An NIH modeling study examined the individual and combined effects of cancer prevention, screening, and treatment.
A study led by researchers at the National Institutes of Health (NIH) has found that improvements in cancer prevention and screening have prevented more deaths from five major cancer types over the past 45 years than advances in treatment. The findings were published on December 5, 2024, in JAMA Oncology.
The study examined deaths from breast, cervical, colorectal, lung, and prostate cancer that were prevented due to a combination of prevention, screening, and treatment advances. These five cancers were chosen because they are the leading causes of cancer-related deaths and have established strategies for prevention, early detection, or treatment.
In recent years, these five cancers have accounted for nearly half of all new cancer diagnoses and deaths.
“Although many people may believe that treatment advances are the major driver of reductions in mortality from these five cancers combined, the surprise here is how much prevention and screening contribute to reductions in mortality,” said co-lead investigator Katrina A. B. Goddard, Ph.D., director of NCI’s Division of Cancer Control and Population Sciences. “Eight out of 10 deaths from these five cancers that were averted over the past 45 years were due to advances in prevention and screening.”
Smoking Cessation: A Major Contributor
A single prevention intervention, smoking cessation, contributed the lion’s share of the deaths averted: 3.45 million from lung cancer alone. When considering each cancer site individually, prevention and screening accounted for most deaths averted for cervical, colorectal, lung, and prostate cancer, whereas treatment advances accounted for most deaths averted from breast cancer.
“To reduce cancer death rates, it’s critical that we combine effective strategies in prevention and screening with advances in treatment,” said W. Kimryn Rathmell, M.D., Ph.D., director of NCI. “This study will help us understand which strategies have been most effective in reducing cancer deaths so that we can continue building on this momentum and hopefully increase the use of these strategies across the United States.”
The researchers used statistical models and cancer mortality data to estimate the relative contributions of prevention, screening, and treatment advances to deaths averted from breast, cervical, colorectal, lung, and prostate cancers between 1975 and 2020.
In total, the modeling showed, 5.94 million deaths were averted from these five cancers between 1975 and 2020. Of these, prevention and screening interventions accounted for 4.75 million, or 80%, of the averted deaths.
The individual contributions of prevention, screening, and treatment varied by cancer site:
- In breast cancer, 1 million deaths (out of 2.71 million that would have occurred in the absence of all interventions) were averted from 1975 to 2020, with treatment advances contributing to three-quarters of the deaths averted and mammography screening contributing to the rest.
- In lung cancer, prevention through tobacco control efforts accounted for 98% of the 3.45 million deaths averted (out of 9.2 million), and treatment advances accounted for the rest.
- In cervical cancer, the 160,000 deaths averted (out of 370,000) were entirely through cervical cancer screening (i.e., Pap and HPV, or human papillomavirus, testing) and removal of precancerous lesions.
- In colorectal cancer, of the 940,000 deaths averted (out of 3.45 million), 79% were due to screening and removal of precancerous polyps, with treatment advances accounting for the remaining 21%.
- In prostate cancer, of the 360,000 deaths averted (out of 1.01 million), screening via PSA testing contributed 56% and treatment advances contributed 44%.
“These findings suggest that we need to continue to have strong strategies and approaches in all of these areas,” Dr. Goddard noted. “It’s not just treatment advances alone, or prevention and screening alone, that is helping us to reduce cancer mortality.”
Future Directions and Limitations
The authors pointed out that more recent prevention and screening strategies, such as HPV vaccination and lung cancer screening, were not in wide use during the study period and could further reduce cancer death rates. Other opportunities for reducing cancer deaths include making screening more accessible, such as with HPV tests that allow for self-collection, and developing new treatments.
The authors acknowledged that the five cancer sites included in the study account for less than half of all cancer deaths and that the findings for these cancers may not necessarily apply to other cancers, especially those for which there are not effective prevention, screening, or treatment interventions.
