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An estimated 5.94 million deaths from breast, cervical, colorectal, lung, and prostate cancers were averted from 1975 to 2020 due to a combination of prevention, screening (for interception and early detection), and treatment advances, according to a model-based study.

Cancer prevention and screening efforts averted 4.75 million of these deaths (80%), reported Katrina Goddard, PhD, of the National Cancer Institute, and colleagues in .

The researchers noted that the contribution of each intervention varied by cancer site:

• For breast cancer, 1.03 million deaths (out of 2.71 million that would have occurred in the absence of all interventions) were averted during the study period, with treatment advances contributing to 770,000 of those averted deaths, and mammography screening contributing to the rest.
• For lung cancer, tobacco control efforts accounted for 3.39 million (98%) of the estimated 3.45 million deaths averted (out of 9.2 million), with treatment advances accounting for the rest.
• An estimated 160,000 cervical cancer deaths (out of 370,000) were averted through screening efforts, such as Pap and human papillomavirus (HPV) testing, as well as removal of precancerous lesions.
• For colorectal cancer, 740,000 (79%) of the estimated 940,000 deaths averted (out of 3.45 million) were due to screening and removal of precancerous polyps. Treatment advances accounted for the rest.
• For prostate cancer, screening via prostate-specific antigen testing contributed to 200,000 (56%) of 360,000 deaths averted (out of 1.01 million), with the rest due to treatment advances.

"A multi-prong approach is needed to reduce the burden of cancer in the United States," said co-author Philip E. Castle, PhD, MPH, also of the National Cancer Institute, during a press briefing. "And while cancer treatment keeps those with cancer from dying, cancer prevention and control keeps people from ever getting cancer, keeps healthy people healthy, and the quality of life of those who never get cancer is much greater than those who have to undergo cancer treatment."

"There is more work to be done," he added. "Not only is there more to be done in terms of people accessing the current methods of prevention and control, we need new methods for prevention and control of recalcitrant cancers, such as those of the ovary and pancreas, which cause more than 10,000 and 50,000 deaths, respectively, annually."

Castle also emphasized that there is more that people can do to reduce their risk of cancer and cancer death.

For example, he noted that screening tests can reduce the risk of other cancers, including HPV and/or cytology screening for anal cancer, hepatitis C screening for liver cancer, and H. pylori screening or endoscopy for stomach cancer in high-risk individuals. Combatting the obesity epidemic and reducing alcohol consumption could also reduce the risk of developing multiple other cancers, he said.

For this study, the authors used population-level cancer mortality data and statistical models from the Cancer Intervention and Surveillance Modeling Network and National Cancer Institute collaborators to estimate the relative contributions of prevention, screening, and treatment advances to cumulative mortality of the five cancer sites. These cancer sites were chosen because they are among the most common causes of cancer death, and strategies are in place for their prevention, early detection, and treatment.

Model inputs were based on national data on risk factors, cancer incidence, cancer survival, and mortality due to other causes, and dissemination and effects of prevention, screening (for interception and early detection), and treatment.

The authors acknowledged that their study had several limitations. For example, the models did not quantify emerging interventions with low uptake (such as lung cancer screening and HPV vaccination) that could further decrease mortality.

In addition, they noted that the study did not model cancers with high mortality rates such as liver, pancreatic, and ovarian cancers, explaining that population models for those cancers are less mature "and challenging to validate." They also did not include rare cancer sites, which account for a quarter of all cancer deaths.

Finally, they pointed out that their study focused solely on the U.S. population, which doesn't reflect the burden of cancer worldwide.

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