Action Needed to Hit ‘Moonshot’ Goal of Halving Cancer Deaths by Mid-Century

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The United States will fall short of its Cancer Moonshot goal of cutting cancer deaths by at least half over the next 25 years unless more action is taken, a new U.S. National Cancer Institute analysis concludes.

Cancer deaths recently have been declining by an average 2.3% a year, which is an accelerated rate compared to the 1.4% per year reduction observed from 2000 to 2015, said lead researcher Meredith Shiels, a senior investigator with the NCI’s Division of Cancer Epidemiology and Genetics.

But that trajectory will cut the cancer death rate by only 44% by 2047, Shiels and her colleagues estimated.

“This would be a tremendous amount of progress over this time period, but it would fall short of the 50% decline goal as outlined in the Cancer Moonshot,” Shiels said during a Monday media briefing at the American Association for Cancer Research’s annual meeting, in Orlando, Fla.

The cancer death rate instead needs to decline by a more rapid 2.7% per year to reach the Moonshot goal of a 50% reduction by 2047, according to the analysis published April 17 in the AACR journal Cancer Discovery.

To achieve that higher rate, disparities in cancer prevention, early detection and treatment must be available to all Americans, the NCI researchers said.

For example, Black men and women have the highest cancer death rates in the United States of any racial or ethnic group, the researchers noted.

Cancer death rates also are significantly higher in America’s lowest-income counties compared to the wealthiest — 56% higher for young and middle-aged adults and 14% higher for seniors, the researchers found.

“Disparities are such a key issue in everything we think about at NCI right now, from the basic biology of tumors all the way to how we deliver health care,” National Cancer Institute Director Dr. Monica Bertagnolli said during the media briefing.

The analysis also called for specific advances in prevention or treatment of the six leading causes of U.S. cancer deaths.

Cancers of the lung, colon, pancreas, breast, prostate and liver together “caused 57% of the 600,000 cancer deaths that occurred in the year 2019,” Shiels said. “Progress against these types is required to meet the Cancer Moonshot goal.”

Three of the cancers already are in substantial decline, the analysis found: lung (-4.7% per year), colon (-2%) and breast (-1.2%)

But greater reduction in these cancers could occur, the researchers said, by:

• Reducing smoking, obesity, sedentary behavior and alcohol consumption
• Improving the use of effective screening tools (low-dose CT scans, colonoscopy and mammography)
• Increasing the use of hormone therapy to prevent and treat breast cancer.

Progress against the other three top cancers has been less than ideal, the report found.

Death rates from prostate cancer had been dropping an average 3.4% a year between 2003 and 2013, but the decline has slowed to 0.6% a year between 2013 and 2019, researchers said.

Death rates from liver cancer recently have begun to decline a modest 0.5% per year, while pancreatic cancer deaths have been increasing by 0.2% a year, the analysis says.

To better address these cancers, the analysis called for:

• Development of new drugs targeting KRAS, a gene whose mutations are implicated in 90% of pancreatic cancers
• Increased detection and treatment of hepatitis B and C infections, to reduce the risk of liver cancers
• Better risk-driven PSA screening and improved diagnostic testing for prostate cancer, as well as new strategies to reduce over-treatment and eliminate disparities.

Death rates from all other cancer types combined have declined by 1.7% annually in recent years, the report noted.

A healthy lifestyle can prevent many different types of cancers, and should be promoted as part of this effort, Bertagnolli noted.

“It’s very clear that so many things that lead to an overall healthy, good life also help prevent cancer,” Bertagnolli said, pointing out the importance of avoiding cancer risk through everyday things such as exercise, diet and sunscreen use.

Cancer doctors and experts also must remain vigilant regarding new and emerging risk factors, said Dr. Elizabeth Jaffee, chair of the President’s Cancer Panel and deputy director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine.

“Obesity is an epidemic in young people, in teenagers and young adults, and we know this is going to have consequences,” Jaffee said during the briefing. “We really need to understand how it will have consequences and how to intercept before they do get the cancers that are associated with obesity.”

Bertagnolli added that improvements need to be made in the way health data is collected in the United States, to give researchers and public health officials the crucial information they need.

“One of the goals of the National Cancer Plan is about data — data-sharing, data use,” Bertagnolli said. “We live in a time, especially with health care, where information is critical to us understanding how we’re doing and what to do next.

“This wonderful analysis that was done by the team with the best current data available used data that ended in 2019,” Bertagnolli noted. “We’re in 2023, yet the best data we have about cancer survival and how we’re doing with progress toward that endpoint is at 2019 levels.

“Boy, we have to fix that,” she concluded.

The Cancer Moonshot initiative first launched in 2016 under President Barack Obama.

Last year, President Joe Biden and First Lady Jill Biden reignited the initiative, with the goal of reducing the age-adjusted cancer death rate by at least 50% over the next quarter-century and improving the experience of cancer patients and their families.

More information

The U.S. National Cancer Institute has more about the Cancer Moonshot.

SOURCES: Meredith Shiels, PhD, senior investigator, U.S. National Cancer Institute’s Division of Cancer Epidemiology; Monica Bertagnolli, MD, director, National Cancer Institute; Elizabeth Jaffee, MD, chair, President’s Cancer Panel, and deputy director, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore; Cancer Discovery, April 17, 2023, online

Source: HealthDay

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