Cancer Leads in Deaths Under 85

Cancer is now the leading cause of death for Americans under the age of 85, surpassing deaths from heart disease for the first time, researchers said Wednesday.

The death rate from both diseases is declining, but the rate for heart disease is dropping faster, causing the change in positions.

In 2002, the most recent year for which data are available, 476,009 Americans under 85 died of cancer, compared with 450,637 who died of heart disease, according to the American Cancer Society’s annual report, issued Wednesday.

But when Americans 85 and over are factored in, heart disease retains its lead. They represent 1.6% of the population.

About 950,000 Americans will die of heart disease this year, compared with about 570,000 who will die of cancer.

The overall death rate for heart disease is not expected to fall below that for cancer until about 2018, according to Dr. Harmon Eyre, the cancer society’s chief medical officer.

Dr. Michael A. Friedman, chief executive and president of the City of Hope Cancer Center in Duarte, however, cautioned that “whether something is No. 1 or 2 is really not important. What is really important is the terrible cost in productivity, lifestyle, relationships, comfort and all the important parameters of life. Those costs are all very, very high” for cancer and heart disease.

The cancer report found several areas of improvement. The death rate from lung cancer in women -- which first surpassed that for breast cancer in 1980 -- has apparently peaked at about 73,000 per year and may even be starting to decline, said epidemiologist Elizabeth Ward of the cancer society.

The rate for men, now about 90,500, peaked in 1989. It has been declining by about 1.9% per year since 1991.

The main reason for the difference in lung cancer rates between the sexes is that, while smoking has always been more common among men, they began to quit earlier. The incidence of smoking in men began to drop after the Surgeon General’s 1964 report on the risks of tobacco, while that in women continued to grow for another 20 years.

Overall, the proportion of American adults who smoke fell from 42% in 1965 to 22% in 2000. Nonetheless, smoking still accounts for a third of the cancer cases in this country.

Another third of cancer cases are associated with obesity, lack of physical activity and poor diets, Ward said, and those are among the few types of cancer for which incidence and mortality rates are increasing.

In men, obesity is most closely associated with cancers of the liver, pancreas, stomach and esophagus. Obese men have about a 50% higher risk of these cancers than those of normal weight.

In women, obesity is associated with cancers of the uterus, kidney, cervix and pancreas. Obese women have about a 70% higher risk of developing these than do women of normal weight.

In a new section of the report this year, the society’s researchers concluded that about 17% of cancers worldwide -- compared with about 7.2% in the United States and other developing countries -- are caused by infections.

Those cancers include liver cancer, caused by the hepatitis B and C viruses; cervical cancer, caused by the human papillomavirus; stomach cancer, caused by the Helicobacter pylori bacterium, which produces ulcers; and Kaposi’s sarcoma, which is caused by human herpesvirus 8 but whose incidence has been increasing because of HIV infections.

“We are highlighting these because many of them are highly preventable,” Ward said.

Other highlights of the report:

* There will be an estimated 1,373,000 new cases of cancer in the United States this year and an estimated 570,000 deaths. Both represent small increases from last year, largely due to the growth and aging of the population.

* California will have 134,300 new cases this year and 55,340 deaths.

* The death rate for men has declined 1.5% per year since 1993, while that for women has declined 0.8% per year -- both due primarily to decreases in smoking.

* Prostate (232,090 cases), lung (93,010) and colorectal cancers (71,820) will account for 56% of new cases in men and 51% of deaths.

* Breast (211,240 cases), lung (79,560) and colorectal cancers (73,470) will account for 55% of new cases in women and 52% of deaths.