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
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.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
