The coronavirus 2019 (COVID-19) pandemic has been in the health care spotlight since 2019, but the reality is that heart disease and cancer killed more people than COVID-19 in 20201 (see Figure 1) and were our nation’s leading causes of death for decades before that. Among Americans younger than 85 years of age, cancer remains the leading cause of death.2
FIGURE 1. Provisional* number of leading underlying causes of death, National Vital Statistics System, U.S., 2020
Can I convince you that cancer has been an ongoing pandemic since life expectancy increased during the 20th century?
As shown in Figure 2, average life expectancy before 1850 was less than 40 years in many countries. Around 1850, life expectancy began to double because of global, though uneven, improvements in public health, including living conditions and water and food quality. By 2000, life expectancy averaged 80 years. Note that several countries, including Bangladesh, India, Kenya, and Russia, lagged behind the group cluster of 80 years.3
FIGURE 2. Life expectancy 1558 to 2011
From 1900 to 2010, the causes of death in the U.S. and the rest of the world began to shift from infectious/communicable diseases, cholera, tuberculosis, influenza, and diphtheria to noncommunicable diseases, predominantly cancer and heart disease.4
Globally, in 2018, 17 million new cancer cases and 9.5 million cancer deaths were reported. It is estimated that these numbers will nearly double by 2040 to 27.5 million new cases and 16.3 million deaths. Large populations over a wide geographic area are affected.5 This fits the definition of a pandemic (see glossary, this page). Even though the Commission on Cancer since 1922 (when it was still the Committee on Cancer) has promoted and continues to promote advances in cancer care to improve prevention, promote early detection, enhance treatments, and decrease mortality, we have not kept pace with cancer’s faster rise. We have a crisis in cancer care because of limited access, coordination, and practice of evidence-based care.6
Plagues and pandemics throughout history
The following review of some plagues and pandemics throughout history will put this in perspective:
Plagues of Egypt: The Old Testament Exodus 7:14–12:36 and the Ipuwer Papyrus, an ancient Egyptian poem circa 1900 BCE, describe the 10 plagues of Egypt without counting deaths; plagues are not pandemics.
Black Death: Responsible for an astonishing 350–475 million deaths involving 30–60 percent of Europe, Asia, and North Africa in the 1300s.7 It was at this time that Pope Gregory I introduced the simple blessing, “God bless you,” for those who sneezed in the morning and might be dead by nightfall.
Spanish Flu: Infected 25 percent of the world population with 20–50 million deaths in 1918 and 1919. Fifty percent of those killed over two years by this H1N1 influenza A pandemic were 40 years old or younger.8
Asian Flu: In 1957, up to 1.5 million people died from another strain of influenza A (H2N2). It was similar to, but worse than, the Spanish Flu because an even higher number of young adults, adolescents, and children died from it. This pandemic did not receive the attention and soul searching that has occurred with COVID-19, but it did inspire the Billboard 1957 top hit “Rockin’ Pneumonia and the Boogie Woogie Flu” by Huey “Piano” Smith.
COVID-19: Global and deadly, it has already killed more than 5.1 million people worldwide, and in the U.S. we had lost nearly 790,000 lives as of November 16, 2021.9,10 The current U.S. death rate is nearly 237/100,000 population. It was the third leading cause of death in the U.S. in 2020 (see Figure 1, page 31). As previously noted, the leading two causes of death were heart disease and cancer.
Cancer: Global and deadly, it killed 9.5 million people in 2020. In the U.S., about 600,000 (180/100,000 population),11 or 1.27 people per minute, have died every year from cancer since 1975. That is 27.6 million deaths since we started counting, but cancer was lethal well before 1975. Some might argue that cancer is endemic, but it hasn’t stopped spreading like an endemic disease such as chicken pox or malaria.
No end in sight
Cancer is a pandemic, but will it ever end? An article in The New York Times sheds some light, stating, “According to historians, pandemics typically have two types of endings: the medical, which occurs when the incidence and death rates plummet, and the social, when the fear of the disease wanes.”12
Cancer incidence and mortality continue to increase, and everyone who has cancer is scared. The word alone produces real fear.
The cancer pandemic hasn’t ended and continues silently in the background of current events.
- Ahmad FB, Cisewski JA, Miniño A, Anderson RN. Provisional mortality data—United States, 2020. MMWR Morb Wkly Rep. 2021;70(14):519-522.
- Ahmedin J, Siegel R, Xu J, Ward E. CA Cancer J Clin. 2010;60(5):277-300.
- Roser M, Ortiz-Ospina E, Ritchie H. Life expectancy. Our World Data. Global Change Data Lab. 2013. Revised October 2019. Available at: https://ourworldindata.org/life-expectancy. Accessed November 24, 2021.
- Jones D, Podolsky S, Greene J. The burden of disease and the changing task of medicine. N Engl J Med. 2012;366(25):2333-2338.
- Sung H, Ferlay J, Siegel R, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249.
- Institute of Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, DC: The National Academies Press, 2013.
- Gottfried RS. The Black Death. New York, NY: Free Press, 1983.
- Gagnon A, Miller MS, Hallman SA, et al. Age-specific mortality during the 1918 influenza pandemic: Unraveling the mystery of high young adult mortality. PLoS One. 2013;8(8):e96586.
- Johns Hopkins University & Medicine. Coronavirus Resource Center. Available at: https://coronavirus.jhu.edu/region. Accessed November 24, 2021.
- Worldometer. COVID-19 coronavirus pandemic. Available at: https://www.worldometers.info/coronavirus/. Accessed November 24, 2021.
- American Cancer Society. Cancer Facts & Figures 2021. Atlanta, GA: American Cancer Society, 2021.
- Kolata G. How pandemics end. New York Times. May 14, 2020. Available at: https://www.nytimes.com/2020/05/10/health/coronavirus-plague-pandemic-history.html. Accessed November 24, 2021.