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OPINION | Where you want to get cancer

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CHEER up, folks. For all the political grousing about health-care costs, the good news out this week is that cancer survival rates have improved enormously over the last three decades. The chances of beating most types of cancer are increasing, and that’s especially true if you live in the United States.

The American Cancer Society reported this week that the cancer mortality rate in the U.S. has plunged nearly 30 percent since its peak in 1991, with the biggest annual decline occurring in 2017. Fewer Americans are smoking, which has reduced the incidence of lung cancer in particular. More Americans are also being diagnosed with cancer at earlier stages thanks to better tests and screening, increasing the odds of survival.

The five-year survival rate is now 98 percent for prostate cancer, 92 percent for melanoma and 90 percent for breast cancer. Between 2013 and 2017, the death rate for men with melanoma declined by a stunning 7.6 percent annually. Screening and treatment improvements also helped reduce the death rate for breast cancer by an average of 1.5 percent annually from 2008 to 2017.

Scientific understanding of cancer and its genetic determinants has advanced by leaps over the past decade. Personal DNA testing companies like 23andMe arm people with more information about their risk factors. Most women now know, for example, that mutations in the BRCA1 and BRCA2 genes increase the risk for breast and ovarian cancers.

Breakthrough therapies that harness a victim’s immune system have also increased survival rates by multiples over traditional treatments such as chemotherapy. That’s especially true for cancers with low survival rates such as metastatic melanoma and lung cancer.

But the drugs require enormous investment and therefore aren’t cheap once they’re approved by the Food and Drug Administration. The United Kingdom’s National Institute for Health and Care Excellence has rejected immunotherapies because they were too expensive, though it has had to relent in some cases after patient protests. Such government rationing and price controls on drugs are one major reason that countries with socialized medicine like the United Kingdom have lower cancer survival rates than the U.S. The age-adjusted cancer mortality rate is about 20 percent higher in the U.K and 10 percent higher in Canada and France than in the U.S. Survival rates for hard-to-treat cancers are also higher in the U.S. than in most countries with nationalized health systems.

According to a study in the journal Lancet last year, an individual diagnosed with pancreatic cancer between 2010 and 2014 had nearly twice the likelihood of surviving five years in the U.S. than in the U.K. The five-year survival rate for brain cancer in the U.S. is 36.5 percent compared to 27.2 percent in France and 26.3 percent in the U.K. For stomach cancer the five-year survival rate is 33.1 percent in the U.S. compared to 26.7 percent in France and 20.7 percent in the U.K.

Diagnostic and treatment advances in the U.S. are also accelerating. Google’s artificial intelligence can now detect breast and lung cancers with better accuracy — meaning fewer false positives and negatives — than radiologists. AI systems are also enabling researchers to identify more genetic links and to personalize treatments.

Even the report’s gloomiest news has a silver lining. Death rates for liver cancer are rising faster than for other forms of the disease, but Hepatitis C drugs could greatly reduce the incidence and have come down 80 percent in price since 2014. It’s also worth highlighting that the disparity in cancer death rates between blacks and whites declined to 13 percent in 2017 from a peak of 33 percent in 1993.

Almost everyone knows someone who has been struck with cancer, and many have had bouts of their own. The good news is that the prognosis has never been better, and innovative drug therapies are a major reason.

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