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The 34-year retreat of cancer death rates

The 34-year retreat of cancer death rates

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How Smoking Reductions, Screening, and Treatment Advances Have Averted 4.5 Million Deaths Since 1991

April 21st, 2025: NCI Reports Continued Decline in Cancer Death Rates

Overview

Cancer death rates in the United States peaked in 1991 at 215 deaths per 100,000 people. Since then, they have fallen 34%, averting an estimated 4.5 million deaths. The decline accelerated from about 1% annually in the 1990s to 2% annually by 2015-2020, driven primarily by plummeting smoking rates, earlier detection through screening, and advances in targeted therapies and immunotherapy.

The trajectory is not uniformly positive. While five-year survival rates now exceed 70% for the first time in history, cancer incidence is rising among women and younger adults. Obesity-related cancers are climbing. Racial disparities persist, with Native American and Black populations facing mortality rates two to three times higher than white populations for several cancer types. The question facing oncology is whether gains from tobacco control are sustainable as new risk factors emerge.

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Key Indicators

34%
Mortality decline since 1991
Overall cancer death rate reduction from peak of 215 to 142 per 100,000 population
4.5M
Deaths averted
Estimated cancer deaths prevented since 1991 due to reduced smoking, earlier detection, and better treatment
70%
Five-year survival rate
Up from 49% in the mid-1970s, marking a historic milestone reached in 2025
2.04M
Projected new cases in 2025
More Americans will be diagnosed with cancer in 2025 than ever before
59%
Lung cancer death rate drop in men
Decline from peak in 1990, the largest improvement for any major cancer type

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People Involved

Rebecca Siegel
Rebecca Siegel
Lead author of annual Cancer Statistics report
 William Dahut
William Dahut
Leading ACS research strategy
 Mohamed E. Abazeed
Mohamed E. Abazeed
Active researcher and clinician

Organizations Involved

National Cancer Institute
National Cancer Institute
Federal Research Agency
Lead author of Annual Report to the Nation

The NCI is the primary federal agency for cancer research, coordinating the National Cancer Program and publishing the Annual Report to the Nation on cancer trends.
American Cancer Society
American Cancer Society
Nonprofit health organization
Publishes annual Cancer Facts & Figures report

The ACS funds cancer research, provides patient support services, and publishes definitive annual statistics on cancer incidence, mortality, and survival in the United States.
Advanced Research Projects Agency for Health
Advanced Research Projects Agency for Health
Federal Research Agency
Investing over $500 million in cancer-related projects

ARPA-H was created to drive high-risk, high-reward health research breakthroughs, with cancer detection and treatment among its primary focus areas.

Timeline

  1. NCI Reports Continued Decline in Cancer Death Rates

    Report

    Annual Report to the Nation confirms 34% mortality decline since 1991, with 4.5 million deaths averted. Report also flags rising incidence among women and obesity-related cancers.

  2. Five-Year Survival Rate Reaches 70%

    Milestone

    American Cancer Society reports that for the first time, 7 in 10 cancer patients survive at least five years after diagnosis.

  3. Biden Reignites Cancer Moonshot

    Policy

    The administration sets a goal to cut cancer death rates by half within 25 years and establishes a Cancer Cabinet across 20 agencies.

  4. U.S. Preventive Services Task Force Lowers Colorectal Screening Age

    Guidelines

    Recommended screening age drops from 50 to 45 in response to rising early-onset colorectal cancer rates.

  5. 21st Century Cures Act and Cancer Moonshot

    Legislation

    Congress authorizes $1.8 billion for the Cancer Moonshot initiative, accelerating research toward reducing cancer deaths by half.

  6. FDA Approves First Checkpoint Inhibitor

    Treatment

    Ipilimumab becomes the first approved checkpoint inhibitor, launching the immunotherapy revolution in cancer treatment.

  7. Master Settlement Agreement with Tobacco Companies

    Legal

    States and major tobacco companies agree to a $206 billion settlement, funding anti-smoking campaigns and restricting tobacco marketing.

  8. Cancer Death Rate Peaks at 215 per 100,000

    Milestone

    U.S. cancer mortality reaches its highest point, driven largely by the lung cancer epidemic among men who smoked heavily in earlier decades.

  9. Nixon Signs National Cancer Act

    Legislation

    The 'War on Cancer' begins with expanded NCI funding and authority, establishing the modern cancer research infrastructure.

