Steve Halasey, chief editor, CLP

Clinical laboratory testing is critical for determining health and disease status among individual patients, but it is also playing an increasingly important role in improving broader understandings of disease on a population level.

In statistical analyses of the most common types of cancer, the “Annual Report to the Nation on the Status of Cancer, 1975–2011,” indicates that cancer deaths for nearly all major cancer sites are continuing to decrease among US men, women, and children. During the period of the report, overall cancer incidence decreased in men, remained stable in women, and increased in children.

Published online March 30 in the Journal of the National Cancer Institute, the report was coauthored by experts from the North American Association of Central Cancer Registries, the American Cancer Society, the Centers for Disease Control and Prevention (CDC), and the National Cancer Institute (NCI).

The authors found that there has been a relatively consistent decline in overall cancer mortality rates since the early 1990s, with rates from 2002 to 2011 decreasing by about 1.8% per year among males and by 1.4% per year among females. Among children up to 19 years old, mortality rates have continued to decrease since 1975, with the exception of the period between 1998 and 2003.

“The continued decline in cancer death rates among men, women, and children is encouraging, and it reflects progress we are making in cancer prevention, early detection, and treatment,” said CDC Director Tom Frieden, MD.

The report also includes a special section on the four major molecular subtypes of breast cancer now being recorded by US cancer registries. The subtypes are defined by whether they express hormone receptors (estrogen receptor and progesterone receptor) and whether they produce excess amounts of the protein HER2, resulting in different combinations of HR and HER2 expression:

  • Luminal A (HR+/HER2–)
  • Luminal B (HR+/HER2+)
  • HER2-enriched (HR–/HER2+)
  • Triple negative (HR–/HER2–)

The report marks the first time that comprehensive national data on HR and HER2 status have been available for assessing the incidence of the four breast cancer subtypes by age, race/ethnicity, poverty level, and other factors.

“This year’s report assesses breast cancer as four molecularly defined subtypes, not as a single disease. This is a welcome step, depending on medically important information that already guides therapeutic strategies for these subtypes,” said NCI Director Harold Varmus, MD. “Further, it is a harbinger of the more rigorous classification of cancers based on their molecular features that is now being aggressively pursued under the president’s precision medicine initiative. The new diagnostic categories now being defined will increasingly support our ability to prevent and treat breast and many other kinds of cancer, as well as monitor their incidence and outcomes more rigorously over time.”

With the continued contributions of pathologists and laboratorians to such population-level analyses, equivalent insights into many more diseases seem readily attainable.

Steve Halasey
Chief Editor, CLP
[email protected]
(626) 219-0199


Kohler, BA, Sherman RL, Howlander N, et al. Annual report to the nation on the status of cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. JNCI. 2015;107(6):djv048; doi: 10.1093/jnci/djv048. Epub March 30, 2015. Available at: http://jnci.oxfordjournals.org/content/107/6/djv048.full?sid=c56f408a-1b77-425f-b785-9aa68fe02f6c. Accessed April 1, 2015.