Cancer Deaths Drop But New Cases Rise in Surprising Ways

The Good News Is Real. The Bad News Is Weirder.

For the first time in decades, something strange is happening to cancer in America. We are getting better at saving people who get it. But we are also getting worse at preventing it from showing up in the first place.

Consider this: Between 2019 and 2020, while COVID was killing hundreds of thousands of Americans, the cancer death rate kept falling. It dropped another 1.5%. That is not a typo. Even during a pandemic that disrupted nearly every aspect of healthcare, the long term decline in cancer mortality did not pause. Since 1991, the overall cancer death rate has fallen by 33%, which translates to roughly 3.8 million deaths averted (Siegel et al., 2023).

But here is the part that kept me up after reading the American Cancer Society's latest annual report. While deaths are dropping, new cases are rising for some of the most common cancers. Prostate cancer incidence jumped 3% every year from 2014 through 2019, after two decades of decline. That single uptick added 99,000 new cases. Breast cancer and uterine cancer are also increasing. So are liver cancer and melanoma in certain age groups (Siegel et al., 2023).

We are living in a paradox. The treatments are working better than ever. But the disease itself is shifting under our feet.

How Do You Count 1.9 Million New Cancers?

The report, published in CA: A Cancer Journal for Clinicians by Rebecca Siegel, Kimberly Miller, Nikita Sandeep Wagle, and Ahmedin Jemal, is the American Cancer Society's annual statistical reckoning. Every year, the authors compile data from central cancer registries across the country and mortality data from the National Center for Health Statistics. They project the numbers for the coming year and analyze long term trends.

For 2023, they projected 1,958,310 new cancer cases and 609,820 cancer deaths in the United States. That is roughly 5,360 new diagnoses per day. The numbers are estimates, but they are based on actual reported cases and deaths from previous years, adjusted for population growth and aging. The methodology is consistent enough that year over year comparisons reveal real trends.

What makes this year's report different is the divergence. For most of the last three decades, incidence and mortality moved in the same direction. Both went down, or both went up. Now they are splitting. And the split is telling us something about where cancer is heading.

The Prostate Cancer Surprise Nobody Saw Coming

Prostate cancer had been declining for 20 years. Then it reversed.

From 2014 to 2019, incidence rose 3% per year. That is not a blip. That is a sustained increase that added nearly 100,000 cases over five years. Siegel and colleagues report that this is the first significant rise in prostate cancer incidence since the early 2000s, when routine PSA screening was at its peak.

What changed? The authors point to a complex mix of factors. More screening is part of it, but not all of it. The US Preventive Services Task Force changed its recommendations on PSA testing multiple times over the last decade, which created confusion about who should get tested and when. Some men who would have been screened in the past stopped getting tested. Others started again. The net effect appears to be a rebound in diagnoses, but the authors caution that not all of the increase is due to screening changes. Some of it may reflect a genuine rise in underlying risk.

Here is the uncomfortable implication: We do not fully understand why prostate cancer is becoming more common. Obesity rates, dietary changes, environmental exposures, and shifts in the microbiome are all candidates. None of them are proven. The report does not settle the question. It raises it.

The Gender Gap That Keeps Widening

When you break the numbers down by sex, a striking pattern emerges. Men are doing better than women in terms of cancer incidence trends. That is not something you hear often.

Lung cancer in women is declining at half the pace of men. From 2015 to 2019, lung cancer incidence in men dropped 2.6% per year. In women, it dropped only 1.1% per year (Siegel et al., 2023). That gap reflects historical smoking patterns. Women started smoking in large numbers later than men, and they quit later too. The lag is built into the data.

But smoking alone does not explain everything. Breast cancer incidence continues to rise. Uterine corpus cancer is also increasing. Liver cancer and melanoma, which had been stabilizing in men over 50 and declining in younger men, are still rising in women.

The authors note that these sex specific trends have real consequences. Women are now more likely than men to be diagnosed with cancer at younger ages. The reasons are not fully understood, but they likely involve a combination of hormonal factors, differences in healthcare utilization, and genuine biological differences in how cancers develop.

The HPV Vaccine Miracle Hiding in the Data

Amid the bad news, there is a bright spot that deserves more attention than it gets. Cervical cancer incidence dropped 65% among women in their early 20s between 2012 and 2019 (Siegel et al., 2023).

