Cancer Mortality: The ACS Adjusts Its Goals

The American Cancer Society learned an important lesson when issuing its latest report assessing progress against its goals for reducing cancer mortality in the U.S.: be realistic about your expectations.

The original goal stated in 1996 was to reduce deaths from cancer by 50% over a 25-year period, from 1990-2015. The year 1990 was chosen because that was when cancer mortality levels had begun to level off.

In a telephone interview with MedPage Today, Richard C. Wender, MD, ACS's chief cancer control officer, said that ACS decided in 1996 that it was time to establish a set of goals around cancer outcomes that could guide the society's investments and activities, and that those goals served as sort of a report card throughout the 19-year period following.

He added that the 50% challenge to reduce cancer mortality in the U.S. over 25 years was calculated at the outset by co-author Tim Byers, MD, MPH, and other epidemiologists based on what was known at that time about prevention, early detection, and treatment.

"They literally went cancer by cancer and determined that if we applied all that we knew then, cancer mortality could be reduced by 40% with another 10% reduction being achieved through new discoveries leading to treatment breakthroughs," Wender said.

Wender explained that about midway between ACS's 1996 announcement and the 2015 end date, the society's leadership reevaluated its original goal and realized it would probably only be half-accomplished largely because of the 45 million uninsured Americans who would not have access to available prevention, early detection, and treatment.

But there have been victories: a reduction in smoking that correlates with a marked reduction in lung cancer deaths in men as well as reductions in both prostate cancer and colon cancer mortality. Yet smoking among women has not declined as rapidly as has been observed with men, thus there was a more modest reduction in lung cancer deaths in women.

The latest ACS report -- released online and published in CA: A Cancer Journal for Clinicians -- said that the resulting mortality figures "should be seen as a glass half full," and that the progress made "should eliminate any historical remnants of cancer fatalism, and it should now stimulate our national imagination about what might be possible to achieve in the future."

By the Numbers

The report found that overall cancer death rates in 2015 were 26% lower than in 1990, with men lower than 32%, and women lower than 22%.

In the report, Wender and his co-authors explained that: "The 50% reduction goal was more fully met for the cancer sites for which there was enactment of effective approaches for prevention, early detection, and/or treatment."

These decreased mortality rates included:

• Among men, mortality rates dropped for lung cancer by 45%, for colorectal cancer by 47%, and for prostate cancer by 53%.

• Among women, mortality rates dropped for lung cancer by 8%, for colorectal cancer by 44%, and for breast cancer by 39%.

• The decline in mortality from all other cancers was substantially smaller, with 13% among men and 17% among women.

The report also pointed out that there have been several cancer mortality challenge goals over the years.

In 1986, 10 years prior to ACS announcing its 25-year reduced mortality goal, the National Cancer Institute issued its own 50% reduction goal from 1980-2000.

However, the reduction over that period was only 4%, according to the authors.

In 2003 then-NCI director Andrew C. von Eschenbach, MD, asserted that with adequate NCI funding it would be possible "to eliminate suffering and death from cancer by 2015."

But the ACS report authors commented: "Because there was no obvious pathway to that goal, it was never adopted by any organization."

In addition, the lack of reduction in cancer mortality due to the large number of uninsured prompted ACS to wage a $15 million awareness campaign related to the importance of health insurance.

Lessons Learned

The report cited four lessons that could be taken from ACS's past experiences that involved realism, pathways, surveillance, and leadership.

• Goals need to be realistic and have to reach "a sweet spot in goal setting between projecting what will likely happen regardless of renewed efforts (setting the bar too low) and creating unrealistic challenges that tend to paralyze us (setting the bar too high)."

• Goals also "need to be accompanied by a clear path to success."

• Setting goals should "be followed by monitoring, surveillance, and clear communication about progress."

• "Effective leadership is essential to synergize combined efforts of the many organizations and systems involved in a nationwide effort," according to the report.

Wender said there are two ACS goal-related initiatives that are taking those lessons to heart.

"80 by 2018" is a project of the National Colorectal Cancer Roundtable -- chaired by Wender and established by the ACS and the Centers for Disease Control and Prevention -- to eliminate colorectal cancer as a major public health concern by working toward the goal of screening 80% for colorectal cancer by the year 2018.

And ACS is currently working on an internal document developing a cancer control "blueprint" for the nation.

"We're looking at certain things that are now proven to work in early detection, prevention, and cancer therapies, as well as new discoveries and research priorities that need to be addressed because of gaps in our knowledge," Wender said.

He added that a national effort has to ensure that everyone benefits and has access to the best available cancer screening, prevention, and treatment.

"There will be no pulling a goal from the sky. We will engage thought leaders to identify what some of these research priorities are so we can set some specific goals and define what actions to take next," he said.

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Cancer Mortality: The ACS Adjusts Its Goals