MICHELE NORRIS, Host:

The nation's annual report card on cancer is out today. For the first time, the rate of new cancers is down. Experts credit some prevention strategies, including anti-smoking campaigns and colonoscopies. NPR's Richard Knox has our story.

RICHARD KNOX: Overall cancer death rates have been going down for several years, but it hasn't been clear if or when the nation would see a decline in cancer incidence, the annual rate of new cancer cases. Robert Croyle is the director of Cancer Control at the National Cancer Institute.

ROBERT CROYLE: We've been saying for some years that mortality is declining. But then, of course, people say, well, gee, it seems like everybody I know is getting cancer. So to turn the corner on incidence in addition to mortality is an important and significant event.

KNOX: Michael Thun of the American Cancer Society says the turnaround has partly been due to a leveling off of lung cancer rates in American women.

MICHAEL THUN: Everyone has been waiting for the lung cancer incidence and death rates in women to begin to go down.

KNOX: That's begun to happen. It might have happened earlier, Thun says, except for something that happened more than 30 years ago - the advent of cigarette brands targeted to young women.

THUN: The big marketing of Virginia Slims that caught the people who were passing through adolescence in the '60s really boosted smoking rates in that age group.

KNOX: Some of those women have already died of lung cancer, although it will take many years for that effect to disappear. Another big contributor to the decline in new cancers among women occurred in the last decade. Millions of menopausal women stopped hormone replacement therapy. That made breast cancer cases go down. But Thun says there is another contributor to the decline in breast cancer cases that's not so good.

THUN: The uncertain part is that the decrease in breast cancer incidence in women is also partly due to a leveling off and decrease in mammography.

KNOX: Women are getting fewer mammograms, and that means fewer breast tumors diagnosed. But presumably those cancers, or many of them, will eventually emerge. That will affect overall cancer incidence among women.

THUN: So whether incidence continues to go down in women as well as men, time will tell.

KNOX: The new report, which is in the Journal of the National Cancer Institute, has some other important numbers about lung cancer, says Dr. Tim Byers of the University of Colorado.

TIM BYERS: The most striking thing about lung cancer in this report is the enormous variation between states in risk of getting lung cancer and dying from it.

KNOX: For instance, California has the nation's most aggressive program of tobacco control, and lung cancer death rates have recently dropped by nearly three percent a year there. Kentucky, where rates of smoking remain high, has a lung cancer rate three times higher than the lowest state, Utah.

BYERS: One of the questions that this observation raises in my mind is whether or not we should be thinking about the control of tobacco as more of a federal or of a national program.

KNOX: In fact, Congress is expected to consider giving the Food and Drug Administration regulatory authority over tobacco products, and there is debate about increasing the federal excise tax on cigarettes to cut smoking rates. Dr. Ed Benz, the president of Dana Farber Cancer Institute in Boston, says when he became a cancer specialist nearly 30 years ago, he never expected to see a day when cancer incidence turned around.

ED BENZ: I would not have imagined that we'd see a decline in cancer rates back in 1979 because the rate at which people were smoking was increasing, and all the things that people imagined would cause more cancer were going up. So this is actually a pleasant surprise for me.

KNOX: And 30 years from now, Benz thinks some cancers will be curable, others will have become chronic diseases, but cancer will probably still be a significant public health problem. Richard Knox, NPR News.

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