The 34-year retreat of cancer death rates

Overview

Cancer death rates in the United States peaked in 1991 at 215 deaths per 100,000 people and have since fallen 34%, averting an estimated 4.5 million deaths. The decline accelerated from about 1% annually in the 1990s to 2% annually by 2015-2020, driven by plummeting smoking rates, earlier detection through screening, and advances in targeted therapies and immunotherapy.

The trajectory is not uniformly positive. While five-year survival rates exceed 70% for the first time in history, cancer incidence is rising among women and younger adults. Obesity-related cancers are climbing.

Racial disparities persist, with Native American and Black populations facing mortality rates two to three times higher than white populations for several cancer types. Will gains from tobacco control prove sustainable as new risk factors emerge?

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Key Indicators

34%

Mortality decline since 1991

Overall cancer death rate reduction from peak of 215 to 142 per 100,000 population

4.5M

Deaths averted

Estimated cancer deaths prevented since 1991 due to reduced smoking, earlier detection, and better treatment

70%

Five-year survival rate

Up from 49% in the mid-1970s, marking a historic milestone reached in 2025

2.04M

Projected new cases in 2025

More Americans will be diagnosed with cancer in 2025 than ever before

59%

Lung cancer death rate drop in men

Decline from peak in 1990, the largest improvement for any major cancer type

Voices

Curated perspectives — historical figures and your fellow readers.

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Timeline Five events from this story — drag them oldest to newest. Log in to play

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People Involved

Rebecca Siegel

Lead author of annual Cancer Statistics report

William Dahut

Leading ACS research strategy

Mohamed E. Abazeed

Active researcher and clinician

Organizations Involved

National Cancer Institute

Federal Research Agency

Lead author of Annual Report to the Nation

The NCI is the primary federal agency for cancer research, coordinating the National Cancer Program and publishing the Annual Report to the Nation on cancer trends.

American Cancer Society

Nonprofit health organization

Publishes annual Cancer Facts & Figures report

The ACS funds cancer research, provides patient support services, and publishes definitive annual statistics on cancer incidence, mortality, and survival in the United States.

Advanced Research Projects Agency for Health

Federal Research Agency

Investing over $500 million in cancer-related projects

ARPA-H was created to drive high-risk, high-reward health research breakthroughs, with cancer detection and treatment among its primary focus areas.

Timeline

January 1964 April 2025

10 events Latest: April 21st, 2025 · 1 year ago

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April 2025
NCI Reports Continued Decline in Cancer Death Rates
Latest Report

Annual Report to the Nation confirms 34% mortality decline since 1991, with 4.5 million deaths averted. Report also flags rising incidence among women and obesity-related cancers.
April 21st, 2025
January 2025
Five-Year Survival Rate Reaches 70%
Milestone

American Cancer Society reports that for the first time, 7 in 10 cancer patients survive at least five years after diagnosis.
January 16th, 2025
February 2022
Biden Reignites Cancer Moonshot
Policy

The administration sets a goal to cut cancer death rates by half within 25 years and establishes a Cancer Cabinet across 20 agencies.
February 2nd, 2022
May 2021
U.S. Preventive Services Task Force Lowers Colorectal Screening Age
Guidelines

Recommended screening age drops from 50 to 45 in response to rising early-onset colorectal cancer rates.
May 18th, 2021
December 2016
21st Century Cures Act and Cancer Moonshot
Legislation

Congress authorizes $1.8 billion for the Cancer Moonshot initiative, accelerating research toward reducing cancer deaths by half.
December 13th, 2016
March 2011
FDA Approves First Checkpoint Inhibitor
Treatment

Ipilimumab becomes the first approved checkpoint inhibitor, launching the immunotherapy revolution in cancer treatment.
March 25th, 2011
November 1998
Master Settlement Agreement with Tobacco Companies
Legal

States and major tobacco companies agree to a $206 billion settlement, funding anti-smoking campaigns and restricting tobacco marketing.
November 23rd, 1998
January 1991
Cancer Death Rate Peaks at 215 per 100,000
Milestone

U.S. cancer mortality reaches its highest point, driven largely by the lung cancer epidemic among men who smoked heavily in earlier decades.
January 1st, 1991
December 1971
Nixon Signs National Cancer Act
Legislation

The 'War on Cancer' begins with expanded NCI funding and authority, establishing the modern cancer research infrastructure.
December 23rd, 1971
January 1964
Surgeon General Links Smoking to Cancer
Public Health

Luther Terry's landmark report establishes smoking as a cause of lung cancer, triggering tobacco control efforts that would eventually drive cancer mortality declines.
January 11th, 1964

Historical Context

3 moments from history that rhyme with this story — and how they unfolded.

January 1964

The Surgeon General's Report on Smoking (1964)

Surgeon General Luther Terry released a 387-page report concluding that cigarette smoking caused lung cancer in men and was a probable cause in women. The report, based on review of over 7,000 scientific articles, marked the first official U.S. government acknowledgment of the smoking-cancer link. At the time, 42% of American adults smoked.

Then

Congress mandated warning labels on cigarette packages in 1965 and banned broadcast cigarette advertising in 1971.

Now

Adult smoking rates fell from 42% to 11% over six decades. Lung cancer death rates in men dropped 59% from their 1990 peak. The report established the template for evidence-based public health interventions.

Why this matters now

The 2025 mortality decline is largely downstream of the 1964 report. Tobacco control accounts for 98% of the 3.45 million lung cancer deaths averted since 1991.

December 1971

The National Cancer Act (1971)

President Nixon signed legislation dramatically expanding NCI funding and authority, giving its director the ability to submit budget requests directly to the president. The act established the National Cancer Program, cancer centers, and cooperative clinical trial groups. Initial funding was $400 million annually.

Then

Cancer research funding tripled within five years. The NCI established a network of designated cancer centers that became hubs for clinical trials.

Now

The research infrastructure created by the act produced chemotherapy regimens, targeted therapies, and immunotherapies that now save millions of lives. NCI's annual budget exceeds $7 billion.

Why this matters now

The 34% mortality decline since 1991 reflects returns on five decades of research investment initiated by the 1971 act. Treatment advances account for a majority of deaths averted from breast cancer and substantial portions for other cancers.

1968-Present

Heart Disease Mortality Decline (1968-Present)

Heart disease death rates in the U.S. fell by more than 70% from their peak in the late 1960s. The decline resulted from a combination of reduced smoking, better blood pressure and cholesterol management, improved emergency cardiac care, and surgical advances like bypass grafting and stenting.

Then

Heart disease remained the leading cause of death but claimed progressively fewer lives per capita each decade.

Now

The decline demonstrated that major causes of death can be substantially reduced through sustained investment in prevention, treatment, and public health infrastructure.

Why this matters now

Cancer is now following a similar trajectory to heart disease, with mortality declining through a combination of prevention and treatment. Cancer may eventually surpass heart disease as the leading cause of death simply because heart disease mortality fell faster.