That is not a gradual improvement. That is a cliff. And it has a clear cause.

These are the first women to receive the human papillomavirus vaccine when it was introduced in 2006. They were the cohort that got vaccinated before they became sexually active, which is when the vaccine is most effective. The result is a near elimination of cervical cancer in the age group that should have been at highest risk.

The authors describe this as a foreshadowing of what is to come. Cervical cancer is caused by HPV. So are many cancers of the throat, anus, penis, vagina, and vulva. The majority of HPV associated cancers occur in women, but men get them too. If the vaccine continues to be widely used, the entire landscape of HPV related cancers could shift dramatically over the next two decades.

The catch is that vaccination rates are still not where they need to be. Many children and young adults remain unvaccinated, either because of parental hesitation, lack of access, or simply not knowing the vaccine exists. The data from the early 20s cohort shows what is possible. The rest of the population shows what is not yet achieved.

Treatment Is Winning, But Only for Some Cancers

The biggest driver of the overall decline in cancer deaths is treatment. That is the story that does not get told enough.

For leukemia, melanoma, and kidney cancer, mortality dropped about 2% per year from 2016 to 2020. That is remarkable because incidence for these cancers is stable or even increasing. More people are getting these cancers, but fewer are dying from them. The authors attribute this to advances in targeted therapies and immunotherapies, particularly checkpoint inhibitors and CAR T cell therapies.

Lung cancer mortality is also declining faster than ever, driven by better treatments and earlier detection. The decline accelerated during the 2016 to 2020 period, even as incidence continued to drop slowly.

But here is the nuance. Treatment advances are not distributed equally. The cancers that are rising fastest breast, prostate, uterine are also the ones with the largest racial disparities in mortality. Black women are more likely to die from breast cancer than white women, even though incidence rates are similar. Black men are more than twice as likely to die from prostate cancer as white men. The authors highlight this explicitly: the cancers that are increasing are also the ones where inequality is worst.

Progress in treatment is real. But it is not reaching everyone at the same rate.

What the Report Does Not Tell You

Every good study has limits. This one is no exception.

The data on incidence comes from cancer registries, which are excellent at counting diagnosed cases. But they do not capture undiagnosed cancers. If screening rates change, the number of diagnosed cases can change even if the underlying risk does not. The prostate cancer increase could partly reflect more screening, but the registries cannot tell you how much.

The mortality data is more reliable because death certificates are standardized. But cause of death is not always straightforward, especially in older patients with multiple conditions. The authors use statistical models to adjust for these issues, but no model is perfect.

The report also does not explain why incidence is rising for certain cancers. It documents the trend. It does not prove causation. The authors are careful to describe possible explanations increased screening, obesity, environmental factors but they do not claim to have the answer. That is the job of future research.

Finally, the report covers the United States only. Cancer trends in other countries are different, sometimes dramatically so. The HPV vaccine story in the US is promising. In countries with higher vaccination rates, the results are even better. In countries with limited access to vaccines or treatments, the picture is much worse.

What This Actually Means

• ▸The cancer death rate is still falling, and it fell even during a pandemic. If you are diagnosed with cancer today, your chances of surviving are better than at any point in modern history. That is not optimism. That is arithmetic.

• ▸Prostate cancer is coming back, and we do not fully understand why. If you are a man over 50, talk to your doctor about your individual risk and whether screening makes sense for you. The old rules about PSA testing no longer apply cleanly.

• ▸Women's cancer incidence is rising in ways that demand more research. Breast cancer, uterine cancer, and lung cancer in women are all increasing or declining too slowly. The gender gap in cancer trends is real and poorly understood.

• ▸The HPV vaccine works better than almost any other cancer prevention tool we have. A 65% drop in cervical cancer in young women is not a fluke. It is a preview. If you have children or young adults in your life who are not vaccinated, this is the data to show them.

• ▸Racial disparities in cancer mortality are not going away on their own. The cancers that are rising fastest are also the ones where Black Americans face the worst outcomes. Treatment advances are not reaching everyone equally, and the gap is widening.

The story of cancer in 2023 is not a simple one. We are winning in some places and losing in others. The deaths are dropping. The cases are rising. And the most important question why one group gets better while another gets worse remains unanswered. That is not failure. That is the next thing to figure out.