Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute (Surveillance, Epidemiology, and End Results [SEER] Program), the Centers for Disease Control and Prevention (National Program of Cancer Registries), and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. In 2016, 1,685,210 new cancer cases and 595,690 cancer deaths are projected to occur in the United States. Overall cancer incidence trends (13 oldest SEER registries) are stable in women, but declining by 3.1% per year in men (from 2009-2012), much of which is because of recent rapid declines in prostate cancer diagnoses. The cancer death rate has dropped by 23% since 1991, translating to more than 1.7 million deaths averted through 2012. Despite this progress, death rates are increasing for cancers of the liver, pancreas, and uterine corpus, and cancer is now the leading cause of death in 21 states, primarily due to exceptionally large reductions in death from heart disease. Among children and adolescents (aged birth-19 years), brain cancer has surpassed leukemia as the leading cause of cancer death because of the dramatic therapeutic advances against leukemia. Accelerating progress against cancer requires both increased national investment in cancer research and the application of existing cancer control knowledge across all segments of the population.

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Cancer statistics, 2016

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. A total of 1,660,290 new cancer cases and 580,350 cancer deaths are projected to occur in the United States in 2013. During the most recent 5 years for which there are data (2005-2009), delay-adjusted cancer incidence rates declined slightly in men (by 0.6% per year) and were stable in women, while cancer death rates decreased by 1.8% per year in men and by 1.5% per year in women. Overall, cancer death rates have declined 20% from their peak in 1991 (215.1 per 100,000 population) to 2009 (173.1 per 100,000 population). Death rates continue to decline for all 4 major cancer sites (lung, colorectum, breast, and prostate). Over the past 10 years of data (2000-2009), the largest annual declines in death rates were for chronic myeloid leukemia (8.4%), cancers of the stomach (3.1%) and colorectum (3.0%), and non-Hodgkin lymphoma (3.0%). The reduction in overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of approximately 1.18 million deaths from cancer, with 152,900 of these deaths averted in 2009 alone. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket and other underserved populations.

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Cancer statistics, 2013

Each year the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute (Surveillance, Epidemiology, and End Results [SEER] Program), the Centers for Disease Control and Prevention (National Program of Cancer Registries), and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. A total of 1,658,370 new cancer cases and 589,430 cancer deaths are projected to occur in the United States in 2015. During the most recent 5 years for which there are data (2007-2011), delay-adjusted cancer incidence rates (13 oldest SEER registries) declined by 1.8% per year in men and were stable in women, while cancer death rates nationwide decreased by 1.8% per year in men and by 1.4% per year in women. The overall cancer death rate decreased from 215.1 (per 100,000 population) in 1991 to 168.7 in 2011, a total relative decline of 22%. However, the magnitude of the decline varied by state, and was generally lowest in the South (∼15%) and highest in the Northeast (≥20%). For example, there were declines of 25% to 30% in Maryland, New Jersey, Massachusetts, New York, and Delaware, which collectively averted 29,000 cancer deaths in 2011 as a result of this progress. Further gains can be accelerated by applying existing cancer control knowledge across all segments of the population.

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Cancer statistics, 2015.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data were collected by the National Center for Health Statistics. A total of 1,665,540 new cancer cases and 585,720 cancer deaths are projected to occur in the United States in 2014. During the most recent 5 years for which there are data (2006-2010), delay-adjusted cancer incidence rates declined slightly in men (by 0.6% per year) and were stable in women, while cancer death rates decreased by 1.8% per year in men and by 1.4% per year in women. The combined cancer death rate (deaths per 100,000 population) has been continuously declining for 2 decades, from a peak of 215.1 in 1991 to 171.8 in 2010. This 20% decline translates to the avoidance of approximately 1,340,400 cancer deaths (952,700 among men and 387,700 among women) during this time period. The magnitude of the decline in cancer death rates from 1991 to 2010 varies substantially by age, race, and sex, ranging from no decline among white women aged 80 years and older to a 55% decline among black men aged 40 years to 49 years. Notably, black men experienced the largest drop within every 10-year age group. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population.

