Cancer may become the leading cause of death by 2020

The Centers for Disease Control (CDC) looked at data for the five leading causes of death (heart disease, cancer, stroke, chronic lower respiratory diseases, and accidents) which together account for 63 percent of all deaths in the United States,. 

They used mortality data, population estimates and projections to estimate and predict heart disease and cancer deaths from 1969 through 2020.

The report indicates that fewer people died prematurely from cancer, stroke and heart disease between 2010 and 2014.

They predicted that from 1969 through 2020, the number of heart disease deaths would decrease 21.3% among men and 13.4% among women while the number of cancer deaths would increase 91.1% among men and 101.1% among women. They suggest that cancer would become the leading cause of death around 2016.

In 2014, more than 614,000 Americans died of heart disease and approximately 592,000 died of cancer that year.  However, in 2016, almost 601,000 Americans may die as a result of cancer, while more than 597,000 may die from heart disease.  Thus cancer could surpass heart disease as the leading cause of death among Americans this year, according to the report.

The authors conclude that the risk of death declined more steeply for heart disease than cancer over the past 4 decades. If current trends continue, cancer will become the leading cause of death by 2020.

Insufficient sleep common among US adults

The Centers for Disease Control and Prevention (CDC) released a report revealing that about one-third of adults in the US appear to be getting insufficient sleep. 

After surveying 444,306 US adults in 2014, CDC found that while two-thirds of white people nationally got enough sleep, only about half of blacks, Native Hawaiians and Pacific Islanders did. 

Among the respondents, 11.8% reported a sleep duration of 5 hours or less, 23.0% reported 6 hours, 29.5% reported 7 hours, 27.7% reported 8 hours, 4.4% reported 9 hours, and 3.6% reported 10 hours or more.

Overall, 65.2% reported the recommended healthy sleep duration of 7 hours.  The age-specific prevalence of sleeping ≥7 hours was highest among respondents aged ≥65 years (73.7%).  The prevalence of healthy sleep duration was highest among respondents with a college degree or higher (71.5%). The prevalence was higher among married respondents (67.4%) compared with those who were divorced, widowed, or separated (55.7%), or never married (62.3%).

Healthy sleep duration ranged from 71.6% in South Dakota, which has the largest proportion of residents who get at least seven hours of sleep each night, to 56.1% of Hawaii that has the lowest proportion. A lower prevalence of healthy sleep duration was observed in the southeastern United States and in states along the Appalachian Mountains.

       

CDC’s report states that sleeping less than seven hours per night is associated with increased risk for obesity, diabetes, high blood pressure, coronary heart disease, stroke, frequent mental distress, and all-cause mortality.

As more than one third of U.S. respondents, or approximately 84 million U.S adults reported sleeping less than 7 hours in a 24-hour period.  The need for public awareness and public education about sleep health is urgently needed.  In addition worksite shift policies that ensure healthy sleep duration for shift workers, particularly medical professionals, emergency response personnel, and transportation industry personnel should be implemented.

Two out of three Americans with invasive cancer are living more than five years

Α report by Henley et al from the Centers for Disease Control and Prevention published in Morbidity and Mortality Weekly Report indicates that “two out of three Americans with invasive cancer are living five years or more after diagnosis.”

     

Because of improvements in early detection and treatment of cancer, the proportion of persons with cancer who survive more than 5 years after diagnosis has increased. The authors analyzed data from U.S. Cancer Statistics (USCS) for 2011. 

In 2011, a total of 1,532,066 invasive cancers were diagnosed and reported to central cancer registries in the United, including 786,102 among males and 745,964 among females. The age-adjusted annual incidence for all cancers was 451 per 100,000 population: 508 per 100,000 in males and 410 per 100,000 in females. Among persons aged <20 years, 14,754 cancer cases were diagnosed in 2011. By age group, rates per 100,000 population in 2011 were 18 among persons aged <20 years, 154 among those aged 20–49 years, 816 among those aged 50–64 years, 1,840 among those aged 65–74 years, and 2,223 among those aged ≥75 years.

