Report: Overall
cancer deaths are down, but breast cancer diagnoses
increase

Liver cancer seems to be on the rise, a blip of bad news in the nation's otherwise optimistic annual report on cancer that shows survival continuing to improve. Overall, Americans' death rates from cancer have dropped 1.1% a year since 1993, a trend that continued in 2002--the most recent year for which figures are available--researchers reported Tuesday in the Journal of the National Cancer Institute.

Rates of new cases are holding steady for men. But a small but stubborn increase in female diagnoses continues--0.3% a year since 1987--fueled mostly by steadily rising rates of breast and thyroid cancer, melanoma, and lymphoma.

Surprisingly, another fairly rare malignancy is becoming more common: liver cancer. The report found annual increases of 3% among white men, 4.5% among African-American men, 3.7% among white women, and 5% among Latina women. It's not clear what's spurring the rise; one factor may be hepatitis infections.

"It's a concern worldwide," said Brenda Edwards of the NCI, who cowrote the report with scientists from the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries.

Another concern is ensuring that patients receive care based on the latest expert guidelines. The report shows growing numbers of patients do, which is considered a significant reason why deaths are dropping. But there are gaps, including:

More breast cancer patients are getting just the tumor removed instead of the entire breast, but a significant number skip the follow-up radiation recommended to kill any leftover cancer cells.

Patients 65 or older are less likely to receive recommended chemotherapy after surgery for advanced colorectal cancer.

Only 34% of female Medicare beneficiaries had their ovarian cancer removed by a gynecologist-oncologist, a specialist considered to have better outcomes than more general surgeons.

While there is a dispute over what is the most appropriate prostate cancer treatment, in general African-American men receive less aggressive care than white men. (AP)