https://www.medpagetoday.com/upload/2014/1/7/caac21208.pdf

Cancer statistics, 2014

Colorectal cancer (CRC) is one of the most common malignancies in the United States. Every 3 years, the American Cancer Society provides an update of CRC incidence, survival, and mortality rates and trends. Incidence data through 2013 were provided by the Surveillance, Epidemiology, and End Results program, the National Program of Cancer Registries, and the North American Association of Central Cancer Registries. Mortality data through 2014 were provided by the National Center for Health Statistics. CRC incidence rates are highest in Alaska Natives and blacks and lowest in Asian/Pacific Islanders, and they are 30% to 40% higher in men than in women. Recent temporal patterns are generally similar by race and sex, but differ by age. Between 2000 and 2013, incidence rates in adults aged ≥50 years declined by 32%, with the drop largest for distal tumors in people aged ≥65 years (incidence rate ratio [IRR], 0.50; 95% confidence interval [95% CI], 0.48-0.52) and smallest for rectal tumors in ages 50 to 64 years (male IRR, 0.91; 95% CI, 0.85-0.96; female IRR, 1.00; 95% CI, 0.93-1.08). Overall CRC incidence in individuals ages ≥50 years declined from 2009 to 2013 in every state except Arkansas, with the decrease exceeding 5% annually in 7 states; however, rectal tumor incidence in those ages 50 to 64 years was stable in most states. Among adults aged <50 years, CRC incidence rates increased by 22% from 2000 to 2013, driven solely by tumors in the distal colon (IRR, 1.24; 95% CI, 1.13-1.35) and rectum (IRR, 1.22; 95% CI, 1.13-1.31). Similar to incidence patterns, CRC death rates decreased by 34% among individuals aged ≥50 years during 2000 through 2014, but increased by 13% in those aged <50 years. Progress against CRC can be accelerated by increasing initiation of screening at age 50 years (average risk) or earlier (eg, family history of CRC/advanced adenomas) and eliminating disparities in high-quality treatment. In addition, research is needed to elucidate causes for increasing CRC in young adults. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:177-193. © 2017 American Cancer Society.

Colorectal cancer statistics, 2017.

Racial disparities have been demonstrated at each step of the cancer-care continuum, ranging from the unequal distribution of cancer risk factors to inequities in prompt diagnosis and appropriate therapy.1–3 Even among patients who have Medicare insurance, for whom a substantial proportion of cancer therapy costs are reimbursed, there is abundant evidence of inequity in cancer care among patients diagnosed in the early and mid-1990s.2, 4–11 Increased recognition of the prevalence of healthcare disparities during the 1990s has led not only to increased attention but also to substantive initiatives promoted by foundations and by all levels of government.1, 12–16

Given the recent attention and investment in ensuring access to appropriate cancer care, it is important to address 2 key knowledge gaps. First, there is a need to assess whether access to cancer therapies has increased in the overall population. Second, it is unclear whether there has been any reduction in cancer disparities. Some analyses have reported that racial therapy disparities persisted from 1992 through 1999 among patients diagnosed with early stage prostate or breast cancer.11, 17–19 Conversely, a separate analysis of colorectal cancer therapy in the National Cancer Data Base suggested that while a racial disparity in receipt of adjuvant therapy existed in 1990–1991, it no longer existed in 2001–2002.20 However, these findings were not adjusted for patient, tumor, or health system characteristics.20

We, therefore, evaluated the cancer care received by Medicare beneficiaries who were diagnosed with common cancer types from 1992 through 2002. We identified cancer therapies for which racial disparities had been previously recognized and determined whether there had been a temporal change in cancer care for the overall Medicare population or in the magnitude of racial disparities.

Racial disparities in cancer therapy: did the gap narrow between 1992 and 2002?

