Cancer is a disease so frequently referenced in our society it seems almost inescapable.
And the talk of cancer seems to only increase as time goes by. In the last year, it feels like there’s been a flurry of reports about cancer cases increasing in younger age groups.
So, what is the reality? Are cancer cases exponentially increasing? Is a country that spends over $50 billion a year on cancer research actually setting money on fire?
If you were to read President Trump’s executive order “Establishing the Make America Healthy Again Commission” you might think so.
Our national cancer statistics were used in a global context as the order’s first example of the country’s poor health, stating “[the] United States had the highest age-standardized incidence rate of cancer in 2021, nearly double the next-highest rate” and that, over the last 31 years, “the United States experienced an 88% increase in cancer, the largest percentage increase of any country evaluated.”
If those numbers sound shocking to you, please know you’re not alone. They shocked U.S. cancer researchers too. Or, more appropriately, they confused cancer researchers.
That’s because those statistics are vastly different from the statistics from the WHO, the International Agency for Research on Cancer, and the International Association of Registries.
These organizations have a longstanding collaboration to report on international cancer rankings.
That analysis puts the U.S. in third place for cancers excluding non-melanoma skin cancer (a type of cancer that is so seldom fatal that cases aren’t required to be reported).
And our rates were only slightly above Hungary and Denmark.
The data the Trump administration is quoting appears to come from a paper by three researchers in Wuhan, China, in the journal of hematology and Oncology, an open access journal that requires authors to pay nearly $5000 to have their papers published.
Why they would use an obscure paper that directly contradicts what many other established surveillance systems say is unclear, but the inaccuracy doesn’t end with our global rank.
The claim that we have seen an 88% increase in cancer since 1991 is not a verifiable statement.
The U.S. didn’t have an incidence registry for the whole country for that time frame, instead they tracked incidence in just 12 areas.
Based on that data, from 1992 to 2021, cancer incidence actually dropped 14%.
Even so, how many cases of cancer are diagnosed per year isn’t the metric that tells us how well we are doing in our fight against the disease.
Countries with few cases don’t necessarily have incredible health, they might just have horrible diagnostics, and cases are going undetected.
A more important stat to focus on is mortality and survival rates—and in that area, we’re doing a good job!
The five-year survival rate (the likelihood someone with cancer will be alive five years from their diagnosis compared to someone without cancer) has increased from 49% for diagnoses during the mid-1970s to 69% for diagnoses made between 2014 and 2020.
The improvements are driven by better diagnostics, screening, and imaging, which can detect cancer at earlier stages when it’s easier to treat, as well as improved therapies.
It’s also been significantly impacted by reduction in smoking.
Lung cancer death rates in men dropped by 58% from 1990 to 2020, and by 36% for women from 2002 to 2020.
Even with these improvements, smoking still remains the number one cause of preventable death—it’s estimated lung cancer because of smoking will still kill an average of 500 people a day in 2025.
The improvement in survival rates is even more pronounced in certain cancers.
Breast cancer deaths peaked in 1989 and have since declined by 44% thanks to screening recommendations and improved treatments.
Colorectal cancer death rates have dropped 55% for males since 1980 and 60% among females since 1969. And even over the last decade, for both men and women, deaths due to colorectal cancer have declined 1.7% a year.
Though still a rather bleak prognosis, rates of survival for liver cancer have increased from 3% in the 1970s to 22% today.
That doesn’t mean the burden of cancer is nothing.
In 2025, there’s expected to be over 2 million new cancer diagnoses in the U.S. and over 600,000 deaths per year, an average of about 1700 deaths a day.
And the closing of health care centers, loss of employer-based health insurance, and fear of illness during the pandemic caused a steep drop in cancer diagnoses, which will take time to recover from and whose impacts will only be seen later on.
What causes these cancers is a billion-dollar question.
We’ve known for a while there are some genetic factors that predispose certain people to certain cancers (like how those with the BRCA mutation have a higher likelihood of developing breast cancer).
But increasingly, lifestyle and environmental factors are starting to come under scrutiny as the potential culprits in the changing landscape of cancer diagnoses.
Things like diets high in ultraprocessed foods and low in fiber, sedentary lifestyles, consumption of copious amounts of alcohol (something a lot of people were surprised to learn contributes to the risk of developing cancer), and even the gut microbiome or changes in hormones due to things like early menstruation or late age at childbirth have all been put under the microscope as potentially contributing to an increased risk of cancer.
Some theories about colon cancer suggest that microplastics can make their way through the mucous membrane in the bowels and get into the gut’s lining, making it more susceptible to toxins.
