"Fall in US cancer death rates: Time to pop the champagne?": the amazing @oncology_bg and myself comment on the big debate about who deserves credit for the progress in our @EClinicalMed commentary: thelancet.com/journals/eclin…. Read along for a brief tweetorial!
Researchers found that since 1991 the cancer death rate has dropped 29%, but the 2.2% decline in mortality rates from 2016 to 2017 was the largest single-year decline in cancer mortality ever reported. 
Since this fall was primarily driven by lung cancer, many experts speculated that this was the success story of treatment advances which has dramatically changed over the decade with the introduction of genomic and immunotherapy-based drugs.
#1 We believe this downward trend of mortality graphs serves more as a reassurance than a cause for celebration. A decline in the rates of smoking from 20.9% in 2005 to 15.1% in 2015 support the continued role of tobacco control in reduced lung cancer incidence and mortality.
#2 While the contribution of screening is probably minimal given the low uptake of lung cancer screening, the improvement in diagnostics could have some positive effect on mortality.
#3 Important advances in genomic targeted therapy in lung cancer happened in 2004 (erlotinib) and 2011 (crizotinib) so why fall in mortality rates would be delayed until 2016–2017? Osimertinib and alectinib came in late 2015 and 2017 and cannot affect mortality rates in 2016–2017
#4 What about immunotherapies? The only immunotherapies in lung cancer approved before 2016 shown to have an effect on mortality rates between 2016 and 2017 are pembrolizumab monotherapy 2nd line, pembrolizumab monotherapy 1st line and nivolumab 2nd line.
Therefore, based on the timing of drug approvals, as well as the fraction of patients eligible for and ultimately receive these drugs, the contribution of drug innovation to fall in population mortality rates in lung cancer and thereby overall cancer mortality rates is very low.
Take Home Meesage: Reassurance of moving in the right direction but not a cause for celebration yet!
"Miles to go before we sleep"
"Miles to go before we sleep"
The low-hanging fruit to achieve better #outcomes overall seems to be equitable access to cancer care, #cancergroundshot parallel to #cancermoonshot! @UConnIM @uconnhealth @MayoHemeOnc @MayoClinic @queensu @EClinicalMed @TheLancet #meded #oncmeded
@threadreaderapp unroll please