By cancer site, rates were highest for cancers of the prostate (128 per 100,000 men), female breast (122 per 100,000 women), lung and bronchus (61 per 100,000 persons), and colon and rectum (40 per 100,000 persons). These four sites accounted for half of cancers diagnosed in 2011, including 209,292 prostate cancers, 220,097 female breast cancers, 207,339 lung and bronchus cancers, and 135,260 colon and rectum cancers. In 2011, the cervical cancer incidence rate was 7.5 per 100,000 women, representing 12,109 reported cancers.

By state in 2011, all-sites cancer incidence rates ranged from 374 to 509 per 100,000 persons. State site-specific cancer incidence rates ranged from 79 to 195 per 100,000 men for prostate cancer, 106 to 153 per 100,000 women for female breast cancer, 29 to 93 per 100,000 persons for lung cancer, 33 to 49 per 100,000 persons for colorectal cancer, and 4.5 to 13.7 per 100,000 women for cervical cancer. Healthy People 2020 targets were reached in 37 states for incidence of colorectal cancer and in 28 states for incidence of cervical cancer. Compared with the states and DC, cancer incidence rates in Puerto Rico in 2011 were lower for all-sites cancer (339 per 100,000 persons), lung cancer (17 per 100,000 persons), and breast cancer (93 per 100,000 women), but higher for prostate cancer (150 per 100,000 men), colorectal cancer (43 per 100,000 persons), and cervical cancer (13.5 per 100,000 women).

Among persons with cancer diagnosed during 2003–2010, the 5-year relative survival rate was 65%. This percentage was similar for males and females. The 5-year relative survival was highest among those diagnosed with cancer before age 45 years (81%) and decreased with increasing age. Among the most common cancer sites, 5-year relative survival was highest for prostate cancer (97%) and breast cancer (88%), intermediate for colorectal cancer (63%), and lowest for lung cancer (18%). The 5-year relative survival after any cancer diagnosis was lower for black persons (60%) than for white persons (65%) and for each cancer site.

Measles Epidemic

The United States is experiencing a multistate outbreak of measles. The Centers for Disease Control and Prevention (CDC) reports that from Jan 1 to Feb 13, 2015 the number of measles cases was 141 and the disease had spread to 17 states and the District of Columbia.   The CDC reported that as of Feb 24 the number of US measles cases had increased to 154 and the cases were linked to “three separate outbreaks” – Disneyland, and unrelated outbreaks in Illinois and Nevada.

The multistate outbreak is believed to have started when a traveler who was infected with measles overseas visited Disneyland, though the specific source isn’t known, according to the CDC. An analysis of the virus causing this outbreak shows it is identical to a virus type that caused a large outbreak in the Philippines last year. But the virus type appears to be common: it has also been identified in 14 other countries and at least six U.S. states with cases that aren’t linked to the Disneyland outbreak.

Also, seven countries in Europe and Central Asia (Kyrgyzstan, Bosnia, Russia, Georgia, Italy, Germany, Kazakhstan) have reported 22 567 cases of measles in 2014 and thus far in 2015.  According to the World Health Organization (WHO), the outbreaks are due to a growing number of parents who either refuse to vaccinate their children or are facing barriers in getting the immunizations they need. 

Before the era of widespread vaccination measles was a disease that affected the overwhelming majority of children.  The symptoms of measles generally appear about 7 to 14 days after a person is infected and typically begin with

•   high fever

•   cough

•   runny nose and

•   red, watery eyes

Two or three days after symptoms begin, tiny white spots may appear inside the mouth and a skin rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may join together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.  After a few days, the fever subsides and the rash fades.

The Persian physician and philosopher Rhazes (860-932) in the 10th century A.D. wrote and described measles as a disease that is “more dreaded than smallpox”.  In 1757, Francis Home a Scottish physician, found that measles is an infectious disease.

In the decade before 1963 when a vaccine became available, nearly all children got measles (Rubeola) by the time they were 15 years of age. It is estimated 3 to 4 million patients in the United States were infected each year and approximately 400 to 500 patients died and 4,000 suffered encephalitis from measles.

