The Gender Gap in Cancer Death Rates

On Wednesday, after decades of grim news, the American Cancer Society reported the steepest decline in United States cancer deaths in the 70 years since nationwide data has been compiled. In 2004, there were 3,014 fewer cancer-related deaths than in 2003—which was the first year the society had ever recorded a drop in cancer deaths. The back-to-back decreases have specialists hoping that they may at last be gaining the upper hand in their long battle against the disease.

"Our work over the years is finally paying off," says Ahmedin Jemal, Ph.D., a specialist in cancer occurrence and the lead author of the report. He pointed to medical advances, early detection and antitobacco campaigns as key factors in the progress made.

But the report also underscores a stark disparity between men and women when it comes to surviving cancer. Death rates are falling about twice as fast for men as for women. Between 1990 and 2003, mortality rates for men fell by 16.3 percent; the comparable figure for women was only 8.5 percent. The reason men fared better is likely linked to national smoking habits. While both genders saw dramatic declines in deaths attributed to three major cancers—breast, prostate and colorectal—there was a gap in deaths caused by lung cancer, the most lethal form of the disease. Men have been smoking for more than 100 years, whereas women took up smoking much more recently, with the most notable surge between 1965 and 1985. "Women started smoking and quit smoking later than men," says Jemal.  Because of that 25-30 year lag, tobacco-related ailments may just now being showing up in female smokers. Lung cancer surpassed breast cancer as the leading cause of cancer deaths among women in 1987. And while lung-cancer death rates in women appear to be plateauing—after increasing for several decades—the disease now accounts for about 26 percent of cancer deaths among women.

Women also appear to be more likely to suffer from lung cancer than men even if they are not smokers. Experts say that while 90 percent of lung-cancer cases among men are due to smoking, only 80 percent of cases among women are directly related to lighting up. Second-hand smoke may also play a part in the disparity. Researchers are looking into reasons why female nonsmokers appear to be more susceptible to contracting lung cancer than their male counterparts. Concern about the effects of second-hand smoke spiked after the much-publicized death of Dana Reeve (widow of actor Christopher Reeve), a nonsmoker who died of lung cancer after spending years performing as a singer in smoky bars, though no conclusive link was ever made between her work and her illness. Still, with the overall numbers moving in the right direction, researchers are encouraged. "We're hoping we're at the peak of lung-cancer rates for women and that we'll begin to see a decline soon," said Elizabeth Ward, a top epidemiologist with the American Cancer Society and a coauthor of the report.

There was also a racial gap in the cancer-study results. African-Americans had the worst cancer mortality numbers among women, according to the study. Black women have a 9 percent lower incidence of cancer but an 18 percent higher death rate than white women for all cancers combined. One spot of universally good news was the drop in deaths among both men and women for colorectal cancer; it saw the largest decline of all cancers because of increased awareness and early screening.

Despite the good news, specialists have concerns about getting adequate resources for the battle going forward. While President Bush touted Wednesday's historic American Cancer Society report as the "tangible results" of funding for cancer research, and his administration described the findings as part of a "new era in cancer prevention," the American Cancer Society pointed out that Congress recently cut the budget for the National Institutes of Health for the first time in 35 years, and for the National Cancer Institute for the first time in more than a decade. "We're definitely worried," says Jemal.

And though the death rates are down, the numbers are still sobering. Fifteen hundred Americans will die of cancer every day for the rest of the year, according to estimates for 2007. A new, more accurate method to project cancer rates that was introduced this year utilizes cancer data from 86 percent of the U.S. population (previous methods used only 10 percent of the population). The new method of monitoring resulted in increased estimates of lung and leukemia cases but a drop in the number of estimated prostate cancer cases for 2007. "Next year we expect a continued decline," said Jemal. That would be good news for Americans across the board.