Prevention and screening are outpacing advances in treatment to prevent death from five types of cancer, research shows

Improvements in cancer prevention and screening have averted more deaths from five types of cancer combined over the past 45 years than advances in treatment, according to a modeling study led by researchers at the National Institutes of Health (NIH).

The study, published on December 5, 2024, in JAMA Oncologylooked at deaths from breast, cervical, colorectal, lung and prostate cancer that were averted through the combination of prevention, screening and advances in treatment.

The researchers focused on these five cancers because they are among the most common causes of cancer deaths and strategies exist for their prevention, early detection and/or treatment. In recent years, these five cancers have accounted for almost half of all new cancer diagnoses and deaths.

“While many people may believe that advances in treatment are the main cause of the reduction in mortality from these five cancers combined, the surprise here is how much prevention and screening contribute to the reduction in mortality,” says co-lead investigator Katrina A.B. Goddard, Ph. D., director of the NCI Division of Cancer Control and Population Sciences.

“Eight out of 10 deaths from these five cancers averted over the past 45 years were due to advances in prevention and screening.”

A single preventive intervention, smoking cessation, contributed to the lion’s share of deaths avoided: 3.45 million from lung cancer alone. When each cancer site is considered separately, prevention and screening were responsible for the most deaths averted from cervical, colorectal, lung and prostate cancer, while advances in treatment were responsible for the most deaths averted from breast cancer.

“To reduce cancer mortality rates, it is critical that we combine effective prevention and screening strategies with advances in treatment,” said W. Kimryn Rathmell, MD, Ph.D., director of NCI .

“This study will help us understand which strategies have been most effective in reducing cancer deaths so we can continue to build on this momentum and hopefully increase the use of these strategies in 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 prevented from breast, cervical, colorectal, lung and prostate cancer between 1975 and 2020.

In total, the models showed that 5.94 million deaths from these five cancers were prevented between 1975 and 2020. Of these, prevention and screening interventions were responsible for 4.75 million, or 80%, of the deaths avoided.

The individual contributions of prevention, screening and treatment varied by cancer location:

• In breast cancer, 1 million deaths (out of the 2.71 million that would have occurred without all interventions) were prevented between 1975 and 2020, with advances in treatment contributing to three-quarters of the deaths and mammography screening contributing to the remainder.
• In lung cancer, prevention through tobacco control efforts accounted for 98% of the 3.45 million deaths avoided (out of 9.2 million), while advances in treatment accounted for the remainder.
• In the field of cervical cancer, the 160,000 preventable deaths (out of 370,000) were caused entirely by cervical cancer screening (that is, Pap and HPV, or human papillomavirus, testing) and removal of precancerous lesions.
• In colorectal cancer, 79% of the 940,000 deaths avoided (out of 3.45 million) were due to screening and removal of precancerous polyps, while advances in treatment accounted for the remaining 21%.
• In prostate cancer, of the 360,000 deaths avoided (out of 1.01 million), screening via PSA testing contributed 56% and progress in treatment 44%.

“These findings suggest that we need to continue to have strong strategies and approaches in all these areas,” noted Dr. Goddard on. “It’s not just advances in treatment, or just prevention and screening, that will help us reduce cancer mortality.”

The authors pointed out that more recent prevention and screening strategies, such as HPV vaccination and lung cancer screening, were not widely used during the study period and could further reduce cancer death rates. Other options for reducing cancer deaths include making screening more accessible, such as with HPV tests that allow self-examination, 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 do not necessarily apply to other cancers, especially those for which there is no effective treatment. prevention, screening or treatment exists. interventions.

“We must optimize the use and use of prevention and screening for these five cancers so that all Americans can benefit, especially underserved populations, and develop new prevention and screening strategies to reduce deaths from other, highly lethal forms of cancer. prevent cancers, such as those of the pancreas and ovaries,” said co-principal investigator Philip E. Castle, Ph.D., MPH, director of NCI’s Division of Cancer Prevention.

Additionally, the authors noted that the findings are based on population averages in the United States and may not be generalizable to specific populations. The study also did not take into account 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.