In 1954, John F. Enders and Dr. Thomas C. Peebles collected blood samples from several ill students during a measles outbreak in Boston, Massachusetts in an effort to isolate the virus and make measles’ vaccine. They succeeded in isolating the virus in the blood of a 13-year-old boy.  In 1963, John Enders and colleagues transformed their Edmonston-B strain of measles virus into a vaccine. Measles vaccine today is usually combined with mumps, rubella and varicella and given in one or two doses.

According to CDC most of those infected this year were not vaccinated. Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, said, “it is not a problem with the measles vaccine not working. ...It is a problem of the measles vaccine not being used”.

As measles is a viral disease no specific medication is available for its treatment.  However some measures such as acetaminophen for high fever, a humidifier for relief of cough and vitamin A do provide symptomatic relief.

In non-immunized patients, measles vaccination within 72 hours of exposure to the virus may provide protection against the disease.

Pregnant women, infants and patients with weakened immune systems who are exposed to the virus may receive an injection of antibodies called immune serum globulin. When given within six days of exposure, these antibodies can prevent measles or make symptoms less severe.

Vaccination still remains the best way to prevent measles.  One dose of the Measles, Mumps and Rubela vaccine (MMR) is 93% effective while two doses are 97% effective in preventing the disease.  On Feb 21 two California senators introduced legislation that “would permit only medical exemptions as legitimate reasons to sidestep vaccinations,” The WHO has issued a warning and demands that counties control the outbreaks with "no exception" as the epidemic threatens the goal of eliminating measles in the region by the end of 2015.

Cigarette smoking remains a leading cause of Death

January 11, 2014 marked the 50^th anniversary of the first Surgeon General’s Report on Smoking and Health. This year the office of Surgeon General has presented half a century's worth of progress in tobacco prevention and control on their website to commemorate the 1964 landmark report, by Dr. Luther Terry^1. That report was the first federal government document to link smoking with poor health such as lung cancer and heart disease.

The reputation that smoking held during the first half of the 20th century was very different to how it is viewed today. Smoking became popular in America during 1930s. During this time, smoking was regarded as sophisticated and glamorous. Due to its newfound popularity, research on smoking during this era often failed to find clear evidence of serious pathology.

In 1947, Richard Doll and A. Bradford Hill of the British Medical Research Council created a statistical technique to evaluate the dangers of smoking. In 1950 they published an article in the BMJ²   documenting the association between rising rates of lung cancer and increasing numbers of smokers.

In 1950, Wynder EL, a medical student, and Graham EA, published a landmark article in JAMA³ comparing the incidence of lung cancer in their nonsmoking and smoking patients at Barnes Hospital in St. Louis. They concluded “cigarette smoking, over a long period, is at least one important factor in the striking increase in bronchogenic cancer.”

Tobacco use remains the single largest preventable cause of death and disease in the United States according to the Centers forDisease Control and Prevention (CDC). Cigarette smoking kills more than 480,000 Americans each year, with more than 41,000 of these deaths due to exposure to secondhand smoke. In addition, smoking-related illness in the United States costs more than $289 billion a year, including at least $133 billion in direct medical care for adults and $156 billion in lost productivity.

The CDC states that smoking harms nearly every organ of the body. In fact, smoking is the cause for one in five deaths in the United States. Smoking can cause cancer in almost every organ (bladder, blood-acute myeloid leukemia, cervix, colon and rectum, esophagus, kidney and ureter, larynx, liver, oropharynx-includes parts of the throat, tongue, soft palate, and the tonsils, pancreas, stomach, trachea, bronchus, and lung).

•    Smoking causes about 90% of all lung cancer deaths in men and women and 80% of chronic obstructive pulmonary disease (COPD).

•    Smoking is estimated to increase the risk for coronary heart disease and stroke by 2 to 4 times and for lung cancer by 25 times.

Two recent studies present risks from smoking and its prevalence in the different countries across the globe.

