NCI's Annual Report to Nation:
Overall Cancer Death Rates Continue to Decline
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Between 2001 and 2018, declines in lung cancer death rates accelerated, and death rates for melanoma declined considerably in more recent years, reflecting a substantial increase in survival for metastatic melanoma.
The annual report is a collaborative effort among the American Cancer Society; the Centers for Disease Control and Prevention; the National Cancer Institute, part of the National Institutes of Health; and the North American Association of Central Cancer Registries.
The report shows a decrease in death rates for 11 of the 19 most common cancers among men and for 14 of the 20 most common cancers among women over the most recent period (2014-2018).
Although declining trends in death rates accelerated for lung cancer and melanoma over this period, previous declining trends for colorectal and female breast cancer death rates slowed and those for prostate cancer leveled off.
And death rates increased for a few cancers, like
- brain and other nervous system cancers and pancreas, in both sexes
- oral cavity and pharynx in males
- and liver and uterus in females
The report, appearing in JNCI: The Journal of the National Cancer Institute, also finds that overall cancer incidence rates continue to increase among females, children, and adolescents and young adults. All trends in this report cover the period before the COVID-19 pandemic.
Other key findings include:
- Overall cancer incidence rates were higher among men than women in every racial and ethnic group, except in the Asian/Pacific Islander population, where the rates were similar.
- Overall cancer incidence rates were slightly lower among African Americans than Caucasians.
- In contrast, overall cancer death rates were higher among African Americans than Caucasians.
- Incidence rates of liver cancer were previously increasing, but data show rates have stabilized among both men and women.
- Two-year relative survival for advanced-stage melanoma cases diagnosed during 2001-2009 was stable, but it increased 3.1% per year for those diagnosed during 2009-2014.
- Two-year relative survival only slightly increased for early- and intermediate-stage melanoma cases diagnosed during 2001-2014 (0.03% and 0.4% per year, respectively).
The authors indicate these findings can help inform health care providers about the need to increase efforts related to cancer prevention, early detection, and treatment, as well as the need for equitable implementation of effective interventions, especially among under-resourced populations.
"Cancer is an extremely complex, individualized disease," said Prescott Deininger, PhD, Tulane Cancer Center Director. "All of these improvements are the result of decades of research into risk factors, early detection, and treatment."
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Liquid Biopsy Analysis Reveals Genetic Differences
in Advanced Prostate Tumors
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"African American men with prostate cancer have been diagnosed with more aggressive disease, at younger ages, and generally their prognosis is poorer than for non-Black patients," said Pedro Barata, MD, assistant professor medicine. "But, when we start looking at how these patients respond to treatments, the emerging data suggest quite the opposite – that African American men respond similarly if not better than non-Black patients to different systemic therapies."
Barata and colleagues hypothesized that the reasons for this may be found in the underlying genetics of the tumors themselves. And so, they undertook a retrospective study – the largest reported to date, according to Barata – to find racial differences in the molecular characterization of advanced prostate tumors using liquid biopsies.
A liquid biopsy is a blood test that looks for tumor DNA circulating in the blood stream of cancer patients. "It's basically cancer in circulation," said Barata. This study analyzed the genomic profiles of circulating or cell-free DNA from advanced prostate cancer tumors and compared the data by race. "More specifically, we were looking for signatures or gene expressions in the samples from African American patients that could have therapeutic implications," said Barata.
Knowing about the presence of genomic alterations may allow patients to be treated in a way that wouldn't be possible if you didn't know you had a target present. "It opens the door to precision oncology, allowing us to more precisely tailor our treatments to the biology of our patients."
The study retrospectively analyzed the genomic profiling data from the liquid biopsies of 552 advanced prostate cancer patients (125 African American, 427 Caucasian) from six participating institutions – University of Utah School of Medicine, Emory University School of Medicine, Karmanos Cancer Institute, the University of Alabama at Birmingham, the Medical University of South Carolina, and Tulane Cancer Center – the top users of liquid biopsies for genitourinary tumors in the country.
