Progress in Chronic Disease Prevention Years of Potential Life Lost due to Cancer -- United States, 1968-1985

Although the incidence of cancer is relatively low in persons less than 65 years of age (82.9 deaths per 100,000 persons in this age group in 1985), it is the second leading cause of years of potential life lost (YPLL) for this age group, exceeded only by injuries. In 1985, 1,952,171 YPLL were attributable to cancer*. This is essentially unchanged (a 0.7% increase) from the YPLL for 1984. In 1985, white males contributed 43.1% of the cancer-attributable YPLL; white females, 40.1%; black males, 7.9%; and black females, 7.0%. Males and females of other races account for the remaining 1.9%. Between 1968 and 1985, cancer mortality rates in persons less than 55 years of age declined 23% from 43 to 35 deaths per 100,000 persons in this age group, while rates in those greater than or equal to55 years of age increased 17% from 775 to 905 per 100,000 persons (1). During this period, total YPLL remained relatively constant, with an average annual decline of less than 1%. However, the age-adjusted rate of cancer-attributable YPLL for the total population steadily decreased from 1968 to 1985 (Table 1), reflecting the overall decline in cancer mortality in younger persons. Rates of cancer-attributable YPLL in 1985 were age-adjusted by race-gender groups: the highest rate occurred for black males (1208.1 per 100,000), followed by white males (949.4), black females (876.7), and white females (840.5). The rates in all four major race-gender groups also declined differentially (Figure 1). The average annual decline between 1968 and 1985 was approximately twice as great for black females (a decline of 18.9 per 100,000 per year) as for black males (9.4), white females (9.6), or white males (9.9). Reported by: Div of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: As life expectancy increases and all causes of death in earlier years of life decrease, mortality patterns and public health priorities may change. The patterns for cancer mortality and YPLL illustrate the complex shifts that may alter perception of the importance of cancer in young persons. Declines in mortality from infectious diseases and major chronic conditions such as cardiovascular disease in younger persons have increased the relative public health burden of cancer mortality. YPLL reflects both the rate of disease and the size of the population at risk. Although the rate of cancer in younger persons, particularly those less than 55 years, is decreasing, some of the largest population increases by age group occur for persons 30-50 years of age, the result of higher birth rates during 1946-1964. Because cancer rates have decreased while the size of the population at risk has increased, virtually no change has occurred in the annual total number of cancer-attributable YPLL from 1968 to 1985. Thus, cancer-attributable YPLL has produced a constant disease burden. Age-adjusted YPLL rates (Table 1) show an overall downward trend, however, reflecting diminishing cancer mortality rates in persons less than 55 years of age. This downward trend, which occurred in each of the four largest race-gender groups (Figure 1), is most prominent for black women, whose decrease is twice that of the other groups. This decrease does not appear to be attributable to greater population growth among black women, since their growth rate is identical to that of black men, whose decline in age-adjusted YPLL was the smallest of the four groups. Instead, the differential decline in age-adjusted YPLL appears to be related to a complex interaction between cancer incidence, mortality, and survival; this interaction may vary by tumor sites for different segments of the population. Since the number of cancer cases occurring in certain population groups may be small, data are insufficient to address such interactions (1,2). Although the decline in age-adjusted rates for cancer-attributable YPLL is encouraging, understanding the basis and public health implications of this decline requires further investigation. These efforts may need to focus on cancer incidence, mortality, and survival among younger population subgroups and on the relative impact of these measurements and programs designed to affect them (3).

References

1. National Cancer Institute. Annual cancer statistics review, 1987. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health; NIH publication no. 88-2789. 2.National Cancer Institute. Cancer incidence and mortality in the United States, surveillance, epidemiology and end results. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health; NIH publication no. 85-1837. 3.US Department of Health and Human Services. Report of the Secretary's Task Force on Black and Minority Health. Washington, DC: US Department of Health and Human Services, 1985. *This report examines cancer mortality and YPLL for all mentions of cancer on death certificates, using multiple cause of death tapes from the National Center for Health Statistics. Cancer is selected as the underlying cause of death on 88% of death certificates mentioning cancer as a cause of death. Cancer-attributable YPLL is computed using differences between age at death from cancer and 65 years.

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