
Cancer death rates are falling, five-year survival rates rising - hecubus
https://ourworldindata.org/cancer-death-rates-are-falling-five-year-survival-rates-are-rising
======
jzl
The article goes into this, but reminder that cancer survival rates must be
carefully considered as a part of a bigger picture. In short, if cancer
patients are surviving on average 5 more years than, say, X years ago, but
cancer is at the same time being detected 5 years earlier, then the expected
length of life for a cancer patient remains the same. This is well-understood
phenomenon in cancer statistics but often glossed over in press pieces and not
particularly well understood by the general public.

~~~
duado
The detection has value itself. I’d much rather know now that I have a year to
live today than a week to live in 51 weeks.

~~~
Scarblac
Someone I knew was diagnosed with lung cancer, spent a year in hospitals
getting chemo, radiation, scans, etc and had lots of pills, against the side
effects of the treatment, against pain, against the side effects of the pills.
Then he died.

At the end he wished he had never been diagnosed, then he probably would have
had a decent half year or so.

~~~
TaupeRanger
Sure, but you can't know whether treatment will work ahead of time. You could
have a decent half year if you do nothing, or you could have a decent 20 years
if the treatment works.

~~~
xyzzyz
You can't _know_ , but that doesn't mean that you're completely in the dark.
The doctors can provide you with _estimates_ regarding the chances having
decent 20 years.

~~~
TaupeRanger
Of course. If you're going through radiation and chemo there's a good chance
the Drs think it has a good chance of helping. Not always though.

------
ed312
Cancer represents a broad class of diseases (like "viral infection" is
everything from common cold to HIV). If you or someone you know is diagnosed
with cancer, and especially if it is later stage, please seriously consider
comprehensive genomic profiling (CGP). CGP can help identify targeted
therapies (and often clinical trials) which treat the specific genetic
alterations or other factors in your disease.

I'd like to shamelessly plug the company I work for, Foundation Medicine
([https://www.foundationmedicine.com/](https://www.foundationmedicine.com/))
who is a leader in this area. Regardless of who you go with, please do CGP to
learn more about your disease and the options you have.

~~~
throwawaymath
Is there any reason not to do CGP preemptively?

~~~
yread
Mutations can be divided to germline (~what you inherited, it's part of your
normal dna, but it increases likelihood of getting cancer, for example by
making dna self repair less effective, think Angelina Jolie) and somatic
(random (?) mutations that enable unlimited growth, switch off cell death and
so on and are only present in the tumor). There can be multiple mutation
groups within a single tumor.

Preemptive testing is useful and done for people with history of early cancers
in family but obviously can detect only germline mutations. Most of the
targeted therapies target somatic mutations.

Some hospitals doing genomic testing share their data through AACR GENIE
project

[https://www.aacr.org/Research/Research/Pages/aacr-project-
ge...](https://www.aacr.org/Research/Research/Pages/aacr-project-genie.aspx)

------
sandwall
Stage Migration, otherwise known as, "The Will Roger's Phenomenon," is an
important consideration.

Derived from a joke, "When the Okies left Oklahoma and moved to California,
they raised the average intelligence level in both states."

When we move members of one set (undiagnosed) into another (diagnosed) it
changes the values of both. In other words, if we diagnose people earlier, the
entire diagnosed set appears to be living longer.

See this classic for more information:
[https://www.nejm.org/doi/full/10.1056/NEJM198506203122504](https://www.nejm.org/doi/full/10.1056/NEJM198506203122504)

~~~
nabla9
How does 5 years survival rate relate to cancer deaths?

Do people survive longer with cancer before eventually dying, or are more
people cured?

~~~
sandwall
We're not sure.

One interesting study on breast cancer patients receiving radiotherapy, found
that local control was obtained but more women were eventually dying from
heart failure from being in the radiation field. This essentially offset the
gain. This couldn't be seen with 5 year survival rates. Now physicians are
focused on protecting the heart and hopefully, eliminating cardiac toxicities.

That vignette just shows that 5y survival is a difficult metric and only shows
a small piece of the picture. Others have rightly pointed out, stratification
of data based on stage would be helpful. Improvement in 5 year survival of
stage 4 patients, could be very meaningful.

Unfortunately, new treatments are adding months (on average) not years.

The best thing we (as a country) did, was wake up to the dangers of smoking.
When per capita cancer diagnoses decline and survival rates remain steady (or
improve), then we know more people are living longer.

~~~
pfdietz
My mother in law lived with breast cancer for ten years, and dropped dead of a
heart attack in a dentist's waiting room. Radiation effect on coronary
arteries may well have contributed.

~~~
sandwall
I am sorry for your loss. It may very well may have been due to the
radiotherapy. Left Breast cancer patients were at greatest risk. The Left
Anterior Descending (LAD) has been identified as the "Organ At Risk."

We used to treat the heart as a parallel organ, like the lungs; damage a piece
with no significant harm to the overall function. We've discovered that it may
be a serial organ, like the spine; damage a piece and you impair the entire
organ. Or in this case the LAD is a critical element.

The mechanism of action is believed to be accelerated atherosclerosis;
hardening of the artery leading to blockage:

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188157/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188157/)

We now use breath hold techniques and completely spare the heart, but mistakes
were made -- that only a long retrospective review of the data was able to
reveal:

[https://www.nejm.org/doi/full/10.1056/NEJMoa1209825](https://www.nejm.org/doi/full/10.1056/NEJMoa1209825)

~~~
pfdietz
Thanks! I'll send those links to my daughter, who's in her residency right
now.

