Perspectives in Disease Prevention and Health Promotion Premature Mortality due to Malignant Neoplasms -- United States, 1983

In 1984, malignant neoplasms* ranked as the second leading cause of years of potential life lost before age 65 (YPLL) (1) (see Table V). They accounted for 1.8 million YPLL, or 15% of the total of YPLL from all causes. In this report, YPLL was calculated with detailed mortality data from computer tapes of the National Center for Health Statistics for 1979-1983, the latest years for which tapes are available. Data were analyzed on YPLL attributable to all malignant neoplasms, as well as site-specific malignant neoplasms, by sex, race (white, black, other races), and year. To compare differences in YPLL across time and among different race/sex groups, independent of changes and differences in population size, YPLL rates per 100,000 persons under 65 years of age were calculated (2).

All malignant neoplasms. In 1983, malignant neoplasms among white males accounted for 43% of the total YPLL attributable to malignant neoplasms (Table 3). Malignant neoplasms among white females accounted for another 41%. Black males, however, had the highest YPLL rate due to malignant neoplasms in 1983 (1,130/100,000), followed by black females (937/100,000), white males (889/100,000), and white females (842/100,000). The percentage of total YPLL attributable to malignant neoplasms and the YPLL rate due to malignant neoplasms did not change markedly in 1979-1983 for the six race/sex groups.

Site-specific neoplasms. Respiratory-system cancers in 1983 accounted for 24% of all YPLL due to malignant neoplasms, followed by digestive-system cancers (17%), breast cancer (12%), and cancers of other and unspecified sites (19%). Although these four sites also accounted for more than 70% of the deaths from malignant neoplasms among persons under 65 years of age, their rank order based on percentage of deaths differed from that based on YPLL: respiratory system cancers accounted for 31% of all deaths; digestive system cancers, 21%; breast cancer, 11%; and cancers of other and unspecified sites, 14%.

YPLL rates for males exceeded comparable rates for females by at least 40% for all sites except breast and genital cancers (Table 4). Similarly, death rates for males under 65 years of age also exceeded comparable female rates by at least 40% for these same sites.

YPLL rates for blacks of both sexes exceeded comparable rates for whites by at least 10% for all malignant neoplasms except hematologic and lymphatic cancers (leukemia, lymphoma, and multiple myeloma) and cancers of other and unspecified sites (Table 5). For those under 65 years of age, black death rates exceeded comparable white death rates by at least 10% only for four sites: lip, oral cavity, and pharynx; digestive system; respiratory system; and genital organs. Black YPLL rates for breast cancer and cancer of the urinary organs exceeded comparable white YPLL rates, but black death rates for these cancers were 7% and 15% lower, respectively, than comparable white death rates. Reported by Chronic Disease Control Div, Center for Environmental Health, CDC

Editorial Note

Editorial Note:As an underlying cause of death, malignant neoplasms ranked second in the United States in 1983, accounting for 442,986 deaths, or about 22% of all deaths (3). Of these deaths, 36% occurred among persons under 65 years of age. In 1986, 472,000 cancer deaths are expected to occur among U.S. residents, 54% among males. Almost 1.4 million newly diagnosed cancer cases are expected, about one-third of which would be due to nonmelanotic skin cancers and carcinomas in situ. For a child born in 1985, the probability at birth of eventually developing cancer (excluding nonmelanotic skin cancers) is about 33%, and the probability of eventually dying of cancer, about 20% (4).

Because over one-third of cancer deaths occur among persons under 65 years of age, cancer retains its importance as a cause of death when ranked either by summary death rates, which emphasize mortality at older ages, or by YPLL, which emphasizes mortality at younger ages (5,6). For all malignant neoplasms, males have higher death rates for persons under 65 years of age and higher YPLL rates than females; blacks have higher death rates and YPLL rates than whites or other races. Differences in exposures to risk factors (e.g., cigarette smoking, occupation) and biological differences (e.g., hormonal effects, immunity) may account for the sex differences. For almost all cancers except those with notably poor survival rates, whites have a better chance of survival after diagnosis than blacks (7,8). White patients have tended to be somewhat older at diagnosis than blacks and to have higher percentages of cancers diagnosed while localized.

For specific sites, however, this ranking changes. The category cancers of other and unspecified sites ranks higher than digestive system cancers when ranked by YPLL but lower when ranked by death rates. Cancers of the bone, connective tissue, skin, and nervous system--prevalent cancers of childhood and young adulthood--probably account for this difference.

The higher YPLL rates but lower death rates for breast and urinary-organ cancers for blacks compared with whites may indicate that younger blacks with these cancers are not surviving as long after diagnosis as whites of comparable age. In one study, 5-year relative survival rates for both breast and urinary-bladder cancers were markedly better for whites than for blacks, only partly because whites had higher percentages of localized cancers (7). Even among those with localized cancers, relative survival rates for whites exceeded those for blacks. This study, however, considered patients of all ages, not just those under 65 years of age.

Different malignant neoplasms may have similar or different causes (9,10). Diet, tobacco use, infection, exposure to sunlight, reproductive and sexual behavior, occupation, and alcohol use are risk factors associated with more than 80% of all cancer deaths (10). These risk factors are important among persons under 65 years of age, as well as older persons. Only a few cancers found in those under 65 years--childhood cancers, young-adult Hodgkin's disease, premenopausal breast cancer, and cancers associated with specific genetic disorders--are likely to have different sets of causes from malignant neoplasms in those 65 years of age or older. Therefore, preventive measures (e.g., stopping cigarette smoking, making available cervical cytology screening services) should reduce both premature and total mortality from malignant neoplasms (11).

References

1. CDC. Table V. Estimated years of potential life lost before age 65 and cause-specific mortality, by cause of death--United States, 1984. MMWR 1986;35:365.

2. U.S. Bureau of the Census. Statistical abstract of the United States: 1985. 105th edition. Washington, D.C.: U.S. Department of Commerce, 1984;28.

3. Silverberg E, Lubera J. Cancer statistics, 1986. Ca-A Cancer Journal for Clinicians 1986;36:9-25.

4. Seidman H, Mushinski MH, Gelb SK, Silverberg E. Probabilities of eventually developing or dying of cancer--United States, 1985. Ca-A Cancer Journal for Clinicians 1985;35:36-56.

5. Haenszel W. Standardized rate for mortality defined in units of lost years of life. Am J Public Health 1950;40:17-26.

6. Perloff JD, LeBailly SA, Kletke PR, Budetti PP, Connelly JP. Premature death in the United States: years of life lost and health priorities. J Public Health Policy 1984;5:167-84.

7. Myers MH, Hankey BF. Cancer patient survival in the United States. In: Schottenfeld D, Fraumeni JF, Jr, eds. Cancer epidemiology and prevention. Philadelphia: W. B. Saunders Co., 1982:166-78.

8. CDC. Cancer patient survival by racial/ethnic group--United States 1973-1979. MMWR 1985;34:248-55.

9. Schottenfeld D, Fraumeni JF Jr, eds. Cancer epidemiology and prevention. Philadelphia: W. B. Saunders Co., 1982:519-1035.

10. Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst 1981;66:1191-308.

11. Foege WH, Amler RW, White CC. Closing the gap: report of the Carter Center health policy consultation. JAMA 1985;254:1355-8. *International Classification of Diseases, Ninth Revision, 140-208.

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