ContextMedicare's reimbursement policy was changed in 1998 to provide coverage for screening colonoscopies for patients with increased colon cancer risk, and expanded further in 2001 to cover screening colonoscopies for all individuals.ObjectiveTo determine whether the Medicare reimbursement policy changes were associated with an increase in either colonoscopy use or early stage colon cancer diagnosis.Design, Setting, and ParticipantsPatients in the Surveillance, Epidemiology, and End Results Medicare linked database who were 67 years of age and older and had a primary diagnosis of colon cancer during 1992-2002, as well as a group of Medicare beneficiaries who resided in Surveillance, Epidemiology, and End Results areas but who were not diagnosed with cancer.Main Outcome MeasuresTrends in colonoscopy and sigmoidoscopy use among Medicare beneficiaries without cancer were assessed using multivariate Poisson regression. Among the patients with cancer, stage was classified as early (stage I) vs all other (stages II-IV). Time was categorized as period 1 (no screening coverage, 1992-1997), period 2 (limited coverage, January 1998-June 2001), and period 3 (universal coverage, July 2001-December 2002). A multivariate logistic regression (outcome = early stage) was used to assess temporal trends in stage at diagnosis; an interaction term between tumor site and time was included.ResultsColonoscopy use increased from an average rate of 285/100 000 per quarter in period 1 to 889 and 1919/100 000 per quarter in periods 2 (P<.001) and 3 (P vs 2<.001), respectively. During the study period, 44 924 eligible patients were diagnosed with colorectal cancer. The proportion of patients diagnosed at an early stage increased from 22.5% in period 1 to 25.5% in period 2 and 26.3% in period 3 (P<.001 for each pairwise comparison). The changes in Medicare coverage were strongly associated with early stage at diagnosis for patients with proximal colon lesions (adjusted relative risk period 2 vs 1, 1.19; 95% confidence interval, 1.13-1.26; adjusted relative risk period 3 vs 2, 1.10; 95% confidence interval, 1.02-1.17) but weakly associated, if at all, for patients with distal colon lesions (adjusted relative risk period 2 vs 1, 1.07; 95% confidence interval, 1.01-1.13; adjusted relative risk period 3 vs 2, 0.97; 95% confidence interval, 0.90-1.05).ConclusionsExpansion of Medicare reimbursement to cover colon cancer screening was associated with an increased use of colonoscopy for Medicare beneficiaries, and for those who were diagnosed with colon cancer, an increased probability of being diagnosed at an early stage. The selective effect of the coverage change on proximal colon lesions suggests that increased use of whole-colon screening modalities such as colonoscopy may have played a pivotal role.

https://jamanetwork.com/journals/jama/articlepdf/204635/joc60165_2815_2822.pdf

Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer.

The COVID-19 pandemic continues to grow in the United States and, in the absence of a vaccine or effective treatment, social distancing measures are essential to slow the spread of this disease. Using cellular mobility data from 2019 and 2020, I demonstrate that there have been substantial increases in social distancing since the start of the pandemic. Rates of voluntary, as opposed to mandatory, social distancing varies by county characteristics, including partisanship, media consumption, and racial and ethnic composition. Mandatory measures to increase social distancing appear to be effective, most notably stay at home orders which increase the share of devices at home by 2 percentage points. Social distancing orders also appear to have substantial informational content and, in the case of mask mandates, the informational content appears to be greater than the gross effect of mask mandates on behavior. These results provide insight into the importance of communicating the threat posed by COVID-19, since most changes in social distancing appear to be voluntary, plausibly reflecting beliefs about disease risk.

Early Evidence on Social Distancing in Response to COVID-19 in the United States

Most U.S. colleges have reopened campuses for in-person teaching this Fall, following rapid closures at the onset of the COVID-19 pandemic this Spring. Despite administrative efforts at mitigation and preventive measures, the large congregation of students within close quarters has caused public health concerns. In this paper, we examine college reopenings9 association with changes in human mobility within campuses and in COVID-19 incidence in the counties of the campuses, over a two-week period before and after college reopenings. To estimate the daily reproduction number (Rt), we used a Bayesian framework. Using a difference-in-differences design comparing areas with a college campus, before and after reopening, to areas without a campus, we find that after college reopenings for face-to-face instruction, COVID-19 incidence in the county increased on average by a statistically significant 0.024 per thousand residents, following increases in mobility on campus. Similarly, we estimated increased transmission locally after reopening, with a rising trend in Rt. The increase in cases was larger in counties with colleges that drew students from areas with increasing incidence rates.

/pdf/college-openings-mobility-and-the-incidence-of-covid-19-3nvs0x3ppz.pdf

College Openings, Mobility, and the Incidence of COVID-19 Cases

This study quantifies the effect of state reopening policies on daily mobility, travel, and mixing behavior during the COVID-19 pandemic. We harness cell device signal data to examine the effects of the timing and pace of reopening plans in different states. We quantify the increase in mobility patterns during the reopening phase by a broad range of cell-device-based metrics. Soon (four days) after reopening, we observe a 6% to 8% mobility increase. In addition, we find that temperature and precipitation are strongly associated with increased mobility across counties. The mobility measures that reflect visits to a greater variety of locations responds the most to reopening policies, while total time in vs. outside the house remains unchanged. The largest increases in mobility occur in states that were late adopters of closure measures, suggesting that closure policies may have represented more of a binding constraint in those states. Together, these four observations provide an assessment of the extent to which people in the U.S. are resuming movement and physical proximity as the COVID-19 pandemic continues.

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Martin Andersen

Papers

Racial disparities in cancer therapy: did the gap narrow between 1992 and 2002?

Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer.

Early Evidence on Social Distancing in Response to COVID-19 in the United States

College Openings, Mobility, and the Incidence of COVID-19 Cases

Impacts of State Reopening Policy on Human Mobility