"The data show multiple genomic differences – including in DNA repair genes – in the tumor profiles between African American and Caucasian patients with advanced prostate cancer," said Barata. Of particular interest was the CDK12 mutation, found more prominently in a subset of African American patients. This gene alteration has therapeutic implications. "Meaning we should treat these patients differently," said Barata. "Identification of molecular drivers of tumor progression in African American patients may allow the development of tailored systemic therapies for these men and decrease disparities in disease-related outcomes."
And that's the true value of these types of studies, according to Barata. "The vast majority of clinical trials for prostate cancer enroll mainly white men. And so generating data in the African American population is extremely important. The data suggest they have different cancers and respond differently to treatment. We have to build upon this if we want to improve outcomes for our minority patients. Ultimately, that's what this is all about," he said.
Dr. Barata was first-author on the poster presenting the results of this study at the recent American Society of Clinical Oncology meeting. He and his colleagues expect to also publish these results in a scientific journal later this year.
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USPSTF Lowers Recommended Age
to Begin Colon Cancer Screenings
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The U.S. Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine, recently lowered their recommended age to begin regular colorectal cancer screening in average-risk adults from 50 to 45.
The recommendation follows a growing body of research indicating a rising incidence of colorectal cancer in younger adults. A recent Annals of Internal Medicine publication – Contributions of Adenocarcinoma and Carcinoid Tumors to Early-Onset Colorectal Cancer Incidence Rates in the United States – was directly cited by the USPSTF as a key finding in the decision to lower the screening age threshold. Eric Montminy, MD, a Tulane Gastroenterology Fellow, is first author on this paper, and Jordan Karlitz, MD, who was associate clinical professor of medicine at Tulane when the research was performed, is senior corresponding author. (Dr. Karlitz is currently chief of GI at Denver Health Medical Center and a faculty member at the University of Colorado School of Medicine.)
The USPSTF now recommends regular colon cancer screenings for average-risk individuals aged 45 to 75 to reduce their risk of dying from this disease. It is recommended that the decision to screen individuals aged 76 to 85 years be individualized based on screening history and overall health status. Colorectal cancer screening is not recommended after age 85.
These final recommendations apply to adults without symptoms and who do not have a personal history of colorectal polyps or a personal or family history of genetic disorders that increase the risk of colorectal cancer.
This updated guidance is also corroborated by a study led by Dr. Karlitz that was published in JAMA Network Open early last year.
“Our findings suggested a high case burden of pre-clinical, undetected early onset colorectal cancers in patients younger than 50 that was not reflected in observed incidence rates,” said Karlitz. His team also found that almost 93% of the cases discovered at age 50 were invasive, meaning that most would require more aggressive treatment including surgery and were likely lingering for some time before diagnosis.
The study added fuel to the debate at the time about whether screenings should begin at age 45. “Our data supported that the incidence of colorectal cancer increases substantially among individuals in their early 50s compared with individuals in their late 40s, not because rates are truly lower among those aged 45 to 49 years, but because colorectal cancers were present but undetected until diagnosed when screening was ultimately initiated,” he said.
Colorectal cancer is the third leading cause of cancer deaths in the United States. Despite strong evidence that screening for colorectal cancer is effective, about a quarter of people aged 50 to 75 have never been screened.
"Our research team is very supportive of the decision of the USPSTF to lower the average-risk screening threshold to age 45," said Karlitz. "However, now that this recommendation has been formalized, we need to make sure that screening rates are maximized. Unfortunately, younger patients (i.e., those in their 50s) have historically had much lower colorectal cancer screening rates than older patients and we want to insure that is no longer the case going forward."
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Chancellor Donald, MD,
Honored as a "Health Care Hero"
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Started in 2007, Health Care Heroes honors New Orleans-area health care professionals – first responders, nurses, physicians, professionals and volunteers – for their industry achievement and community involvement.
Dr. Donald attended Florida A&M University for undergraduate studies – where he graduated Magna Cum Laude – and the University of Miami School of Medicine for his medical degree. He completed his internship, residency and fellowship at Tulane University and was selected as Chief Resident and Chief Fellow during his training.