------
martin_a
Cancer really gives me shivers.

I can be hit by a car this evening and get killed. I can get a stroke in sleep
and not wake up tomorrow morning. I could even be electrocuted by some stupid
accident I make while tinkering with electronic components.

Somehow all those "types of death" are fine for me. They are accidents, bad
luck, whatever. But they all come sudden.

Knowing that you are ill and will not get well again and can just "sit around"
and wait till you die. That really hits me whenver I think about it.

Nevertheless I don't see a doctor regularly to do a checkup. I'm in my 30s,
maybe I should start doing that.

~~~
gus_massa
I don't want to make you more nervous, but there are some car accidents that
are not fatal but breaks so many things that you have a loooooong time to
recovery with many operations and medical problems (perhaps you loose most of
your liver?). I'm not sure if they are predictible fatal after a long time.

Some with heart or brain stroke. There are some variants between no stroke and
fatal stroke.

~~~
martin_a
Oh, I know, I know. I crashed with my motorcycle and had a concussion on my
milt. Didn't think about it first but realized how bad it was, after doctors
wouldn't let me go after four days in hospital.

There is lots of scary stuff out there, I'm aware of that. Maybe it's also
about the "actio = reactio" thing in my head. Crash = you may die or be
severly injured. Overweight might lead to strokes, ok. I can grasp all of
those concepts and understand them.

But cancer can just come out of nowhere and it could kill you, although you
did nothing wrong.

~~~
skohan
Yeah it was like that with my dad. He was super fit, didn’t drink, probably
worked too much but that was about it as far as vices. But all the same the
cancer came and just swallowed him up. We tried everything but it was just the
disease was totally indifferent to our efforts.

Before that experience I never really got what the big deal with cancer was.
But when it clicked that it’s basically your own cells evolving to destroy
you: well it’s pretty dark if you think about it.

------
Bucephalus355
Medical statistics is an entire field of study that has multiple disciplines.
There are many controversies in this field.

Regarding how death rates are calculated, there are controversies in the field
regarding how to best calculate from both a math and even a philosophical
standpoint.

This article, which talks about the famous paper from 2015 that first noted
the dramatic rise in suicide, covers the controversy well. Some of the best
statisticians and researchers in med stats, who all are competent and mean
well, simply cannot agree if the death rate has gone up or down [1].

[1] [https://www.thecut.com/2015/11/gender-controversy-over-
white...](https://www.thecut.com/2015/11/gender-controversy-over-white-
mortality.html)

~~~
jzl
As the old saying goes, "smoking is the leading cause of statistics."

------
AtlasBarfed
A more comprehensive immunotherapy approach to cancer (which in my unqualified
opinion is the real path to "cure") will probably require custom treatments
specific to the patient's genome and cancer biochemistry/gene expression.

This does not match any sort of modern drug/device delivery method, which is
all the corporate types want. It probably takes lots of labor and tests, not
necessarily expensive, just not extremely profitable.

Which doesn't make me optimistic for its near term implementation.

Anyway, I've had a mother and three friends die of cancer. Basically, if the
drugs and radiation failed, it was game over.

~~~
sjg007
At some point we will be able to program the immune system to function like a
smart bomb and kill most cancers. Some cancers may not be immunological
targetable but might be druggable. Or druggable and later targetable.

------
admiralspoo
Sad caners of the pancreas, lung, liver, esophasgus, stomach and brain are
still pretty deadly.

------
fizixer
Great. But we need to tackle it at multiple levels, specifically prevention
and not just treatment.

Furthermore, we need to develop a way of sustainable organ and blood
availability. The only way I can see this happening is through
synthetic/artificial means. What Organovo is doing is a good start, but they
still need the matrix from an existing organ.

Here is what I see as ideal:

\- Around the time a baby is born (before or after, or both), some stem cells,
DNA samples etc are collected.

\- We need a tech for storing those samples for decades, not years. Including
a tech for "feeding" and growing them in a sustainable manner.

\- Then we need to have a way to differentiate organs out of them.

\- And be able to store working organs for decades, not years.

\- And a tech to artificially grow, maintain, and store blood.

\- And inject that person's immune system culture into those stored samples
and organs on recurring basis. So that they are up-to-date with that person's
immune system.

That means, if and when a person has organ failure, or is in need of blood,
(s)he has the stuff ready from his/her own stash. No dependence on one
another.

It's crazy and super-moonshot? yes. But it's a very realistic way forward. And
it's a holy grail worth working towards.

