A Comprehensive Approach to Cancer Prevention and Control:
A Vision for the Future

Cancer Burden

The American Cancer Society (ACS) estimates that, in 2003, more than 556,500 Americans will die of cancer—more than 1,500 people every day—and that about 1,334,100 new cases of cancer will be diagnosed.¹ These estimates do not include carcinoma in situ (except urinary bladder) or basal and squamous cell skin cancers. Cancer is the second leading cause of death in the United States, accounting for one of four deaths. From 1950 to 1991, cancer death rates increased steadily. Rates began to decline in 1991, largely because of a decline in rates of lung cancer deaths.² However, the aging and increasing size of the U.S. population will cause the total number of cancer cases to double by 2050 if current incidence rates remain steady.³

The National Cancer Institute (NCI) of the National Institutes of Health (NIH) estimates that almost nine million Americans with a history of cancer were living in 1997; some were under treatment and some were considered cured.⁴ The combined 5-year survival rate for Americans with any type of cancer is 62%.¹

The ACS estimates that cancers that can be detected by screening account for about half of all new cancer cases. If all these cancers were detected at a localized stage through appropriate screening, the 5-year survival rate would approach 95%.¹ For these reasons, the bulk of cancer prevention and control research dollars are dedicated to the prevention and early detection of these cancers.

Table 1. Statistics for Selected Cancers

African Americans have higher rates of many cancers than other racial or ethnic groups. During 1992–1999, the overall cancer incidence rate per 100,000 persons was 526.6 among African Americans, 480.4 among whites, 329.6 among Hispanics, 348.6 among Asian/Pacific Islanders, and 244.6 among American Indians/Alaska Natives. Racial disparities in outcomes are often even more pronounced than disparities in incidence rates. For example, although breast cancer is diagnosed more often in white women, African American women are more likely to die of the disease. The overall cancer mortality rate is also about one-third higher among African Americans than among whites.¹

Mortality rates also vary by gender. The most recent age-adjusted annual cancer death rates were 259.1 for U.S. men and 171.4 for U.S. women.³

Cancer’s financial costs are significant. NCI estimates that cancers cost the nation more than $171.6 billion in 2002: $60.9 billion in direct medical costs (i.e., expenditures for medical procedures and services associated with treatment and care for cancer), $15.5 billion in indirect morbidity costs (such as the value of work disability and absenteeism associated with cancer), and $95.2 billion for indirect mortality costs (such as the cost of lost productivity due to premature death). More than half of all medical costs for cancer are estimated to be for the treatment of breast, lung, prostate, and colorectal cancers,⁴ again underscoring the importance of directing prevention and early detection activities toward these cancers.

The nonmonetary costs of cancer are also substantial but cannot be adequately quantified. Cancer pain, though usually manageable, can be a significant problem, as can the discomfort of treatment and damage to the cancer patient’s self-image. After treatment for cancer, many people can continue an active, vital life—but they must live with the fear and uncertainty that the cancer might return. As one cancer survivor commented, “the fear for me now, eight and a half years out from my diagnosis, is generally background noise. Most of the time I am not aware of it, yet it waits ready to pounce at the slightest provocation.” ⁵ Because between eight and nine million Americans have a history of cancer, the toll of the disease is enormous no matter how the burden is calculated.

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