cancer in the first place. If you want to measure
treatment effectiveness, then the right measurement is something like '% of US
population that develops lung cancer who are effectively treated/cured' and
not 'overall cancer death rate'.

The fact this headline is so broad when it's really about lung cancer and not
all cancers and doesn't account for any factors outside of 'treatment
innovation' leads me to believe this was pushed by some healthcare trade
group.

~~~
hirako2000
Thanks for this counter argument. I do wonder why people jump in the comments
and drop name pharmaceutical companies and their products.

------
DrAwdeOccarim
If you're interested in hearing a counter point to these types of medical
"press release" articles, I can't recommend enough following Vinay Prasad on
Twitter. Here is his thread about this report:
[https://twitter.com/VPrasadMDMPH/status/1215081457854468096](https://twitter.com/VPrasadMDMPH/status/1215081457854468096)

------
aSplash0fDerp
I personally think that part of the reductions are coming from foreign
healthcare screenings (off the books) and/or a combination of early term
options).

The cost for treatment [1] may have some considering alternate options for
screenings and treatment after seeing someone elses experience/ordeal
beforehand or reading about first-hand accounts online.

[1] [https://www.aarp.org/money/credit-loans-
debt/info-2018/the-h...](https://www.aarp.org/money/credit-loans-
debt/info-2018/the-high-cost-of-cancer-treatment.html)

~~~
robbiep
The reductions are absolutely coming from new treatments in particular
immunotherapy.

When I started Med school 19 years ago the average survival of metastatic
melanoma was 6 months, it is now closer to 5 years (ie basically remission).
Many other cancers (including lung, which this article pinpoints as being the
main driver in falls over the last 12 months) are now benefiting from the
second and third generation of these drugs

------
rshnotsecure
This absolutely should be taken with a grain of salt.

First realize that these statistics are calculated via an entire field, known
as “medical statistics” not surprisingly, that has enormous controversies
inside of it.

Using a variety of mathematical calculations and formulas, they arrive at
something called the “average death rate” that is supposed to massage out the
differences between geographic regions and populations to determine the final
number.

Devra Davis, Ph.D., M.P.H., wrote about this to tragic degree of detail in her
book “The Secret History of the War on Cancer”. For background she was
Director of the Center for Oncology at the University of Pittsburgh Cancer
Institute and is still also a Professor of Epidemiology there.

The cancer death rate has not budged that much in 40 years. Survivability has
extended, absolutely, and that is worth something, but not more than a few
years. Compared to AIDS, a disease also without a real cure but that has
extended survivability by decades this is unacceptable.

The amount of brilliant researchers driven out of the field, the failure of
the Susan G Komen foundation to invest in actual research (this can be seen as
more of a problem with the nonprofit industrial complex though and not per se
cancer research), the null hypothesis requirement failures at NIH, and just
the general climate of unethicalness and neoliberalism that began emerging in
the mid 1970’s are all blamed, and there is truth in most of those arguments.

There is an old joke about how many white upper middle class cancer patients
does it take to screw in a light bulb? Two, one to do it, and the other to
write a book about it.

I go back and forth about whether that joke is inappropriate, and Mark Nepo is
one such person who falls into that category but has written moving essays
about the experience, but every time I read Barbara Ehrenreich’s “Cancerland”
it makes me incredibly bitter. And I say that as a person who really likes
Tony Robbins for the most part but who still is disgusted by the whole forced
optimism cure through hope that the entire industry has turned into in lieu of
actual breakthrough achievements. The fact that the latest and even somewhat
exciting area of research in cancer treatment is the investigation on the role
and use of viruses, a _soviet_ innovation that has been investigated by the
Russians since Stalin was alive even though they were mercilessly mocked for
decades for this, is just tragic.

~~~
ljw1001
> The cancer death rate has not budged that much in 40 years. Survivability
> has extended, absolutely, and that is worth something, but not more than a
> few years. Compared to AIDS, a disease also without a real cure but that has
> extended survivability by decades this is unacceptable.

Ignoring the fact that cancer is a much harder problem than HIV, extending
survivability is how the cancer death rate changes. Everyone who doesn't die
by other causes would eventually get cancer because DNA replication can only
happen so many times before accumulated replication errors trigger it. In a
sense, curing HIV means more people will die of cancer (other things equal).

Also, cancer is not one thing. You have a particular type (like NSCLC), but
also your particular genetic mutations may be unique or nearly so, affecting
different combinations of oncogenes and tumor suppressors in different ways.
This makes it extremely difficult to treat. Even broadly useful approaches
like cancer immunology work better for some than others.

> There is an old joke about how many white upper middle class cancer patients
> does it take to screw in a light bulb? Two, one to do it, and the other to
> write a book about it. I go back and forth about whether that joke is
> inappropriate,...

IDK about inappropriate, but maybe find an outlet for your anger other than
cancer patients?

~~~
nate_meurer
> _maybe find an outlet for your anger other than cancer patients?_

That's a pretty high horse you're on there. Parent wrote an honest and
thoughtful comment, and you wrote a thoughtful response until that last dig.

------
xwdv
Could someone do some quick math and extrapolate what cancer death rates might
be in 2050?

~~~
bluGill
Sure, but it isn't a useful exercise. Presumably there are limits to the
current new treatments, once we figure out what those limits are we will hit a
new death rate. I expect to see that before 2050. Then we have to wait for the
next new treatment.

It seems unlikely that there are an infinite number of great treatments
waiting to be discovered. Most likely we are asymptotically approaching some
non-zero minimum death rate. (note that the function is not linear, and we
just saw one interesting step)

------
eagsalazar2
With the shift in public perception about keto, carbs, etc maybe we're
actually onto something?

~~~
uhtred
You think carbs cause cancer? Oh my, the anti-carb brainwashing is more
powerful than I thought. If anything I predict there will be a future upsurge
in some cancers (colon etc) if people keep avoiding carbs. We need fiber.
Fiber comes from foods that contain carbs.

~~~
eagsalazar2
Yes people think that.

------
ZainRiz
In unrelated news, the US alcohol-related death count has doubled

[https://www.npr.org/2020/01/08/794772148/alcohol-related-
dea...](https://www.npr.org/2020/01/08/794772148/alcohol-related-deaths-have-
doubled-study-says)

------
anovikov
Let me offer an easy explanation: normal rates of annual progress in cancer
treatment and prevention were compounded by (quite abnormal) decrease in life
expectancy. Which naturally makes cancer, which correlates highly with age,
less common. Basically, people are dying of meth or fentanyl before they get a
chance to get cancer.

~~~
Godel_unicode
This possible explanation is explicitly addressed and debunked in the article
as the reason for cancer deaths declining. As has been mentioned elsewhere in
the thread, this is about immunotherapy.

------
chiefalchemist
Don't mean to be a killjoy, and perhaps this is stating the obvious for the HN
crowd but this doesn't mean the broader rate of cancer is down; but that
medical treatment has improved. The latter being more lucrative than
prevention (at least for the med community).

I'd also like to mention, that these are deaths limited to cancer. Death is
attributed to something else this stat will be affected. This is, in theory,
you can "survive" cancer but die from something related to that condition and
it won't count as a cancer death.

I'd liken it, somewhat, to war. Yes, less soldies are dying. But survival
comes at a cost. No arms. No legs. Mental and emotional wounds. Etc.

I'm not knocking the progress with cancer; only providing some necessary
context that's often missing.

<added>

The point is, beating up data is easy. Be mindful of what you might be looking
at, especially if the outcomes are good for an industy's well-being.

</added>