~~~
forgotmypw3
>prevention and not just treatment.

Unfortunately, this conflicts with "the economy".

Many of us are getting paid to produce cancer-causing products, such as:

* processed foods (most of the things you buy in a supermarket)

* most shampoos, cosmetics, soaps, detergents, cleaning products, etc.

* paraffin candles

* cigarettes and alcohol

* components of all these products and the byproducts of their production

* not to mention shit done on industrial scale

* the air, if you live in a populated area

* and so on.

If you really want to reduce your and your family's chances of getting cancer,
you're doing your research and doing a _lot_ of work to move away from the
mainstream (which is still stuck in 1950's level of knowledge) on these
habits, but most people are not, and just blindly trust the government and
oversight bodies to protect them because it's "easier" and "cheaper" and "they
wouldn't allow it to be sold if it was harmful". Years later: Surprise!

~~~
agumonkey
I'm thinking of ways to start groups of aquaponics to grow local and toxin
free. Spending more time in the green is good, eating simple and fresh too.

The ~power of mainstream is high, it's not super easy to swim across the flow

~~~
forgotmypw3
No, it is not easy at all. And even in educated circles, your opinions will be
in the minority, and cognitive dissonance will work against you too.

People _hate_ finding out that they're wrong, and nobody wants to admit that
they've been poisoning themselves and their family for decades.

It's either that or cancer, though...

~~~
agumonkey
I think it's more fear of doubt than being wrong. I'm sure if you come with a
ready made solution they won't resist nearly as much.

~~~
forgotmypw3
Unfortunately, there is no easy solution at this time...

------
salex89
Can someone explain what does the 0.67 prevalence number mean? That can't be
67%?

~~~
kgwgk
What 0.67 number? Are you refering to "The share of people with cancer (even
when corrected for ageing) has been slowly increasing in recent decades.
Global cancer prevalence has risen from 0.54 percent to 0.64 percent since
1990"?

Prevalence is the the share of people who are currently diagnosed with cancer.
The link in the first sencence quoted
([https://ourworldindata.org/cancer#global-perspective-on-
canc...](https://ourworldindata.org/cancer#global-perspective-on-cancer-
prevalence)) gives more info.

~~~
salex89
Yes, sorry. That's what I meant, thanks.

------
darawk
Obligatory reading before reading cancer statistics:

[https://slatestarcodex.com/2018/08/01/cancer-progress-
much-m...](https://slatestarcodex.com/2018/08/01/cancer-progress-much-more-
than-you-wanted-to-know/)

~~~
glalonde
The article links to that very post.

------
thewhitetulip
I recently researched about cancer and realised that anti oxidants are said to
prevent cancer. There was a study done in US, the Boston study or something
like that, it said that excess dairy consumption is directly linked to cancer.

Green tea, green vegetables and any anti oxidant source prevents cancer.

~~~
SketchySeaBeast
> Green tea, green vegetables and any anti oxidant source prevents cancer.

That doesn't seem to be the case. They seem to have no effect:

[https://www.cancer.gov/about-cancer/causes-
prevention/risk/d...](https://www.cancer.gov/about-cancer/causes-
prevention/risk/diet/antioxidants-fact-sheet)

Or can possibly make it worse:

[https://www.scientificamerican.com/article/antioxidants-
may-...](https://www.scientificamerican.com/article/antioxidants-may-make-
cancer-worse/)

When Dr. Oz is turning on Antioxidants you know there's something there:

[https://www.doctoroz.com/article/can-antioxidants-cause-
canc...](https://www.doctoroz.com/article/can-antioxidants-cause-cancer)

------
Balgair
Though it may seem cliche' and overused, speaking as someone with a close
relative that is affected:

FUCK CANCER

There is vigorous debate in these comments on the exact stats and what they
really mean.

All the same, this is fantastic news. Slowly, we are beating back this evil.

------
agent008t
So what should one do today to minimize their early death from cancer risks?
Do some kind of a genetic screening? Have periodic (annual?) checks for
specific cancers?

~~~
greedo
Avoid getting too much sun (melanoma); reduce your read meat consumption
(colon cancer); don't smoke, or quit if you currently do. Some studies have
indicated that grilled meats can also increase the chance of risk. Other than
that, pay attention to your body. My colon cancer indicated by bleeding that
was not regarded by my GP as more than just a potential hemorrhoid. A year
later a thoracic surgeon discovered a 5cm mass. I got lucky...

------
leptoniscool
5 year survival rate is just a single data point. It would be better to also
look at 7 year and 10 year survival data. Is this available?

------
bigmit37
I’m more interested in incidents of cancer among younger people. Is it rising
or falling?

~~~
ausbah
I believe the incidents of cancer for younger people are predicted to possibly
rise in the future due to obesity becoming more of a liability as people age.

------
ph0rque
Why have uterine cancer survival rates fallen, anybody know?

~~~
yread
Could it be because of the HPV vaccinations? That there are fewer more severe
cases?

