In a model-based study of population-level mortality data, cancer prevention and screening interventions were the main contributors to reductions in mortality due to the most common cancers in the US over the past 45 years. Despite progress, efforts to further reduce the cancer burden will require increased dissemination of effective interventions and development of new technologies and discoveries.
Future efforts should continue to invest significantly in prevention and screening strategies as part of a comprehensive plan to accelerate progress and reduce cancer mortality according to Katrina A. B. Goddard, PhD of the Division of Cancer Control and Population Sciences, National Institutes of Health, National Cancer Institute (NCI) in Bethesda, MD, US and colleagues, who published the findings on 5 December 2024 in the JAMA Oncology.
The authors wrote in the background that a comprehensive plan to reduce cancer mortality includes interventions in cancer prevention, detection, diagnosis, treatment, and survivorship care. It is needed to understand which intervention strategies are most effective in reducing deaths from cancer. Past analyses have only evaluated contributions to mortality for individual cancer sites.
The study team extended models from established Cancer Intervention and Surveillance Modeling Network teams and NCI collaborators to quantify the relative contributions of prevention, screening, and treatment advances to cumulative mortality of breast, cervical, colorectal, lung, and prostate cancers from 1975 to 2020.
Model inputs were based on national data on risk factors, cancer incidence, cancer survival, and mortality due to other causes, and dissemination and effects of prevention, screening (for interception and early detection), and treatment. Simulated or modelled data using parameters derived from multiple birth cohorts of the US population were used.
Interventions were primary prevention via smoking reduction for lung cancer, screening for interception for cervical and colorectal cancers or early detection for breast, cervical, colorectal, and prostate cancers, and therapy for breast, colorectal, lung, and prostate cancers.
An estimated 5.94 million cancer deaths were averted for breast, cervical, colorectal, lung, and prostate cancers combined. Cancer prevention and screening efforts averted 8 of 10 of these deaths (4.75 million averted deaths).
The contribution of each intervention varied by cancer site. Screening accounted for 25% of breast cancer deaths averted. Averted cervical cancer deaths were nearly completely averted through screening and removal of cancer precursors as treatment advances were modest during the study period. Averted colorectal cancer deaths were averted because of screening and removal of precancerous polyps or early detection in 79% and treatment advances in 21%. Most lung cancer deaths were avoided by smoking reduction (98%) because screening uptake was low and treatment largely palliative before 2014. Screening contributed to 56% of averted prostate cancer deaths.
Deaths averted from the impact of tobacco control on lung cancer had the most predominant impact. With the exception of breast cancer, these results indicate relatively fewer deaths will be avoided through treatment advances compared with prevention (via smoking cessation) or screening (for interception or early detection). These 5 cancer sites represent 51% of all patients with cancer, and deaths from these cancers represent 42% of all cancer deaths.
The models did not quantify emerging interventions with low uptake during the study period, suggesting interventions like HPV vaccines, lung cancer screening, and new therapies could further decrease mortality. Reports from Europe provide evidence from clinical practice that HPV vaccination reduces cervical cancer incidence.
Early diagnosis and prevention may reduce or eliminate treatment, minimise harmful adverse effects of the cancer or treatment, and reduce the financial burden of cancer.
Reference
Goddard KAB, Feuer EJ, Mandelblatt JS, et al. Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020. JAMA Oncology; Published online 5 December 2024. doi: 10.1001/jamaoncol.2024.5381