Dr. Donald is the chief medical officer of Taking Aim at Cancer in Louisiana, an initiative formed by the Louisiana Department of Health to improve cancer outcomes for citizens of the state. He also serves as the chair of the Committee on Practice for the American Society of Hematology. He is the immediate past president of the Louisiana Oncology Society and previously served on the Board of Directors of the Community Oncology Alliance. He also holds the position of the American Society of Hematology’s delegate to the American Medical Association’s House of Delegates and serves on the AMA CPT Editorial Panel Advisory Committee. Additionally, he has served as Louisiana’s representative on the Association of Clinical Oncology’s State Affiliate Council. Dr. Donald also serves on the Tulane Medical Alumni Board, as well as the University of Miami Medical Alumni Board of Directors.
Since 2012, Dr. Donald has served as the hematology representative for Louisiana for the Medicare Carrier Advisory Committee (CAC), and he functioned as co-chair of the 2017 and 2018 annual CAC meetings in Washington, D.C. He was appointed to the American Board of Internal Medicine Hematology Examination Committee in 2018. Dr. Donald participated in the plenary session of the 2020 American Society of Hematology annual meeting, and the Association of Clinical Oncology recognized him as a 2020 Advocacy Champion.
Dr. Donald has current board certifications in internal medicine, hematology and medical oncology. His academic focus is advocacy and health disparities regarding patients with hematologic disorders and malignancy and caring for adults with sickle cell disease. He remains committed to extending himself beyond his practice to advocate for patients and the appropriate delivery of care.
"I am honored to receive this recognition," said Donald. "The past and current recipients of this distinction represent individuals with an unwavering commitment to service. I am extremely pleased to be included in such company. I remain grateful for the opportunity and ability to contribute to our community. It is always my intention to demonstrate excellence, integrity and authenticity in the spaces I occupy."
In all, eight Tulane School of Medicine physicians and professionals and one Tulane Health System nurse were selected as part of the 2021 “Health Care Heroes” class. To review the full list, please click here.
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The 10th Annual Baton Rouge Blue Ribbon Soirée is a cocktail party-style prostate cancer research fundraiser, featuring a tasty array of bites and beverages from nearly 20 vendors. It also includes silent and live auctions, a raffle and a cork pull. Guests are encouraged to dress in blue, the color of prostate cancer awareness.
This event - which is held in loving memory of Larry Ferachi and Joel Nasca - has raised in excess of $860,000 since its inception. Just as importantly to its organizers, it has raised awareness of the importance of early detection of prostate cancer.
Dr. Oliver Sartor, head of Tulane Cancer Center's Prostate Cancer Research Program, is primary beneficiary of funds raised through the event. Dr. Oliver Sartor is a world-renowned prostate cancer expert and one of the few medical oncologists in the world to focus on prostate cancer. Combining basic, translational and clinical prostate cancer research and ensuring state-of-the-art clinical treatment have been the major areas of focus throughout this career.
For more information on sponsoring the 10th Annual Baton Rouge Blue Ribbon Soiree or to purchase tickets, please visit www.blueribbonsoiree.org.
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“The funds raised through this event are vitally important to my team’s progress as we continue to explore a deeper understanding of prostate cancer. Through research, our collective understanding of this disease is better defined, and that means progress can follow for patients through the development of novel therapies. There is still much more to learn before we can rid families of the burden of prostate cancer. Our research will continue, and our hope is that patients will have better care. Without your support we could not accomplish nearly as much. My deepest thanks.” --Oliver Sartor, MD
(Photo caption: Pictured above with Dr. Oliver Sartor (second from right) are Blue Ribbon Soiree Planning Committee Members (from left) Kathy Lato, Ricky Lato and Janey Nasca.)
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or visit
To make a tax-deductible donation to Tulane Cancer Center
(Federal Tax ID# 72-0423889) please click here.
Thank you for your generosity and support!
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