Compared with similarly sizable and wealthy countries, the U.S. has lower than average mortality rates for cancers and tumors. However, the U.S. has higher than average mortality rates for all of the other leading causes of death. These 7 leading causes of death accounted for 85 percent of all deaths in the U.S. in 2010.
The U.S. mortality rate for cancers and tumors (neoplasms) is among the lowest for the comparable OECD countries (those with above median GDP and GDP per capita in at least one of the past 10 years). In the U.S., the age-adjusted mortality rate cause by cancer was 203 deaths per 100,000 people, compared to an average of 212 deaths in comparably wealthy countries.
The mortality rate for all cancers and tumors (neoplasms) has fallen in the U.S. and in comparable OECD countries over the last 30 years. In the U.S., the age-adjusted cancer rate has fallen from about 242 deaths per 100,000 population in 1980 to about 203 per 100,000 in 2010. During the period, the rate of cancer deaths decreased by 16% in the U.S. and by 19% in similarly wealthy OECD countries.
While there is debate over the best way to measure outcomes for cancer, the U.S. typically performs better in both mortality rates and five-year survival rates for breast and colorectal cancer. In 2010, the U.S had a lower mortality rats for breast cancer and a much lower (29%) mortality rate for colorectal cancer than the comparable country averages.
Five-year survival rates for breast cancer and colorectal cancer in the U.S. are slightly higher than in comparable countries, while the survival rate for cervical cancer is slightly lower. The gap in survival rates between the U.S. and comparable countries is beginning to close. While mortality rates are used to measure the outcomes for most diseases, the quality of cancer care is also assessed through five-year survival rates. The use of five-year survival rates versus mortality rates has been debated recently, though, as survival rates may be more heavily influenced by the time of diagnosis than the actual longevity of the patient.
Five-year survival rates for breast cancer and colorectal cancer in the U.S. are slightly higher than in comparable countries, but the survival rate for cervical cancer is slightly lower. The gap in survival rates between the U.S. and comparable countries is beginning to close, but one study also found that while the U.S. outperforms comparable countries on survival rates for breast and colorectal cancer, this is not the case for all cancers, including lung cancer.
Cancer is the leading cause of premature death. Premature death is measured by subtracting the age at death from life expectancy.
Another measure of the effect cancer has on health is to look at the burden of disease, which takes into account both years of life lost due to premature death as well as years of productive life lost to poor health or disability. Using a measure called Disability Adjusted Life Years (DALYs), the Institute for Health Metrics and Evaluation finds that cancer is the third leading cause of disease burden in the U.S., following circulatory diseases and mental health conditions. For a given population, DALYs are calculated by summing the Years of Life Lost (YLL) prematurely and the Years Lived with Disability (YLD, which are weighted).
Over time, the diseases that cause the most DALYs in the U.S. have changed. In 1990, cancers were the second-leading cause, but have since declined significantly. Most of the improvement in disease burden has come from improvements in circulatory outcomes, though there have also been significant improvements in disease burden caused by cancer, as well as injuries and neonatal conditions.
For each of the disease categories with improvements in age-standardized DALYs, the improvement has come primarily from a reduction in the years of life lost (as opposed to a reduction in the year lived with disability)
Disease burden due to cancer is most caused by lung cancer for both males and females
Although tracheal, bronchus, and lung cancers are the leading contributor to DALYs due to cancer for both sexes, males have a higher rate of disease burden caused by this and other cancers. For females, breast cancer is the second-leading cause of cancer-related disease burden.
There are well established evidence-based courses of care for various diseases, such as breast cancer. In 2011, 94.3% of women received axillary node dissection or sentinel lymph node biopsy at the time of lumpectomy or mastectomy in order to ensure proper diagnosis and identify the possible spread of cancer to the lymph nodes.
