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. 2025 Feb 1;11(2):162-167.
doi: 10.1001/jamaoncol.2024.5381.

Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020

Katrina A B Goddard  1 , Eric J Feuer  1 , Jeanne S Mandelblatt  2 , Rafael Meza  3   4 , Theodore R Holford  5 , Jihyoun Jeon  6 , Iris Lansdorp-Vogelaar  7 , Roman Gulati  8 , Natasha K Stout  1 , Nadia Howlader  1 , Amy B Knudsen  9   10 , Daniel Miller  11 , Jennifer L Caswell-Jin  12 , Clyde B Schechter  13 , Ruth Etzioni  8 , Amy Trentham-Dietz  14 , Allison W Kurian  12   15 , Sylvia K Plevritis  15 , John M Hampton  14 , Sarah Stein  16 , Liyang P Sun  15 , Asad Umar  17 , Philip E Castle  17   18
Affiliations

Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020

Katrina A B Goddard et al. JAMA Oncol. .

Abstract

Importance: Cancer mortality has decreased over time, but the contributions of different interventions across the cancer control continuum to averting cancer deaths have not been systematically evaluated across major cancer sites.

Objective: To quantify the contributions of prevention, screening (to remove precursors [interception] or early detection), and treatment to cumulative number of cancer deaths averted from 1975 to 2020 for breast, cervical, colorectal, lung, and prostate cancers.

Design, setting, and participants: In this model-based study using population-level cancer mortality data, outputs from published models developed by the Cancer Intervention and Surveillance Modeling Network were extended to quantify cancer deaths averted through 2020. Model inputs were based on national data on risk factors, cancer incidence, cancer survival, and mortality due to other causes, and dissemination and effects of prevention, screening (for interception and early detection), and treatment. Simulated or modeled data using parameters derived from multiple birth cohorts of the US population were used.

Interventions: Primary prevention via smoking reduction (lung), screening for interception (cervix and colorectal) or early detection (breast, cervix, colorectal, and prostate), and therapy (breast, colorectal, lung, and prostate).

Main outcomes and measures: The estimated cumulative number of cancer deaths averted with interventions vs no advances.

Results: An estimated 5.94 million cancer deaths were averted for breast, cervical, colorectal, lung, and prostate cancers combined. Cancer prevention and screening efforts averted 8 of 10 of these deaths (4.75 million averted deaths). The contribution of each intervention varied by cancer site. Screening accounted for 25% of breast cancer deaths averted. Averted cervical cancer deaths were nearly completely averted through screening and removal of cancer precursors as treatment advances were modest during the study period. Averted colorectal cancer deaths were averted because of screening and removal of precancerous polyps or early detection in 79% and treatment advances in 21%. Most lung cancer deaths were avoided by smoking reduction (98%) because screening uptake was low and treatment largely palliative before 2014. Screening contributed to 56% of averted prostate cancer deaths.

Conclusions and relevance: Over the past 45 years, cancer prevention and screening accounted for most cancer deaths averted for these causes; however, their contribution varied by cancer site according to these models using population-level cancer mortality data. Despite progress, efforts to reduce the US cancer burden will require increased dissemination of effective interventions and new technologies and discoveries.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Mandelblatt reported a pending patent (PCT/US2022/028741) filed by Georgetown University, related to “Use of RAGE Inhibitors to Treat Cancer-Related Cognitive Decline,” licensed to Cantex Pharmaceuticals. Dr Mandelblatt has waived her rights to any revenue from this license. Dr Meza, Dr Lansdorp-Vogelaar, Dr Gulati (R50CA221836), Dr Knudsen, Dr Schechter, Dr Trentham-Dietz (U01CA253911, P30CA014520), Dr Hampton, and Dr Sun reported grants from the National Cancer Institute (NCI) during the study. Dr Caswell-Jin reported NCI grants during the study and grants from Effector Therapeutics, Novartis, and QED Therapeutics outside the study. Dr Plevritis reported National Institutes of Health (NIH) grants and serves on Adela Biosciences' advisory board. No other disclosures were reported.

Figures

Figure.
Figure.. Opportunities for Averted Cancer Deaths With Prevention, Screening, and Treatment Interventions
This schematic of cancer progression shows opportunities for prevention, screening (for interception and early detection), and treatment advances to partially or completely interrupt the development and/or progression of disease that would cause death.
See this image and copyright information in PMC

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