Prevention and screening averted more cancer deaths than treatment advances

Advances in cancer prevention and screening have saved more lives from five major cancer types over the past 45 years than treatment breakthroughs, according to a new study.

The research examined deaths from breast, cervical, bowel, lung, and prostate cancers averted through prevention, screening, and treatment between 1975 and 2020. These five cancers, which are among the most common causes of cancer-related deaths, have established strategies for prevention, early detection, and treatment. Collectively, they account for nearly half of all new cancer diagnoses and deaths in recent years.

“Although many people may believe that treatment advances are the major driver of reductions in mortality from these five cancers combined, the surprise here is how much prevention and screening contribute to reductions in mortality,” said Dr Katrina Goddard, co-lead investigator and director of NCI’s Division of Cancer Control and Population Sciences. “Eight out of 10 deaths from these five cancers that were averted over the past 45 years were due to advances in prevention and screening.”

Notably, smoking cessation – a single prevention intervention – played the most significant role, preventing 3.45 million lung cancer deaths. Prevention and screening were the primary drivers of mortality reductions for cervical, colorectal, lung, and prostate cancers, while treatment advances had the most substantial impact on breast cancer.

“To reduce cancer death rates, it’s critical that we combine effective strategies in prevention and screening with advances in treatment,” said Dr Kimryn Rathmell, director of NCI. “This study will help us understand which strategies have been most effective in reducing cancer deaths so that we can continue building on this momentum and hopefully increase the use of these strategies.”

Using statistical models, the researchers estimated that 5.94 million deaths from these five cancers were averted between 1975 and 2020. Prevention and screening interventions accounted for 4.75 million – or 80% – of these averted deaths.

In Australia, the Public Health Association of Australia (PHAA) has renewed calls for the government to invest 5% of total health expenditure in prevention – a 2022 election promise that was never fulfilled. A new patient group coalition has also challenged the government to prioritise preventative health amid a $13 billion surge.

Key Findings by Cancer Type

• Breast Cancer: Of 2.71 million deaths that could have occurred, 1 million were averted. Treatment advances accounted for 75%, with mammography screening contributing the rest.
• Lung Cancer: Tobacco control efforts averted 98% of 3.45 million deaths, with treatment advances accounting for the remainder.
• Cervical Cancer: Screening (Pap and HPV testing) prevented all 160,000 averted deaths, highlighting the effectiveness of early detection and precancerous lesion removal.
• Colorectal Cancer: Of 940,000 deaths averted, 79% were due to screening and removal of precancerous polyps, while treatment advances accounted for 21%.
• Prostate Cancer: Screening via PSA testing contributed to 56% of the 360,000 deaths averted, with treatment advances responsible for the remaining 44%.

The study underscores the potential for newer interventions, such as HPV vaccination and lung cancer screening, to further decrease cancer deaths. Expanding access to screening tools, including self-collection HPV tests, and advancing treatment innovation are critical next steps.

“We need to optimise the uptake and use of prevention and screening for these five cancers so that all consumers can benefit, especially underserved populations, as well as develop novel prevention and screening strategies to avert deaths due to other, very lethal cancers, such as those of the pancreas and ovary,” said Dr Philip Castle, co-lead investigator and director of NCI’s Division of Cancer Prevention.

However, the researchers acknowledged the study limitations. The study focused on population averages in the United States, which may not reflect specific demographic groups, and excluded potential harms of interventions, such as overdiagnosis or false-positive results.

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