What's #1, and does it really matter

Content provided by the Faculty of the Harvard Medical School

What's #1, and does it really matter

Cancer surpasses heart disease among “young” Americans, but isn’t tops overall.

Cancer, not heart disease, is now the leading cause of death among Americans under age 85. So says the American Cancer Society’s 2005 statistical atlas of cancer. This report made headlines for a good reason: Since 1900, heart disease has claimed the top spot every year but one (1918, when the flu epidemic killed a half million Americans).

If you include people age 85 and older, though, the balance tips toward heart disease (see figure). Add in strokes, most of which are caused by the same disease process that causes heart attacks — atherosclerosis — and the catchall of cardiovascular disease far outweighs cancer in the deaths column.

Silver linings

Death rates from heart disease and cancer have fallen steadily over the past few decades. The decline has been steeper for heart disease than cancer, which is one reason these two changed places.

These encouraging trends reflect several changes. One is greater awareness of both diseases. Knowing that they are such important sources of suffering, disability, and death, people are on the lookout for them. We routinely have our blood pressure and cholesterol measured, and seek out screening tests for cancers of the breast, prostate, colon, and other organs. We are also doing a better job today of hewing to healthy lifestyles (though we still have a long way to go). The development of ever more effective treatments has also contributed to the decline in death rates, although prevention efforts probably account for most of the gains.

At the end of the day, which disease is the leading killer isn’t terribly significant. Here’s what is: Cardiovascular disease and cancer plus diabetes account for almost two-thirds of deaths among Americans.

Leading killers

Prevent one, prevent the other

Once these diseases have reared their ugly heads, different strategies are needed to treat and cope with them. Preventing them, though, isn’t quite so complex.

Last year, the American Cancer Society, American Diabetes Association, and American Heart Association published a joint set of guidelines aimed at preventing cancer, diabetes, and heart disease before they blossom and cause problems. None of the recommendations will surprise you. They include the usual suspects: Don’t smoke, and if you do, quit; watch your weight; exercise; eat a healthy diet rich in vegetables, fruits, and whole grains; and talk to your doctor about when and how often to be tested for diabetes, cancer, heart disease, or their precursors.

Last updated:	August 21, 2006