Dramatic Growth in Cancer Rates Among the Elderly and Minorities

M. D. Anderson Cancer Center

Cancer Newsline Audio Podcast Series

Date: May 04, 2009

Duration: 0 / 16:27

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Welcome to Cancer News Line, a weekly podcast series from the University of Texas, M.D. Anderson Cancer Center. Cancer News Line helps you stay current with all the news on cancer research, diagnosis, treatment and prevention, providing the latest information on reducing your family's cancer risk. I'm your guest host, Dr. David Wetter, Professor and Chair of M.D. Anderson's Department of Health Disparities Research. Today in this Breaking News Edition of Cancer News Line we'll talk to Dr. Ben Smith, an Assistant Adjunct Professor in M.D. Anderson's Department of Radiation Oncology about an area that's of interest to me which is the growing incidence of cancer in the elderly and minority populations. A new study by Dr. Smith finds that the number of new cancer cases diagnosed annually in the United States will increase by 45 percent from 1 point 6 million in 2010 to 2 point 3 million in 2030. The most dramatic spike in new cancer cases is found in the elderly and minority populations. In adults age 65 or older, the study predicts a jump from 1 million in 2010 to 1 point 6 million in 2030. In nonwhite individuals over the same 20 year span, the number of new cases is expected to increase by 100 percent from 330 thousand to 660 thousand. The study appears in the current issue of the Journal of Clinical Oncology and is the first to determine such specific long-term cancer case projections. Dr. Smith is actually on active duty in the military and joins us by phone today from Lackland Air Force Base. Thank you very much Dr. Smith for joining us today. These are truly sobering and timely findings, results that will have a tremendous impact on our healthcare system, so let's get some background. Why did you decide to do this study?

 

Dr. Ben Smith:

 

Well for several years, my primary area of research focus has been studying optimal radiation therapy treatments, particularly for older women with breast cancer. And as I would go to write various manuscripts on this topic, I always wanted to include something in my introductions or discussions regarding how many new breast cancer diagnoses we could anticipate in the future as the United States population ages. And to my surprise I could never find a good reference that could actually explain to me how the changing demographics of the United States would impact cancer incidence. So for about a year now I've had an interest in doing a study along these lines to provide some general ballpark estimate for how our population changes will impact future cancer incidence. So that's how I initially got the idea of doing this study. In August of 2008, the United States Census Bureau released updated and very detailed projections on future population growth in the United States through 2050 and that received a fair amount of attention in the lay press. And so that was the final piece of information that I needed to embark on this project.

 

Wetter:

 

Dr. Smith, can you walk our listeners through how you went about doing the research?

 

Smith:

 

Sure, I'd be happy to. We obtained population projections from the United States Census Bureau through 2030 and we also calculated current cancer incidence rates using a data from the SEER Registry which is a population based cancer registry maintained by the National Cancer Institute and comprises approximately 26 percent of the United States population. And what we did was we assumed that the current cancer incidence rates will remain relatively constant per person, but that as the total number of people increases over time and as the population ages the total number of cancers will also increase. And so using this process, we were able to therefore project into the future how many cancers will be diagnosed, what types of cancers will be diagnosed and how that will break down as far as patient age and race and sex.

 

Wetter:

 

Can you tell us about what your key findings were?

 

Smith:

 

Well, the primary key finding is that as our population changes and becomes more diverse and also older, the number of cancers will increase substantially. Between 2010 and 2030 the U.S. population will increase by 19 percent, but the number of cancers diagnosed will increase by 45 percent. So a marked increase in the number of cancers diagnosed. And this is particularly notable for older adults. In 2010, there's going to be about 1 million cases of cancer in older adults, but by 2030 they will be 1 point 6 million cases of cancer in older adults. And I would just note that in 2010 the total number of cancers in the United States is expected to be about 1 point 6 million. So this is really a remarkable increase. And our second key finding was that the number of cancers diagnosed in minorities will also increase approximately double from about 330 thousand currently to about 660 thousand in 2030. And one thing that we found which was interesting is that as far as individual cancer sites, some of the sites that will increase the most rapidly are cancers that are seen more commonly in minority individuals: things like gastric cancer and liver cancer, and also pancreatic cancer will be increasing rapidly. And all 3 of those cancers have a generally a poor survival rate and treatments are not optimal and so it's somewhat disturbing to think about marked increases in these cancers that we're not very good at treating right now.

 

Wetter:

 

Interesting… In the study you note that these findings underscore the growing need for inclusive clinical trials. For so long, both populations have been under represented in therapeutic trials. Can you tell us a little bit about that?

 

Smith:

 

Yeah so it's remarkable. In 2010, our data suggests that approximately 60 percent of cancers will be diagnosed in individuals 65 and older. And also in 2010, about 21 percent of cancers will be diagnosed in nonwhite minorities. So already, the majority of cancers are diagnosed in older adults and yet in the studies that have been done in the 1990s and 2000s, for large clinical trials many times the older individuals and minorities are profoundly under represented in these studies. So that I think is alarming that our fastest growing segment of our population and the most common segment of the population to have cancer older adults - have been so profoundly under represented. And in the past many clinical trials would have an age exclusion criteria so that if you were 71 you couldn't enroll in a trial because the trial only enrolled individuals up to the age of 70. And I think there's been growing awareness in the field of clinical oncology that that's a problem and so there are efforts underway to design clinical trials specifically targeting older individuals. And there's also been a great deal of interest on the part of the National Cancer Institute to stimulate enrollment of minority individuals in clinical trials. And I think Dr. Wetter you may know better than I, but I think that we're starting to just see a little bit of the fruits of those efforts and I certainly hope they will continue.