Jacobs et al research that was published in the Annals ofEpidemiology analyzed data on smoking rates from the National Health Interview Survey, as well as data on the risks of smoking from epidemiologic studies, to estimate the proportion of U.S. cancer deaths caused by smoking— what the researchers called the population attributable fraction (PAF).

The researchers looked at deaths from the 12 cancers formally linked to smoking by the U.S. surgeon general and they observed that the PAF was 28.7 percent. However, after factoring in cancer deaths than may have been caused by smoking, the PAF was 31.7 percent. These estimates don’t factor in other potential cancer deaths caused by secondhand smoke or other kinds of smoking such as cigars, pipes or smokeless tobacco.

While there has been a decline in smoking prevalence, the current and previous PAF estimates may remain similar due to the addition of new cancers that may be caused by smoking, higher rates of lung cancer deaths among female smokers, and a greater focus on reducing deaths from cancer caused by factors other than smoking.

However, the authors noted that efforts to reduce smoking haven’t been futile. According to the CDC, more than 40 percent of Americans smoked in the 1960s, but today, only 18 percent of Americans smoke.

The group by Ng et al reported In JAMA the prevalence and cigarette consumption in 187 Countries between the years 1980-2012. 

The researchers identified nationally representative sources that measured tobacco use (n = 2102 country-years of data) and synthesized age-sex-country-year observations (n = 38 315) using spatial-temporal Gaussian process regression to model prevalence estimates by age, sex, country, and year.

Globally modeled age-standardized prevalence of daily tobacco smoking in the population older than 15 years decreased from 41% in 1980 to 31% in 2012 for men and from 10% to 6% for women. Despite the decline in prevalence, the number of daily smokers increased from 721 million in 1980 to 967 million in 2012.  The populous China is home to more than 300 million smokers and 43% of the world’s cigarette production. The World Health Organization estimates that smoking kills more than one million of the Chinese population each year and the cost from death and complications related to smoking would have cost China $500 billion in the decade ending in 2015.  Modeled prevalence rates exhibited substantial variation across age, sex, and countries, with rates below 5% for women in some African countries to 57% for men in Indonesia.  The following are some examples of prevalence of smoking in males, females and both sexes in few countries with Greece having the most overall smokers and the United States the fewer while Indonesia has the most male smokers and the fewer female smokers.

Countries   Males         Females     Both sexes

Greece        41%             35%             38%

Indonesia    57%               4%             37%

US               17%             14%             16%

The authors concluded that since 1980, large reductions in the estimated prevalence of daily smoking were observed in both men and women, but because of population growth, the number of smokers increased significantly.

Given the importance of tobacco as a risk to health, monitoring the distribution and intensity of tobacco use is critical for identifying priority areas for action and for evaluating progress.  Recent studies in multi-country survey programs have substantially expanded the primary data available for monitoring. The most recent cross-sectional estimates of smoking prevalence were for 2011 and the publication of The Tobacco Atlas has greatly facilitated the development of policies based on these data.

Since the release of the Surgeon General report on the adverse effects of smoking, a wide range of interventions became available, including increasing prices and bans on advertising, promotion, sales to minors, and smoking in public places. The adoption of the Framework Convention on Tobacco Control (FCTC) in 2003 and its subsequent ratification by 177 countries reflects growing global efforts to control tobacco. Despite such efforts, tobacco continues to adversely influence global health patterns, leading to 5.7 million deaths, 6.9% of years of life lost, and 5.5% of disability-adjusted life-years (DALYs) in 2010 requiring that efforts towards further decrease and/or elimination of smoking across the planet should continue. 

References

1.  Terry, Luther et al. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States. U-23 Department of Health, Education, and Welfare. Public Health Service Publication No. 1103. 1964 May

http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBCXB

 2.  Wynder EL, Graham EA.  Tobacco smoking as a possible etiologic factor in bronchogenic carcinoma: a study of 684 proven cases.  Journal of American Medical Association.  1950; 143: 329-36

3.  Doll R, Hill AB.  Smoking and carcinoma of the lung: preliminary report.  British Medical Journal 1950:2 739-48