One study on colon cancers, which is projected to be the most frequently diagnosed cancer in 2025 and the cancer with the second highest mortality, found evidence that exposure to a certain kind of toxin, often produced by a common strain of E. coli, might prime the body for uncontrollable cell replication, resulting in colon cancers years down the road.
This paper theorized that high levels of casual antibiotic use or cesarean deliveries could be impacting children’s gut biomes, making them more susceptible to the toxin at earlier stages in life and therefore pushing the resulting cancer diagnosis up by decades.
Factors like these are potential reasons why rates of cancer are increasing in younger ages in ways that can’t be entirely explained by increased screenings.
People under 50 are the only age group where the risk of cancer is rising, with rates of 14 types of cancer increasing in at least one younger age group.
When compared to rates seen in these younger age groups in 2010, there were about 4800 more cases of breast cancer and 2000 more cases of colorectal cancer, the two types of cancer with the greatest increases.
It's important to emphasize that cancer is still, by and large, a disease of aging.
88% of all cases are diagnosed in people over 50 and 59% are 65 or older.
The unpredictability of diagnoses leaves people wishing there was a blanket approach to prevention…and for some types of cancer there might be.
The HPV vaccine has done an incredible job at reducing the amount of HPV-attributable cancers we’ve seen, and that’s because the vaccine covers the strains of HPV that are responsible for 90% of HPV-related cancers.
In the U.S., since we started our HPV program in 2006, infections with the type of HPV that causes cancers and genital warts has dropped by 81% in young adult women.
Between 2013 and 2021, rates of cervical cancer in women aged 20-24 (the cohort that was first offered the HPV vaccine) have dropped 69%.
Scotland began their HPV vaccine program in 2008, offering it to 12-13 year olds, and last year they found zero cases of cervical cancer in women who got vaccinated over the past 15 years.
And it’s not just for girls! New data suggests that HPV vaccination in boys can reduce the risk of HPV-related neck and throat cancers in men by over 50%
If more people got vaccinated, we could likely reverse the current upward trend of deaths from HPV-associated oral cancers.
Diagnosing HPV could become a lot easier as well.
The FDA just announced the approval of a home vaginal HPV test.
Self-swabbing has been found to be just as accurate as pap smears at a doctor’s office for people 25-60 at average risk.
Allowing people to test at home (like we do with stool samples for colorectal cancer) can increase uptake, particularly amongst people who have limited access to care.
Disparities in health care access have resulted in Black and indigenous women being significantly more likely to die of cervical cancer than white women, so anything to increase the ease of testing could help level the playing field.
Though we are used to talking about mRNA vaccines as a tool to prevent illness, they’re also showing promise as a tool to prevent the recurrence of one of the most aggressive and deadly cancers out there: pancreatic.
A recent phase 1 clinical trial showed promising results that mRNA vaccines reduced the risk of pancreatic cancer returning in a small group of patients after surgery to remove tumors.
One of the appeals of mRNA technology is that it can be quickly and easily updated if there’s a mutation in the antigens it’s designed to teach the immune system to respond to.
So, in the case of pancreatic cancer, the vaccines were tailored to each individual study participant's pancreatic tumors, so that if the tumor began to regrow after surgery, the immune system would already be primed to attack it.
The study was extremely small (it was only phase one) but could be the beginning of treatments for a type of cancer that’s incredibly hard to combat.
Most pancreatic cancer is only identified at stage 4, which has a five-year survival rate of 3%.
Meaning that, by the time cancer is identified in most people, they are about 3% as likely as people who do not have that cancer, to be alive 5 years after their diagnosis.
But even with the improvements we’ve made in detection, prevention, and treatment, some populations are still being left behind when it comes to cancer.
The (now illegal) practice of redlining (in which certain neighborhoods were marked by mortgage companies as “undesirable,” usually because of their high proportion of black residents) has been found to be associated with a later cancer diagnosis, lower likelihood of receiving recommended treatment, and higher likelihood of dying.
Women who live in residential areas that were previously “redlined” are more likely to die within five years of a breast cancer diagnosis compared to women who do not live in a redlined area.
And this is regardless of her health insurance status, treatments received, or socioeconomic status, because redlined neighborhoods are often subjected to more environmental hazards like highways and factories, which expose people to greater amounts of pollution and toxins.
Black people are less likely to have early detection of any cancer that has screening recommendations (like breast, cervical, or lung cancer).
Cancer death rates are highest in the South and Appalachian regions of the U.S.
Recent studies have found that living in a disadvantaged neighborhood increased the risk of aggressive prostate cancer in black men by 30%, but had no impact on white men in the same area, suggesting a particular kind of stress could influence rates.
We can have all the improvement in cancer prevention and mortality we want, but if it’s not equitably distributed then it doesn't really matter.