 

Wetter:

 

Thank you. I would think that effort would need to go hand in hand with making clinical trials and cancer treatment more cost effective.

 

Smith:

 

Well certainly, I completely agree with that. There is a very interesting study that was just published in the Journal of the National Cancer Institute last year. And they used data from Medicare records to quantify how cancer costs have increased between 1991 and 2002. And they found that for common cancers the cost of treating a person with cancer to Medicare increased by about 15 to 20 percent during that time period, even after adjusting for inflation. So we have clear documentation that the cost of treating an individual cancer patient has increased and the total number of people diagnosed with cancer is going to increase substantially. And so we have 2 independent factors which are going to synergistically and remarkably increase the cost of cancer care over the next 20 years. And in my opinion, this increase in cost is going to be unsustainable and so I think that we really need to rethink some of the areas of focus in clinical oncology research and in clinical trial design to support the development of cost effective therapies. It's interesting, I'm a Radiation Oncologist and most of the new research that's presented in radiation oncology is focused towards using newer technologies which happen to be tremendously expensive: technologies like intensity modulated radiotherapy, stereotactic radio surgery, proton beam radiotherapy. And all of these technologies have potential advantages. They may be theoretical or they may have been proven in studies already, but they also carry a tremendous cost. And I think we really need to rethink the focus of our research rather than solely driving -- having technology drive the focus of our research. I think the focus of our research really needs to be in how do we deliver care to patients that's cost effective and achieves the results that we need without imposing more and more of a burden on the healthcare system?

 

Wetter:

 

Can you tell us a little bit about the role of prevention such as screening, chemo prevention, smoking cessation and things like that?

 

Smith:

 

Certainly, well obviously the best way to deal with cancer is to prevent it from occurring. And we assume that the risk of developing cancer for any individual will remain constant over time, but -- and if that risk remains constant as our population grows and changes, the number of cancers will increase substantially. But what would be ideal is if that risk of cancer per person would decrease over time and that will help to soften the blow of the changes in our U.S. population. And so I think there are proven screening strategies such as screening for premalignant colon polyps, screening for cervical cancer, screening for breast cancer and to the extent that those have not fully disseminated to every individual in the United States, I think we need to redouble our efforts to apply those proven screening strategies. There are also screening strategies which are still somewhat investigational and I think further research to identify cost effective and safe screening strategies is clearly very important and should be emphasized as a way of countering the expected growth in the U.S. population.

 

Wetter:

 

This is really a societal issue that will impact us all. Let's talk about how these increases in cancer cases will stress our healthcare system.

 

Smith:

 

Yeah so that's a very interesting question. Between 2010 and 2030, our paper projects that the number of cancers diagnosed in the United States will increase by 45 percent. But the population projections from the U.S. Census Bureau indicate that the number of individuals in the United States under the age of 65 - so those individuals who could be able to work to take care of our older population will only increase by 10 percent. So we have a 4 to 1 ratio in the increase in cancers diagnosed to the increase in younger people who will be available to take care of these older people. And I think this is going to exert a tremendous stressor on our society, both with regard to cancer care but all the other facets of caring for individuals who are aging, and so as I think about the future. I think healthcare is going to be very much a growth industry and we need to recruit people into healthcare to meet all the healthcare needs of our aging population. And this is a topic that has been of great concern to the AAMC - the American Association of Medical Colleges - and they have a work-course group that has been studying this issue in detail. And it's very interesting; by 2025 they project that the demand for physicians in the United States will be roughly 860 thousand, whereas the supply will only be approximately 735 thousand. So we have 145 thousand physician gap projected by 2025 which is very alarming. American Association of Medical Colleges has therefore been strongly encouraging medical schools to increase enrollment across the country and to increase the total number of medical schools across the country to help counter this issue. Thinking specifically about the field of oncology, it's interesting to note that in the field of hematology oncology 40 percent of physicians are age 55 or older. So within the next 10 years, about 40 percent of hematologist oncologists are going to be contemplating retirement which is very concerning and it shows how the aging of the population actually impacts our own ability to care for the population as we lose many of these very skilled and senior physicians to their own retirement. So I think that's very concerning and these are issues that we really need to think about and confront on a societal level so that we'll be prepared for the future.

 

Wetter:

 

Are there organizations and initiatives that are beginning to tackle some of those issues?

 

Smith:

 

Well there are. As I mentioned the American Association for Medical Colleges has been very active in raising awareness of this issue, in lobbying Congress to support efforts to increase the capacity of the healthcare system and in supporting an increase in medical school enrollment across the country. The American Society of Clinical Oncology has also been very active. They have established a workforce committee on -- they have completed their own projections for the anticipated shortfall in hematologists oncologists and they're working with hematology oncology fellowship programs to increase the number of trainees and also help to teach their trainees how to practice in an environment that has scarce resources. And one thing that I found encouraging is that between 2002 and 2007 the total number of fellowship or residency for both hematology oncology and radiation oncology have increased by 30 percent. So we do see that there are increased physicians that are being trained for these cancer fields. And finally, anyone who's read the newspaper recently is well aware that there's a renewed interest on the part of the federal government of confronting the issue of the rising costs of healthcare and in trying to develop novel strategies to help counterbalance that and help bring healthcare costs under better control as we look to the future and anticipate an increase in demand for healthcare services.

 

Wetter:

 

Thank you so much Dr. Smith for talking with us today about your study. These are significant findings that certainly need to be addressed at every level of the healthcare system.

 

Smith:

 

You're welcome. It was a pleasure participating in this podcast. Thank you very much Dr. Wetter.

 

Wetter:

 

Take care. If you have questions about anything you've heard today on Cancer News Line, contact Ask M.D. Anderson at 1-877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer News Line. Tune in next week for the next podcast in our series.

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