  10. Surgeon General Links Smoking to Cancer

    Public Health

    Luther Terry's landmark report establishes smoking as a cause of lung cancer, triggering tobacco control efforts that would eventually drive cancer mortality declines.

Scenarios

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1

Cancer Moonshot Achieves 50% Death Rate Reduction by 2047

If current trends accelerate through continued smoking declines, expanded screening uptake, and breakthrough treatments in immunotherapy and targeted therapy, the Cancer Moonshot's goal becomes achievable. This scenario assumes sustained research funding, successful deployment of multi-cancer early detection tests, and progress on racial disparities.

Discussed by: White House Cancer Cabinet, American Cancer Society, NCI researchers
Consensus —
2

Obesity Epidemic Reverses Mortality Gains

Rising obesity rates drive continued increases in colorectal, liver, kidney, pancreatic, and uterine cancers. If obesity-related cancers offset gains from tobacco control, overall mortality decline stalls or reverses. GLP-1 medications could mitigate this trajectory if adoption becomes widespread.

Discussed by: American Cancer Society, epidemiologists studying early-onset cancers, IARC researchers
Consensus —
3

Research Funding Cuts Slow Progress

A 31% decline in cancer research grant funding was reported in early 2025. If sustained reductions in NIH and NCI funding continue, fewer clinical trials launch, early-career researchers leave the field, and promising treatments take longer to reach patients.

Discussed by: Senate HELP Committee Democrats, cancer research advocates, academic medical centers
Consensus —
4

Multi-Cancer Early Detection Tests Transform Screening

Blood-based screening tests that detect multiple cancer types from a single draw gain FDA approval and insurance coverage. Early detection expands beyond the five cancers with established screening to dozens more, potentially preventing cancers that currently have no screening option.

Discussed by: Grail/Galleri developers, American Cancer Society, FDA reviewers
Consensus —

Historical Context

The Surgeon General's Report on Smoking (1964)

January 1964

What Happened

Surgeon General Luther Terry released a 387-page report concluding that cigarette smoking caused lung cancer in men and was a probable cause in women. The report, based on review of over 7,000 scientific articles, marked the first official U.S. government acknowledgment of the smoking-cancer link. At the time, 42% of American adults smoked.

Outcome

Short Term

Congress mandated warning labels on cigarette packages in 1965 and banned broadcast cigarette advertising in 1971.

Long Term

Adult smoking rates fell from 42% to 11% over six decades. Lung cancer death rates in men dropped 59% from their 1990 peak. The report established the template for evidence-based public health interventions.

Why It's Relevant Today

The 2025 mortality decline is largely downstream of the 1964 report. Tobacco control accounts for 98% of the 3.45 million lung cancer deaths averted since 1991.

The National Cancer Act (1971)

December 1971

What Happened

President Nixon signed legislation dramatically expanding NCI funding and authority, giving its director the ability to submit budget requests directly to the president. The act established the National Cancer Program, cancer centers, and cooperative clinical trial groups. Initial funding was $400 million annually.

Outcome

Short Term

Cancer research funding tripled within five years. The NCI established a network of designated cancer centers that became hubs for clinical trials.

Long Term

The research infrastructure created by the act produced chemotherapy regimens, targeted therapies, and immunotherapies that now save millions of lives. NCI's annual budget exceeds $7 billion.

Why It's Relevant Today

The 34% mortality decline since 1991 reflects returns on five decades of research investment initiated by the 1971 act. Treatment advances account for a majority of deaths averted from breast cancer and substantial portions for other cancers.

Heart Disease Mortality Decline (1968-Present)

1968-Present

What Happened

Heart disease death rates in the U.S. fell by more than 70% from their peak in the late 1960s. The decline resulted from a combination of reduced smoking, better blood pressure and cholesterol management, improved emergency cardiac care, and surgical advances like bypass grafting and stenting.

Outcome

Short Term

Heart disease remained the leading cause of death but claimed progressively fewer lives per capita each decade.

Long Term

The decline demonstrated that major causes of death can be substantially reduced through sustained investment in prevention, treatment, and public health infrastructure.

Why It's Relevant Today

Cancer is now following a similar trajectory to heart disease, with mortality declining through a combination of prevention and treatment. Cancer may eventually surpass heart disease as the leading cause of death simply because heart disease mortality fell faster.

Sources

(10)
+4
National Cancer Institute National Institutes of Health American Cancer Society CA: A Cancer Journal for Clinicians Medscape NBC News The White House Journal of Global Health OECD National Cancer Institute