Decline in smoking has helped lower cancer deaths in the United States

According to annual statistics published by the American Cancer Society (ACS)[1], the cancer death rate in the United States has continued to decline. From 1991 to 2018, the cancer death rate fell by 31%. This includes a 2.4% decline from 2017 to 2018—the largest single-year decline in 70 years. These improvements are attributable to a decrease in the number of smokers, as well as advances in early detection and treatment of certain cancers.

Cancer mortality rates increased throughout most of the 20th century, largely due to a rapid increase in lung cancer deaths among men driven by the tobacco epidemic. Today, cancer remains the second leading cause of death in the United States. According to the ACS report, 1,898,160 new cancer cases and 608,570 cancer deaths are expected in 2021. These estimates do not include the potential effects of COVID-19, which disrupted access to cancer care and treatment, particularly during the early stages of the pandemic. This could result in an increase in cancer mortality rates.

The decline in smoking prevalence has contributed to the decline in lung cancer mortality

In 1965, 42% of Americans aged 18 and over smoked, compared to 21% in 2005 and 14% in 2019.[2]This decline in consumption has resulted in a decline in the incidence of lung cancer and in lung cancer mortality. Reductions in the lung cancer mortality rate account for nearly half of the total decline in the cancer mortality rate. Lung cancer incidence continues to decline twice as fast in men as in women, reflecting historical differences in tobacco use.

Despite this continued decline in tobacco use, smoking remains the leading cause of preventable death in the United States, costing more than $300 billion annually. Nearly a quarter of all cancer deaths are due to lung cancer, of which 82% are directly caused by smoking. For women, lung cancer is now the second most commonly diagnosed cancer after breast cancer and accounts for 13% of all cancers (12% for men).

Many disparities between population groups

Although some cancer disparities have narrowed, health inequities (unequal health care across populations) remain a major problem. African-American patients had lower survival rates than white patients for nearly all types of cancer. Overall, the five-year survival rate for white patients was 68% compared to 63% for African American patients from 2010 to 2016. In 2018, there was still an excess cancer mortality of 13% among African Americans, although this figure has declined by 60% since 1993. This improvement likely resulted from a sharp decline in smoking among African American adolescents during the 1980s and 1990s. Although the prevalence of smoking among African American males relative to white males has converged in recent years and is now similar, African American males who smoke have significantly higher incidence and mortality rates for tobacco-related cancers.

Cancer disparities also affect other populations. For Hispanics, Asian Americans, and Alaska Natives, cancer is the leading cause of death. These population groups are also characterized by a higher prevalence of smoking.