Recent decline in U.S. mortality rates largely reflects improvement for circulatory diseases
Lower mortality rates from circulatory diseases (heart disease and strokes) are driving the decline in U.S. rates over the last 30 years. Mortality rates for cancers have also fallen, though with less of an effect on the overall mortality rate. Mortality rates from mental and behavioral disorders (primarily dementia) and diseases of the nervous system (including Alzheimer’s disease) have risen.
In 2012, the U.S. spent $124 billion on the treatment of cancers and tumors, according to estimates by the Bureau of Economic Analysis. This represents nearly 7% of total medical services spending on disease treatment ($1.9 trillion). The top five disease-based spending categories (ill-defined conditions, circulatory, musculoskeletal, respiratory, endocrine, and nervous system conditions) account for roughly half (51%) of all medical services spending by disease category. Circulatory and ill-defined conditions each represent about 13% of overall health spending by disease and musculoskeletal, respiratory, and endocrine conditions represent 10%, 8%, and 7% respectively.
On a per capita basis, the U.S. spends about $394 per year to treat cancer, up from $219 in 2000. This represents the total cost of treating cancer divided by the total population in the U.S. People with a cancer diagnosis have significantly higher average health costs than people who have never been diagnosed.
Cancer accounted for 6.3% of medical services spending growth from 2000-2012. Treatments for ill-defined conditions, musculoskeletal disorders (which include back problems and arthritis) and circulatory diseases were the three largest contributors to overall health services spending growth over the 2000 – 2012 period. While spending on the category of circulatory diseases grew slowest of all disease categories, it still accounts for a substantial portion of overall growth because it is such a large area of spending.
The average annual growth in per capita expenditures for cancer from 2000-2012 was slightly lower than the average growth for spending on all disease categories in the United States. Growth in spending on cancer care over the period was primarily driven by increases in the cost of treating cancer, and less so by increases in the number of people being treated for cancer. In fact, the cost to treat each case of cancer grew somewhat faster than the average treatment cost for other diseases (4.6% vs. 4.4%).
People with a current or prior diagnosis of cancer have higher spending on average than people without a cancer diagnosis. Average health spending (including insurer claims and out-of-pocket costs) for people who had ever had a cancer diagnosis was $11,516 in 2013, compared to an average of $4,411 who had never been diagnosed with cancer.
People with a current or prior diagnosis of cancer face higher average out-of-pocket costs than people without a diagnosis. Average out-of-pocket spending for people who had ever had a cancer diagnosis was $1,419 in 2013, compared to an average of $635 who had never been diagnosed with cancer.
Cancer medications are among the top 3 in spending for specialty therapy drugs. Spending on cancer medications was nearly $42 per-member-per-year in 2014. Medications for inflammatory conditions (rheumatoid arthritis, psoriasis) topped out the list at $80 per-member-per-year, followed by drugs for multiple sclerosis at about $52 per-member-per-year.
Tobacco use is a well-documented risk factor for adverse health outcomes and puts individuals at a higher risk of premature mortality than any other behavioral factor. According to OECD data, overall tobacco consumption (total grams per capita) has decreased dramatically in both the U.S. and comparable countries since the 1980s, with U.S. total consumption similar on average to that of other sizable and wealthy countries. Data from the World Lung Foundation and The American Cancer Society show that fewer cigarettes are smoked per capita per year in the U.S. than in most comparable countries.
Cigarette smoking is the primary risk factor for lung cancer. The U.S. has higher than average disease burden from lung and related cancers (795 DALYs per 100,000 capita), compared to similarly wealthy countries (646 DALYs per 100,000 capita).
Smoking is linked to almost 9 out of 10 instances of lung cancer, and is known to cause cancer in the trachea, bronchus, and elsewhere in the body. Use of tobacco products other than cigarettes also increases the risk of lung and other respiratory organ cancers. Despite a dramatic decrease in overall tobacco consumption in the past fifty years, the risk of developing lung cancer is much higher for smokers today, due in part to changes made to cigarettes over time.