Cancer statistics 2024: All hands on deck

The 2024 update to Cancer Statistics from the American Cancer Society estimates that over 2,000,000 people this year will hear the words, “you have cancer.”¹ This amounts to nearly 5500 people each day, or the equivalent to one person experiencing this every 15 seconds. This marks the first time incidence has eclipsed 2 million Americans, with more people being diagnosed at earlier stages of these diseases, when cure rates are the highest. Consequently, cancer mortality continues to decline, with an estimated 4.1 million lives saved since 1991, because of significant investments in research and screening by the National Institutes of Health, the Centers for Disease Control and Prevention, the American Cancer Society, and others. To us, four parts of the report particularly stand out.

First, historically, cancer has been a disease that disproportionally affects men. However, this report demonstrates that, whereas the cancer incidence in men has been stable since the 2013, the incidence in women has ticked up since the late 1990s, attributed to higher rates of breast and uterine corpus cancers and melanoma. Thus cancer is becoming more gender-indiscriminate, with a male-to-female incidence ratio of 1.14 (95% CI, 1.136–1.143) in all ages. Many have hypothesized that differential lifestyle and risk-taking behaviors, alongside environmental exposures, resulted in higher cancer rates in men. However, as the incidence gap between genders closes, signs may point to risk factors (e.g., obesity, sedentary lifestyle) that are similarly affecting both groups, highlighting the need for a better understanding of this phenomenon.

Second, although the overall cancer incidence is increasing, there are particular cancers and populations disproportionately affected. For example, whereas the rise in uterine corpus cancers in White women has increased by about 1% per year since the mid-2000s, the increase is in excess of 2% in Black, Hispanic, Asian American, and Pacific Islander people. Colorectal cancer (CRC) too shows a variability when age is considered; the declines noted in CRC are largely because of a lower rate in people older than 65 years; among those younger than 55 years, the rate continues to increase by 1% to 2% per year. Finally, men saw their rates stabilize for liver cancer and, potentially, for melanoma between 2015 and 2019, yet women saw their rates increase by 2% per year. Taken together, the report highlights how cancer cannot be over-simplified to one diagnosis, nor can we generalize these trends in a short bullet.

Third, although the report highlights the tremendous advances in the treatment of hematologic and advanced solid tumor malignancies, the impact of disparities cannot be overstated. Compared with White women, for example, more Black women are diagnosed at a more advanced stage (44% vs. 23%) and have a poorer prognosis (5-year survival rate estimates of 63% vs. 84%, respectively). As the authors point out, systemic factors like disparities in guideline-concordant diagnostic and treatment protocols play a big role. Even more, it is likely that self-identification categories, such as Black, White, and Asian, mask the differences in risk and outcomes among groups. Asian, for example, may include descendants or immigrants from as many as 48 distinct countries. Whereas mortality from cancer has seen a 33% drop between 1999 and 2021, the picture is driven by deaths in older adults. A closer look in adults younger than 50 years shows that, although lung cancer death rates have fallen, they coincide with a higher rate of cancer death from CRC. CRC is now the leading cause of death in younger men and the second leading cause in younger women.

Fourth, reports like this highlight the gaps and opportunities in existing databases and data-collection mechanisms. For example, as norms regarding complete data collection of sexual and gender minoritized populations evolve, so must national registries to fully appreciate the distinctive populations affected by cancer. Furthermore, we continue to have an incomplete picture of those living with metastatic disease distinct from populations considered survivors.² Across the United States, tumor registry protocols dictate that stage is assigned at the time of initial diagnosis and is not updated if someone experiences a recurrence or develops metastatic disease. Clinically, it is important because the conversation about prognosis does not occur once; it is an ongoing conversation that changes as one’s circumstances and diagnoses evolve. It is also a question that is not uncommonly asked: how many of me are there living with metastatic disease?

Importantly, there are solutions to this, but this requires an update in documentation procedures. For example, the American Joint Commission on Cancer has a designation for recurrence or re-treatment, r, in its tumor, node, metastasis (TNM) system.^{3, 4} Although someone may be diagnosed with stage I disease at diagnosis (T1N0M0), at recurrence, they could be re-staged in a way to signify the evolution of metastatic disease (rT0N0M1). However, it is not used routinely or in standard fashion but presents an opportunity for us to collect data within a registry that could be subsequently analyzed.

In summary, we continue to make progress in oncology overall, but certain ethnic, racial, age, and geographic populations face a disproportionate burden of cancer incidence and mortality. Like others, we find these health disparities wholly unacceptable and agree with the National Cancer Plan and Biden Moonshot Initiative that bold and new collaborations and thinking will be needed to produce different outcomes. As the report notes, every 15 seconds presents a real reminder of the urgency to end cancer as we know it for everyone.

Don S. Dizon reports personal fees from AstraZeneca and Doximity; service on a Data and Safety Monitoring Board for Clovis Oncology, Inc., and GlaxoSmithKline, LLC; and owns stock options in Midi and Doximity, all outside the submitted work. Arif H. Kamal reports personal fees from Homebase Medical outside the submitted work and is the Chief Executive Officer of Prepped Health.