There's big cancer news this month. The American Cancer Society reports that for the first time, the five-year survival rate for all cancers combined reached 70%. That's for people diagnosed from 2015 to 2021 in the U.S. And the cancer death rate has declined by 34% since its peak in 1991.
The group said those changes are largely due to decades of research, which provided clinicians with the tools to more effectively treat the disease. CPR Health Reporter John Daley spoke with Dr. Hans Elzinga who directs of the Special Procedures Clinic for Salud Family Health in Longmont.
This interview has been edited for brevity and clarity.
John Daley: It’s a big milestone for cancer research that the five-rate survival rate is now around 70%.
Dr. Hans Elzinga: That's a significant increase. The previous had been about 50% back in the 1970s. That's been a slow number to increase, but as you can imagine, five-year survival rate is a huge metric to be able to improve. And the fact that that's now over 70% is a major, major accomplishment.
Daley: When you look at that percentage, that is considerable. What's driving this trend?
Elzinga: There's really three things primarily. Actually the biggest is probably smoking cessation. That's a huge thing. The second is cancer screening, and third, really our new therapies. And that's actually one of the big changes in improvements in survival in some of the more fatal cancers, and the more, late-stage cancers as well. That's where there's been the biggest impact from new medications, new therapies.
Daley: Let's take those one by one. Talk to me about smoking cessation.
Elzinga: So smoking rates have continued to decline overall. There are some demographics that it's not declined as much, including young people, but why that's so important is because the number one cause of cancer death, both in the United States and in Colorado as well, is lung cancer. Um, it is by far the number one cause of cancer death.
Number two is colorectal cancer. Number three is pancreatic cancer. Deaths from lung cancer are greater than colorectal and pancreatic combined. Over 90% of the people who die from lung cancer are smokers. So that direct link between smoking cessation and, and decreases in cancer death, it's our, it's our strongest tool.
Our strongest weapon that we have for decreasing cancer deaths is smoking cessation. Just because lung cancer is so lethal.
Daley: A lot of people are no longer smoking, but the vaping rates have gone up. How does that play into this?
Elzinga: We don't know some of the direct links. It's a little too early to tell on some of those things. There were some good data that came out as far as vaping e-cigarettes being a helpful tool as far as for smoking cessation. But as far as vaping and health effects, um, long-term for cancer, not well-known, not well studied, and we know that there were especially, um, recently there have been some other health issues related to vaping more due to lung damage. But those trends will play out in the future. It's a little too early to tell.
Daley: What is your suspicion about the health risks of vaping? Not to mention other types of tobacco use, like Zyn, nicotine pouches.
Elzinga: I think there's some worrisome signs that they may not be a healthy alternative. There may be some decreased risks of certain kinds of cancer, but we may well find that there are other things that are highly linked to these. It's just a little too early to tell, but yeah, unfortunately there are, there are some indications that we may see some long-term health risks from them, for sure.
Daley: Let's talk about cancer screenings. How have cancer screenings played a role in the survival rate for cancer?
Elzinga: Finding cancers at early stages, obviously when they're more treatable is significantly improved. Survivorship and some screening can actually prevent those cancers from happening in the first place. So a good example of that would be colorectal cancer, whereby removing precancerous polyps, we can actually prevent colon cancer from occurring in the first place. Similar things can happen with cervical cancer screening as well as skin cancer screening.
We still see increased rates of some of these cancers, but with some improved survivorship. So unfortunately, colorectal cancer is still increasing in people under 65 years of age and increasing greatly in younger people. So people less than the age of 50, incredibly, the number one cause of cancer death for men less than age 50 is colon cancer. It's actually incredible how much those numbers have increased by over 1% per year.
We now know that people who were born in 1990 have an over four times increased risk of developing colorectal cancer over the people who were born in 1950. So those numbers are increasing greatly, and those are worrisome trends.
We also see that breast cancer is becoming a very common cancer. So those cancer screening programs are extremely important when we do have effective screening that can significantly improve cancer mortality rates. So those are definitely important parts of our armamentarium for improving cancer mortality.
Daley: Do we know why colon cancer and breast cancer are on the rise?
Elzinga: We don't know the entire story on this, but certainly environmental factors are a big part of things. We know that there are multiple environmental factors and that probably about 50% of colorectal cancer cases can be prevented through lifestyle modifications. So maintaining a healthy body weight, getting regular exercise, eating a healthy diet, including large amounts of fresh fruits and vegetables, whole grains, and limiting alcohol consumption. All of those things can significantly decrease the risk of colon cancer. And we think that those are likely some of the things that are involved with that significant increase in those younger populations.
Daley: The third thing you talked about was improved treatments. How is that helping to drive the survival rate up?
Elzinga: There have been incredible advances. Lung cancer is a great example, so an incredibly lethal cancer, just dismal survival rates. For especially late-stage illnesses, those have improved markedly, some by as much as five times. So, we have many more targeted therapies, immunotherapies, so there are individual advances on these medication fronts that have just made huge changes in certain cancers. Myeloma is another good example where survivorship has increased greatly. These are really important right now where we know that funding for cancer research is at risk. These are hard-won improvements that have taken a long time in coming, but they have made just huge improvements in what were otherwise really difficult to treat types of cancer and making some of them, ideally even more like a chronic illness rather than a death sentence, which is transformational.
Daley: What impact do you think cuts to funding in both research and also public health might have on these rates and survivability in the coming years?
Elzinga: Yeah, we could have some steps backwards, which would be really unfortunate. Obviously, these investments in research have made significant steps forward for all of us that we've all benefited from. And we know too that access to affordable health care to health insurance is greatly correlated with cancer survivorship. Some of the biggest disparities that are there, including racial disparities, are highly linked to inability to access affordable health care.
So we know that some of these risks to funding, both at the research level and health insurance level, we could step backwards from some of these gains and instead of seeing survivorship increasing and uh, we could see it going the other direction, which would be incredibly sad.
Daley: What's your best advice for Coloradans about limiting their risk of cancer or surviving it if they happen to get it?
Elzinga: Those lifestyle factors are incredibly important. So getting regular exercise, maintaining a healthy body weight, eating a healthy diet, avoiding smoking, avoiding excess alcohol — those are incredibly important. And I think talking to your health care provider to assess your personal risk of cancer, um, family history is incredibly important to know.
Unfortunately, cancer, for many generations was sort of a, a something that we couldn't talk about openly, and being able to assess your personal risk and know what screening tests that you may be eligible for and, and making sure that you're getting those in a timely fashion. So talking with your health care provider about those things can greatly help to limit your risk from cancer.
