The number of Americans who die of cancer each year keeps rising: up from 514,684 in 1991 to 613,352 in 2023. But the chance that any particular American dies of cancer has fallen by a third over the same years. While these may seem like countervailing trends, they actually have a common cause in the advancement of medicine and health more generally.

The total number of deaths rises as the population grows and becomes older. Cancer is predominantly a disease of age—60% of diagnoses are in people over 65. So to make more accurate comparisons of a particular person’s likely outcome when diagnosed with cancer, we have to adjust for age. This means comparing a 40-year-old diagnosed with lung cancer in 1991 to a 40-year-old diagnosed with lung cancer in 2023, rather than using population-wide statistics.

From this standpoint, the U.S. cancer death rate peaked at 215 per 100,000 in 1991 and had fallen to 141.8 by 2023, a 34% decline that the American Cancer Society estimates has averted 4.8 million deaths.

The newest data point is the government’s Annual Report to the Nation on the Status of Cancer, published Sept. 22 by the CDC, the National Cancer Institute, the ACS and the cancer registries: “Cancer death rates fell for both men and women from 2019 to 2023, continuing a downward trend that has lasted more than 20 years,” while “overall rates of new cancer cases rose slightly each year from 2018 to 2022.” The decline “is driven largely by accelerated progress against lung cancer.” Lung cancer death rates fell 52% among men and 37% among women between 2004 and 2023, and five-year survival for lung cancer doubled, from 15.1% for patients diagnosed in 2000 to 30.1% for those diagnosed in 2018. Lung cancer was 29% of all cancer deaths in 2004; it is 21% now.

Survival after diagnosis tells the same story across the board. Five-year relative survival for all cancers combined was 49% for Americans diagnosed in 1975–77 and is 70% for those diagnosed in 2015–21, according to the ACS’s Cancer Statistics, 2026. Examples by type: leukemia 34% to 68%; non-Hodgkin lymphoma 47% to 74%; kidney 50% to 79%; myeloma 25% to 62%; stomach 15% to 38%; liver 3% to 22%; colorectal 50% to 65%; female breast 75% to 92%; prostate 68% to 98%. Childhood acute lymphoblastic leukemia, which killed more than nine in ten children who got it in the early 1960s, was survived by nine in ten by 2012. Metastatic melanoma had a median survival of under a year before 2011; in the ten-year follow-up of the trial that established combined immunotherapy, median survival was six years. Chronic myeloid leukemia, once a death sentence, has a ten-year survival of 83% on a daily pill. Progress remains more limited for the pancreas (3% to 13%) and brain (23% to 33%).

Much of the gain did not come from improvements in treatment. An NCI modeling study in JAMA Oncology found that of 5.9 million deaths averted from five major cancers between 1975 and 2020, around 80% were from prevention and screening—most importantly the decline of smoking, from 22.6% of adults in 2001 to 9.9% in 2024—and 20% from improvements in treatment, though the contribution of improved treatments has accelerated over the past decade.

But access to cancer screening and treatment is not universal. The WHO estimates childhood cancer survival at over 80% in high-income countries and under 30% in low- and middle-income ones, where nine in ten children with cancer live.