“We need to optimize the uptake and use of prevention and screening for these five cancers so that all Americans can benefit, especially underserved populations, as well as develop novel prevention and screening strategies to avert deaths due to other, very lethal cancers, such as those of the pancreas and ovary,” said co-lead investigator Philip E. Castle, Ph.D., M.P.H., director of NCI’s Division of Cancer Prevention.
In addition, the authors noted that the findings are based on population averages in the United States and may not be generalizable to specific population groups. The study also did not consider the potential harms of interventions, such as false-positive results and overdiagnosis during screening, nor did it measure other outcomes, such as quality of life.
Reference: “Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020” by Katrina A. B. Goddard, Eric J. Feuer, Jeanne S. Mandelblatt, Rafael Meza, Theodore R. Holford, Jihyoun Jeon, Iris Lansdorp-Vogelaar, Roman Gulati, Natasha K. Stout, Nadia Howlader, Amy B. Knudsen, Daniel Miller, Jennifer L. Caswell-Jin, Clyde B. Schechter, Ruth Etzioni, Amy Trentham-Dietz, Allison W. Kurian, Sylvia K. Plevritis, John M. Hampton, Sarah Stein, Liyang P. Sun, Asad Umar and Philip E. Castle, 5 December 2024, JAMA Oncology.
DOI: 10.1001/jamaoncol.2024.5381
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2 Comments
I am a medical anthropologist breast cancer researcher and author. Interesting, “treatment advances accounted for most deaths averted from breast cancer.” Here’s an idea. How about not censoring the bra-cancer link, as the ACS and NCI are doing.
Bra-free women have about the same risk of breast cancer as men, while the tighter and longer the bra is worn the higher the risk rises, to over 100 times higher for a 24/7 bra user compared to a bra-free woman.
Medicine ignores the impact of tight clothing on the lymphatic system, which is the immune system. But it is known that impairing the lymphatics impairs immunity and increases cancer incidence. See my article, How Bras Cause Lymph Stasis and Breast Cancer. https://www.academia.edu/36287546/HOW_BRAS_CAUSE_LYMPH_STASIS_AND_BREAST_CANCER
By the way, early detection lowers cancer death rates by also inflating the apparent number of people who have cancer, while many of these early detected “cancers” will pose no problem, or will be resolved naturally by the immune system. The more people you can say have cancer, including very early signs of cancer, the more successful treatment will seem. It’s a numbers game. When you treat people for cancer who might not have developed cancer without treatment, it makes the treatment seem amazing.
Re “mammography”
Contrary to the official narrative (which is based on medical business-fabricated pro-mammogram “scientific” data), there is marginal, if any, reliable evidence that routine mammography, both conventional and digital (3D), reduces mortality from breast cancer in a significant way in any age bracket but a lot of solid evidence shows the procedure does provide more serious harm than serious benefit (read the books: ‘Mammography Screening: Truth, Lies and Controversy’ by Peter Gotzsche [https://www.amazon.com/Mammography-Screening-Truth-Lies-Controversy/dp/1846195853] and ‘The Mammogram Myth’ by Rolf Hefti – see author’s synopsis at https://www.rolf-hefti.com/mammograms.html ).
IF…….. women (and men) at large were to examine the mammogram data above and beyond the information of the mammogram business cartel (eg American Cancer Society, National Cancer Institute, Komen), they’d also find that it is almost exclusively the big profiteers of the test, ie. the “experts,” (eg radiologists, oncologists, medical trade associations, breast cancer “charities” etc) who promote the mass use of the test and that most pro-mammogram “research” is conducted by people with massive vested interests tied to the mammogram industry.
Most women are fooled by the misleading medical mantra that early detection by mammography saves lives simply because the public has been fed (“educated” or rather brainwashed) with a very one-sided biased pro-mammogram set of information circulated by the big business of mainstream medicine and their allied corrupt pawns in the governments. The above mentioned two independent investigative works show that early detection does not mean that there is less breast cancer mortality.