"The Heart of the Matter"

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Transcripts: 549.1 and 549.2

Week: 549.1 Guest: Brenda K. Edwards, Ph.D., National Cancer Institute Topic: First-ever overall cancer mortality rate decline measured- Part One of Two Producer/Host: Steve Girard

NEMA: Cancer, still one of the scariest words in our language, is not usually the subject of good news... We're with Brenda Edwards, a Ph.D. with the National Cancer Institute...part of the National Institutes of Health...to talk about the first ever drop in the cancer death rate...

EDWARDS: Typically, cancer mortality rates have been going up, but over the past five years, we're noting a sustained decline in the rate...and that has occurred for many parts of the population that we've been tracking. Compared to our calculations in the past, where we've seen, let's say, over a six percent increase in 20 years prior to the 1990's. We've actually been able to calculate a two to three percent decline overall in the last five years.

NEMA: How about a primer on what the term cancer mortality rate' means...

EDWARDS: We're talking about the number of individuals who died of cancer in 1995, and we divide it by the population in general. Now we actually do that for all age groups and for men and women, for blacks and whites...and so, it's really the number of people who died of cancer in a year by the population, where we've adjusted for the differences in age composition or distribution over time.

NEMA: What are the mortality rate differences in surveying African Americans and Caucasians?

EDWARDS: The mortality rates in African Americans are higher than for Caucasians. For men, they are about 40% higher...for women, 20% higher. But the good part about the recent data is that we're actually seeing a decline in both the African American population and the white population. We've seen a smaller decline in the white population...we've calculated about 1.7%, where we're seeing in the African American population a decline, over the past five years, of almost 6%. So, that is an encouraging piece of news.

NEMA: What's the biggest reason for the drop in the overall cancer mortality rate?

EDWARDS: The drop in cancer mortality rates for men is really driven in large part by lung cancer, but it's also affected by the second leading cause of cancer death - colorectal, as well as prostate cancer, which is one of the major three sites of cancer in men. So, in all of those sites, we've seen a decline. For women, the decline in mortality is really due to breast cancer and colorectal cancer. Unfortunately, for women, both African American and white women, lung cancer rates are continuing to increase...and may do so in the near term, because they adopted the use of tobacco products and smoking in particular, at a later phase in time...and that risk is still moving through the population. We've seen a large increase in the older women, for both African American women and Caucasians.

NEMA: What were the unexpected improvements?

EDWARDS: Actually, prostate cancer was a surprise to us because, certainly since the 1970's, in death due to prostate cancer, it's been a slow, increase. However, in the last five years...or the data from the last five years show that we, actually, have an observed reduction for both African American men and white men - we saw about a 6% decline. A small decrease we might have expected, but we're not entirely sure as to why we're seeing the size of the decrease at this time.

NEMA: Dr. Brenda Edwards of the National Cancer Institute...we'll talk again about the reasons behind these drops in our next program. I'm Steve Girard.


Week: 549.2 Guest: Brenda K. Edwards, Ph.D., National Cancer Institute Topic: The reasons behind the decline in cancer mortality - Part Two of Two Producer/Host: Steve Girard

NEMA: Recent news about the nation's cancer death rate is good. Death from cancer in the overall population is down - nearly 3 percent over the past 5 years...led by a drop in lung, colorectal and prostate cancer deaths in men, and breast, colorectal and gynecological cancer deaths in women. We're with Brenda Edwards, a Ph.D. with the National Cancer Institute...you've explained to me that this decline just didn't happen overnight...it is actually the result of medical advice, government policy, and raising public awareness about the causes and treatments of cancer over the last 30 years....

EDWARDS: Well, absolutely. The current rates that we're seeing are really a reflection of accumulation of effects, both the negative ones, those that may have increased one's risk, and exposure to cancer...but more importantly for us, in cancer control...those things that we've done to try to improve the outlook for the cancer patients and our population in general. In the 60's, there's been a fair amount of awareness and knowledge about the role of tobacco smoking in particular on a number of cancers, especially lung cancer. We, the National Cancer Institute and other agencies have had a vigorous research effort as well as public health applications program to make this information known, and to develop interventions that would enable individuals to quit smoking and to try to prevent children, in particular, from adopting it. But we've also been interested in issues of early detection...that is, finding cancer early when it's most treatable. As well as a whole range of medical interventions that relate to not only the early detection but the medical management and treatment, including dealing with surviving with cancer. So there's been great strides in cancer treatment , education, awareness, changes in diet and diet factors, changes in lifestyle... whether it be smoking or diet, physical activity, or how we may utilize medical information in the medical care system to help us find cancer early, when it is diagnosed, to actually have access to treatment that has the potential of improving our survival or possibly long term cure. We have more individuals that are in the medical profession that have expertise that can treat cancer these days....as well as the auxiliary staff that can help individuals live with cancer during the treatment period, and when they are cancer free.

NEMA: Now, we've been hearing mainly bad news about the increased incidence of cancers for quite a long time....and this is great news. But it should act as impetus toward increasing our efforts now that we know that they work...

EDWARDS: Right...now's no time for any complacency because any projection that we might make is going to say that cancer will still be one of the dominant diseases of our population. But, for those of us, and many around the country who have been working in laboratories and public health, in research and in the actual delivery of care...the current news is really, I think, an affirmation that the results of all those efforts can actually make a difference in the national mortality rates.

NEMA: Brenda Edwards of the National Cancer Institute. We also talked about how part of beating cancer involves recognizing it, accepting it, so that society's attitudes about cancer change, and perhaps help spur the falling mortality rates. I'm Steve Girard.

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