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Lung cancer death rates have fallen sharply in the US in recent years, while survival rates have improved. This is largely due to newer treatments, according to and published recently in the New England Journal of Medicine.

Lung cancer has long been the leading cause of cancer death in both men and women in the US. However, lung cancer death rates have been declining for decades. This is thought to have been driven largely by lower smoking rates, which has led to fewer people being diagnosed with lung cancer in the first place. But it hasn¡¯t been clear how much other factors, such as screening for lung cancer and the development of better treatments, might be contributing to the lower death rates as well.

Different types of lung cancer mean different treatments

Lung cancer is broadly divided into two main groups: non-small cell lung cancer (NSCLC), which accounts for about 3 out of 4 lung cancers in the US, and small cell lung cancer (SCLC), which makes up most of the remaining cases. These different types of lung cancer are treated differently.

Both types can be hard to treat once they¡¯ve spread to other parts of the body, which, unfortunately, is often the case by the time they are diagnosed. But there have been more new drugs approved for treating advanced NSCLC than for SCLC in recent years.

Two newer types of medicines in particular are now commonly used to treat many NSCLCs. Immunotherapy drugs help the body¡¯s own immune system attack the cancer, while targeted therapy drugs attack specific parts of cancer cells that make them different from normal cells. These treatments are sometimes referred to as precision medicines, because they often only affect cancer cells with certain gene or protein changes, which need to be tested for before starting treatment.

Evidence of declining death rates

To see if these newer treatments have been contributing to the decline in lung cancer death rates, the researchers looked at data from the NCI¡¯s Surveillance, Epidemiology, and End Results (SEER) database on lung cancer mortality (which covers a large portion of the US population), as well as data from local cancer registries in SEER database areas.

The researchers found that for NSCLC, death rates have fallen faster than incidence (new case) rates in recent years, which is most likely due to advances in treatment. For example, in men, incidence rates fell by 3.1% a year between 2008 and 2016, while death rates fell by 6.3% a year between 2013 and 2016 (a time when targeted drugs began to be more widely used). Similar trends were seen in women with NSCLC.

Supporting the idea that new treatments have been behind some of the fall in death rates, the percentage of people with NSCLC who didn¡¯t die from it within two years after being diagnosed (the two-year lung cancer-specific survival rate) increased as well, going from 26% to 35% among men and from 35% to 44% among women between 2001 and 2014.

The researchers found that there have been declines in death rates for SCLC as well, but these declines largely paralleled the decline in incidence rates. What¡¯s more, the two-year lung cancer-specific survival rates didn¡¯t change significantly for SCLC between 2001 and 2014, pointing to the declines more likely being from fewer cases (largely due to reduced smoking), rather than from any treatment advances.

Even with the new findings, the researchers acknowledged the continued role that the decline in smoking has had in lowering lung cancer death rates in recent decades. ¡°Reduced tobacco consumption in the US has been associated with a progressive decrease in lung cancer deaths that started around 1990 in men and around 2000 in women,¡± said Douglas R. Lowy, MD, NCI deputy director and co-author of this study, in an NCI press release. ¡°Until now, however, we have not known whether newer treatments might contribute to some of the recent improvement. This analysis shows for the first time that nationwide mortality rates for the most common category of lung cancer, non-small cell lung cancer, are declining faster than its incidence, an advance that correlates with the approval of several targeted therapies for this cancer in recent years.¡±

An ongoing challenge

But despite the recent advances in treatment, lung cancer (both SCLC and NSCLC) remains hard to treat in many people, especially once it reaches an advanced stage.

Not all lung cancers are due to smoking, but it is by far the most important risk factor for this disease. The best way to avoid dying from lung cancer is to not get it in the first place, and the single most important way to lower your risk is to not smoke. If you smoke and would like help quitting, call us at 1-800-¿ìè¶ÌÊÓƵ-2345.

For many current or formers, screening for lung cancer with low-dose CT scans might provide a chance to find lung cancer early, when it¡¯s likely to be easier to treat.