Doctor explains rising cancer rates, says survivor rates and data collection provide reasons for hope

NINA MOINI: The American cancer society reported last week that young and middle aged women are getting diagnosed with cancer more frequently. The report found that six of the most common cancers are on the rise, including cancers found in the breasts and uterus. Doctor Schelomo Marmor is an associate professor at the University of Minnesota Medical School. He's on the line now to walk us through how and why we're seeing these cancer trends. Professor, thank you for joining me.

SCHELOMO MARMOR: Thanks so much for having me on, Nina.

NINA MOINI: This is so important. And everybody's ears perk up at the thought of all of this. The American Cancer Society, I understand, puts out this report on the state of cancer yearly. What stood out to you about this last 2024 report?

SCHELOMO MARMOR: Yeah, and I would say, as cancer researchers, we're always on the lookout for this report. It really gives us a unique window into current and future national trends in the US. And it also gives us a sense of progress that we've made in tackling cancer and improving patient outcomes. So for the big picture, we've witnessed some really impressive declines in mortality. But we also take some pause and we reflect on the potential future gains that are threatened by racial inequalities that the report tells us about, and some of the growing burden of disease in middle aged and young adults, especially women.

So there's a fair amount of work to do and some stubborn disparities persist.

NINA MOINI: Yeah, let's kind of break down some of the details. So the incidences of cervical cancer has plummeted since the 1970s. That's when pap smears became widely available. But according to this report, we're seeing those numbers creep back up again. What was your reading of that?

SCHELOMO MARMOR: Yeah, so let's start with the good news here. Cervical cancer rates have dramatically decreased over the last several decades starting in the '70s. But we are seeing rising rates, especially among some demographic groups. And the report's assessment on this is that we can do more on HPV and pap testing, as you mentioned. And that while we've made some impressive HPV vaccination progress pre-pandemic, the rise in cervical cancer rates is linked to lower HPV vaccination uptake in some communities with a decline also in routine screenings, particularly post-pandemic.

And so the report shows vaccination coverage for teens is 75%. But there are pockets of the country where disparities by region and access play a role in the rising incidence.

NINA MOINI: Sure, it's interesting to hear you talk about research in cancer and some of the findings having to do with inequality in the health care system and things outside of the disease that can be done, prevention and education. So how does all of that play a role into your research?

SCHELOMO MARMOR: Yeah, so I think there's a lot to do. There's a lot of work to be done when it comes to limiting disparities. And we've been really good at identifying cancer disparities over the last few decades. But we're not as nimble as finding at finding solutions to some of those vaccine disparities. And I think that's really the next frontier of action research that is happening at the University of Minnesota.

NINA MOINI: Let's talk about breast cancer rates, which have been rising about 1% every year between 2012 and 2021. We're seeing that especially among women who are younger than 50. Do you have thoughts about why?

SCHELOMO MARMOR: Yeah, I want to first highlight some work that we've done using 15 years of national cancer registry data for a group of native American women. And that we found that most of these women are likely to be diagnosed with breast cancer at a younger age and with later stages of disease. And I think that that's really what the report is getting at.

We've made some really nice headway at catching things early. But the report suggests that lifestyle factors, such as obesity, alcohol consumption are driving-- are also driving some of the increases that we've seen. We've been better at catching things early, but we know that genetics play a huge role. For example, the BRCA gene can increase the risk of developing breast cancer.

So I think the takeaway here is let's continue to be vigilant about screening and do our best to catch things early.

NINA MOINI: Moving on to lung cancer, which has been on the decline in the US for decades. But the report shows that, for the first time, we're seeing lung cancer decline in men more rapidly than in women. I'm curious about that in particular, but also about environmental factors that could be factoring in to some of these diagnoses. Is that something you see with lung cancer in particular?

SCHELOMO MARMOR: Oh, for sure. And I'll start by saying that we don't really know for certain. And it seems like there's really a confluence of events that have contributed to this trend. So we see a large gap where we've seen a large gap in the uptake of smoking between men and women. And that gap has actually attenuated over time. So smoking definitely has something to do with it.

A recent New England Journal of Medicine paper found that folks that were born in the mid '60s-- starting in the mid '60s, rates of lung cancer have become significantly higher among young women than among young men. And the highest burden is confined to whites and Hispanics.

So, as you said, there's environmental exposures that definitely come to play here. But I'd say also smoking rates, exposure to secondhand smoke, and it's also possible but doesn't fully explain the uptick is that women also seem to be more biologically susceptible to some of the environmental exposures that you mentioned. Occupational hazards also come into play. And it's been shown that perhaps women are more likely to use imaging tools to detect early cancers.

NINA MOINI: Pancreatic cancer, it seems, has seen an increase in both men and women for decades. It seems like with some cancers, there are maybe less screenings available or you don't really know until, for many people, it has advanced to a certain place. What is it about pancreatic cancer in particular and how could it be prevented better?

SCHELOMO MARMOR: Yeah, pancreatic cancer is rising partly due to aging population, obesity, and comorbidities such as diabetes. They're all key risk factors. Prevention focuses on maintaining healthy weight, quitting smoking. And our group recently looked at a large administrative database to observe the association of new onset diabetes with subsequent diagnosis of pancreatic cancer. And we did find that factors included increasing age and especially increasing age among Black patients.

So right now, our gap is that we don't currently have good screening mechanisms for pancreatic cancer. And although some progress has been made in genomic testing for pancreatic cancer, it's still quite costly and limited to certain populations. So we really need to start thinking about early detection strategies that target that higher risk population.

NINA MOINI: If you could share with folks some general advice, I've heard you naming a lot of a conditions, other things that people are dealing with. There's probably not just one thing that you would recommend. But is there something, generally, that you would recommend to people to try to not end up in the-- with a disease like cancer or to try to work on prevention or screenings? What would be something that you would say that most people have the access to be able to do?

SCHELOMO MARMOR: Yeah, great question. I think key prevention strategies include staying active, maintaining a healthy weight, limiting alcohol, avoiding tobacco. Regular screenings. We've talked about HPV vaccinations are crucial. For skin prevention, use sunscreen, avoid tanning beds. And of course, I think, the most basic is get plugged in to your annual checks. And I would say even though they are not-- they're known to change every so often, follow the guidelines as much as possible.

NINA MOINI: And before I let you go, doctor, I do want you to be able to share if there are parts of cancer research now that make you really hopeful for the future.

SCHELOMO MARMOR: Yeah, I think the most hopeful part of this report is that we've witnessed some impressive declines in mortality. So that means that we can begin turning some of our attention to survivorship and the downstream implications of cancer-- of a cancer diagnosis. I'd say, looking into the future, the expanding role of precision medicine and immunotherapy is game-changing. Offering tailored treatments based on genetic profiles will really help patients in the long-term. Immunotherapy treatments are-- have dramatically improved survival rates.

But I think a huge hopeful and unspoken success story of this report is that the health data we collect serves as the critical foundation that really drives some of the curative breakthroughs that we've made. And we're a long way to optimize the data we collect, but we've been better at collecting and collating data, creating large scale databases that link genomic and tumor characteristics, and really harnessing artificial intelligence and advanced bioinformatic tools that have helped us really ensure that the treatments we offer are not only effective, but really also tailored to the individual. And I'm encouraged by the fact that the University of Minnesota is a leader in these efforts.

NINA MOINI: Doctor, thank you so much for your time. This is very important. We really appreciate it.

SCHELOMO MARMOR: Thanks so much for having me.

NINA MOINI: That was doctor Schelomo Marmor, associate professor at the University of Minnesota Medical School.