Cancer in Teens and Young Adults: Not Much Improvement?

Our annual Cancer Statistics report garnered plenty of media interest this week, finding that death rates continue to drop. But one story from CBS News caught our eye. It said

“We are making progress in the fight against cancer. The American Cancer Society said Wednesday that death rates are going down. Between 2004 and 2008, they dropped 1.8 percent each year for men and 1.6 percent for women. However, CBS News medical correspondent Dr. Jon LaPook reports there has not been much improvement for teens or young adults….

“Adolescents and young adults aged 15-to-39 account for more than 72,000 new cancers every year — seven times more than pediatric cancers. Unlike other groups, their mortality rates have not improved.”

It is true that young adult cancers have been cancer medicine’s forgotten population, as outlined in an excellent article in our journal, CA: A Cancer Journal for Clinicians by Archie Bleyer back in 2007.

But the claim that mortality rates have not improved is perplexing.

Our epidemiologists heard the CBS report and ran the numbers. Here’s a chart.

The data show despite the challenges facing this population, the overall cancer death rate among people 15 to 39 has decreased by over 50% since 1969.

I asked CBS about the statement, and it turns out what CBS meant to say was that survival rates had not improved.

So what do survival data show? While it is true the improvement in 5-year survival rates over time has been the lowest for ages 15-39 years, 5-year survival in 2001-2007 (81.5%) is similar to that among children (80.4%) and is 17.4% higher than those ages 40 and up (64.1%). It turns out, and this was news to me, that the survival rate in 1977 was already relatively high: 71.1% in adolescents and young adults compared to 58.1% in children and 47.4% in those 40 and older in that same time period. So it had less room to grow.

But using  survival rates is not the best way to measure progress anyway. They can be affected by factors, like increased screening rates, that do not reflect true improvements. In fact mortality rates, a person’s chances of dying of cancer (which we assume is what CBS thought it was reporting) remain the gold standard in marking progress. And death rates, as we saw above, are dropping in young adults.

The unique difficulties facing young adults with cancer is a real issue that demands our attention. The problem is dramatic and serious. It doesn’t require exaggeration.

About David Sampson

I am the director of medical and scientific communications for the American Cancer Society national home office.
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2 Responses to Cancer in Teens and Young Adults: Not Much Improvement?

  1. David Austin says:

    The 50% improvement in death rate is due to changes in diet and lifestyle which recommendations have steadily improved for cancer patients in the last 40 years, and this is expected to have a significant impact for those diagnosed at such an early age as this dynamic has the strongest correlation with those who make those changes earliest in life. 5 year survival rate however is a measure of the actual cancer treatment, as the treatment is responsible for killing the cancer in the short term (remember cancer spreads fast in the impaired human cellular ecosystem so a successful treatment should have a short-term rather than long-term impact). Furthermore, since the drugs used on young adults is the same as those used on the older adults, those same drugs must not be responsible for the improvement for older adults. A more thorough analysis of the data will show that the most significant change made in the last 20 years with regard to cancer is with respect to “early detection”, and this is why there is a marked improvement in the older adults. Young adults (pre-30) still do not undergo early detection. However, some effort has been made in this regard, and it is estimated that early detection for young adults (pre-30) has improved early detection for that crowd by probably 15% … almost exactly the same improvement observed in 5-year survival for that age group.

    In short, through a more careful analysis we have confidently identified that there has been literally no improvement to patient health in the drugs used to treat cancer in the last 40 years for any age group. Mathematically the survival improvement seen in older adults (which is large) and the survival improvement in young adults (which is minimal) is equivalent to what is expected with early detection technology and practices, and the improved death rate for young adults diagnosed with cancer is equivalent to ever improving anti-cancer diet and lifestyles that demographic engages in.

    This actually should come as no surprise, as the yard-stick by which all cancer drugs (especially chemotherapeutic agents) are evaluated is not in terms of survivability, but in terms of cancer cell statistics, such as tumor growth and cancer detection rates. In other words for 40 years we’ve been getting better and better at acutely attacking cancer itself, but are making no headway regarding healing the cancer patient – other than improving early detection and better lifestyle recommendations for those pre-diagnosed with cancer. There’s a word for that outcome: piss-poor.

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