The term “treading water” comes to mind when reading the “Cancer Trends Progress Report,” issued recently by the National Cancer Institute (Bethesda, Maryland).

The report clearly demonstrates the importance of diagnostics, not only for the initiation of therapy but in determining what progress, or not, the U.S. is making in this fight.

It says that the U.S. is indeed making progress in this important battle, but says that it also is “losing ground in other important areas that demand attention.”

The improvements are the result of two factors: changes to healthier behaviors and the increased use of diagnostic screening and testing. But those two factors also relate to the ground being lost: some of our behaviors have become less healthy, and some tests aren’t being used often enough to make major changes in the overall statistics, or they haven’t been proven to show a benefit.

The report says that, overall, for the four major categories of cancer – prostate, breast, lung and colon – the incidence rates have remained fairly stable, and the rates of death have continued to decline since the mid-1990s.

And it emphasizes the importance of early screening, not only to reduce mortality but to reduce the side effects of treatment and potential co-morbidities. In the section on early detection, the report reviews the use of mammography for breast cancer, the Pap test for cervical cancer, and the use of fecal occult blood testing (FOBT) and colorectal endoscopy for colon cancer.

Trends for use of prostate-specific antigen (PSA) testing for prostate cancer, it says, “may be included” in future reports but notes that PSA use has not yet been shown to reduce deaths from prostate cancer. “There is also concern about possible harm caused by unnecessary treatments, because the test can find very early cancers that might not cause any harm if left untreated-especially in older men.”

It goes on to note that new imaging techniques to detect breast or lung cancer and ways to detect early cancer in the blood “require more research on their effectiveness.”

• The report’s conclusions for mammography: “Regular use of screening mammograms, followed by timely treatment when breast cancer is diagnosed, can help reduce the chances of dying from breast cancer. For women between the ages of 50 and 69, there is strong evidence that screening lowers this risk by 30%. For women in their 40s, the risk can be reduced by about 17%. For women ages 70 and older, mammography may be helpful, although firm evidence is lacking.” Overall, it says that use of mammography for women rose until 2000, and then became stable, and continues to increase among other racial groups.

• The report’s conclusions for Pap testing: “In 2003, 79% women ages 18 and older had a Pap test within the past three years,” including 75% of Hispanics, 83% of blacks, and 80% of whites. Among Asian women interviewed in California only, 74% had a Pap test in 2003. The report sets a 2010 target of seeing 90% of all women 18 and older receiving a Pap test within the past three years.

• The report’s conclusion for colorectal screening: Home FOBT rose until 2000, then fell slightly in whites while rising, though not significantly, for blacks and Hispanics. Colorectal endoscopy increased from 1987-1998, and continued to rise from 1998-2003, with a statistically significant increase between 2000 and 2003. Between 1998-2003, this screening rose in blacks and Hispanics, though not significantly for Hispanics.

The report says that when done every two to three years using home tests kits by those ages 50 to 80, the FOBT can decrease the number of deaths, though it does not estimate by how much.

As to colorectal endoscopy (sigmoidoscopy or colonoscopy), it says that regular sigmoidoscopies can reduce colorectal cancer deaths, but that more research is needed to learn the best timing between exams and to determine the effectiveness of screening by colonoscopy.

As to incidence of the major cancers:

• Prostate cancer: “Incidence rose sharply beginning around 1988, peaked in 1992, then declined until around 1995, after which it began to rise again.”
• Breast cancer: “Incidence steadily increased between 1980 and 1987 and has since risen minimally. For ages 50 to 64, there appears to be a slight increase in recent years.”
• Colorectal cancer: “Incidence increased slightly until 1985. It has declined steadily since then, except for a slight non-significant rise during the period 1995-1998.”
• Lung cancer: “Incidence of lung cancer increased until 1991, after which it declined slightly. However, for women, the incidence continued to increase, although it stabilized in 1998-2002.”

While these observations appear to portray a glass that is more than half-full, the report says that the nation is falling behind in several areas, including “Unexplained cancer-related health disparities [that] remain among population subgroups. For example, blacks and people with low socioeconomic status have the highest rates of both new cancers and cancer deaths.”

Other negatives:

• “The incidence of cancers of the breast in women and of prostate and testis in men, as well as leukemia, non-Hodgkin lymphoma, myeloma, melanoma of skin, and cancers of the thyroid, kidney and esophagus is rising.”
• “Lung cancer death rates in women continue to rise, but not as rapidly as before.”
• More people are overweight and obese, and leisure-time physical activity is increasing only slightly.

And the report says that the costs for cancer treatment continue to rise, on pace with overall healthcare spending. It says: “The financial costs of cancer treatment are a burden to people diagnosed with cancer, their families, and society as a whole.”

These costs are estimated at $72.1 billion in 2004, just under 5% of total U.S. spending for medical treatment. And from 1995 to 2004, the overall costs of treating cancer increased by 75%.

The report estimates a faster rate of increase for the costs of treating cancers than the overall healthcare rate.

“As the population ages, the absolute number of people treated for cancer will increase faster than the overall population, and cancer cases will increase relative to other disease categories – even if cancer incidence rates remain constant or decrease somewhat. Costs also are likely to increase at the individual level as new, more advanced and more expensive treatments are adopted as standards of care.”