September 4, 2026We are winning the war on cancer! Age-adjusted deaths from cancer have fallen 34% since 1991, one of the big reasons we are living longer, healthier lives.1
The History of Cancer Deaths in USA
But the overall percentage drop in cancers hides the specific causes and cures. Let’s look at USA cancer deaths by cause over the last hundred years:
Freezing Stomach Cancer
In 1930, the most lethal form of cancer was stomach cancer. This was caused by a combination of the H. pylori bacterium which aggravated the stomach lining and an abundance of smoked, preserved foods. As refrigeration and clean water became more commonplace, H. pylori infections as well as food preservation greatly diminished.2 In the United States, stomach cancer is now ranked the fifteenth highest cause of cancer.3 Unfortunately, in countries without as much access to refrigeration and clean water, stomach cancer is more common, making it the 4th highest cause of cancer globally.4
Sidebar: Japan and the Barium Tilt-a-Whirl
Refrigeration and clean water deployment in Japan were delayed until about 25 years later.5 This led the Japanese doctors to think Japanese were particularly susceptible to stomach cancer, thinking their salty diet was causing it. They began a national program of subsidized stomach cancer scans, including barium drinks, followed by tilt-a-whirl treatment to line the stomach with the barium for the scan. Radiation is then bounced off the barium to look for cancers.
Cigarettes Increase Cancer Through the 1900s
I had thought that tobacco and lung cancer were always with us, but in fact, smoking didn’t become common until the invention of the cigarette rolling machine in the late 1800s, increasing production from manually rolling 4 per minute by hand to 200 per minute by machine.9 In WWI, soldiers got free cigarettes included with their food rations.10 In 1964, the US Surgeon General declared smoking the leading cause of lung cancer,11 and 26 years later, at last, the lung cancer epidemic peaked and has been dropping since. Lung cancer is still the biggest killer, but at half its peak.
Screening for Colorectal Cancer
Over most of the 1900s, colorectal (colon and rectum) cancer slowly declined, likely due to the positive effects of refrigeration and clean water that were reducing stomach cancer. Then, in 1980, the American Cancer Society (ACS) first published screening guidelines for colorectal cancer, basically telling people to get regular stool tests from age 50,12 starting a steady fall in colorectal cancer from about 30 deaths per 100,000 in 1980 to under 14 in 2023. Around the year 2000, colonoscopies became the standard screening test, with Katie Couric getting one live on the Today show in 2000, causing “the Couric effect,” which was a large bump in colonoscopies.13 Looking at the cancer trend, though, you can see that the big bump had no observable effect over the general increase in screening, which continued steadily from about 38% in 2000 to about 73% in 2023.14
One notable effect for colorectal cancer is the immediate reduction in cancer deaths after increased screening. Compare this to the 26 years before the Surgeon General’s warning against tobacco started dropping the numbers. Colorectal screening is accurate, and early treatment is straightforward–a colonoscopy can diagnose and remove cancers in one shot. That said, unless you want to copy Couric’s colonoscopy (TV coverage optional), regular stool tests are equally effective.15 The American Cancer Society recommends every year for Fecal Immunochemical Test (FIT) or every three years for a stool DNA test after age 45.16
Holes in Screening
Unfortunately, this immediate benefit from increased screening has not been replicated in other cancers. Early attempts at increasing awareness of cancers petered out and were rolled back as not effective. Back in the 1970s and 80s, it was common to see Public Service Announcements encouraging women to do self-breast examinations (BSE) every month.12
Then, in 2003 the ACS reversed, and said “It is acceptable for women to choose not to do BSE or to do BSE irregularly.”17 Similarly, in 1992, they encouraged Prostate Specific Antigen (PSA) blood tests for all men over 50.18 Fortunately, prostate cancers are often slow-developing, and men more often die with prostate cancer instead of from it. Further complicating frequent screening, PSA is not nearly as reliable as stool tests for colorectal cancer,19 and prostate surgery carries much more risk than a colonoscopy, and surgery complications for prostate cancer checks can permanently degrade quality of life from incontinence and erectile dysfunction.20
Likewise, at one time, skin cancer was put on high alert, with a guideline to check your moles with a doctor every three years from age 20 and every year from age 40.12 Now, only changing or suspicious moles are recommended to be checked.21
The Effects that Weren’t
Another benefit of looking at long term cancer rates is finding things that *didn’t* increase cancer, or at least did not affect cancer rates enough to show in the long term trends. One that surprised me was the lack of impact of pesticides. Since 1945, when synthetic pesticides barely existed, American pesticide use has increased more than ten-fold, from under 100 million pounds a year to over a billion,2223 but there’s no apparent effect on cancer rates visible on the national scale. Focusing in closer, even farmers, who have more exposure to pesticides than most, have not experienced any particular epidemic of cancer.24
For any other evil of modern society–Microplastic! Sunscreens! Cell phones!–you can be assured that even if their effect on cancer isn’t zero, it isn’t enough to overwhelm the larger forces moving cancer rates.
The Future of Cancer Treatment
Despite the lower lung cancer (thanks to reduced smoking), stomach cancer (thanks to refrigeration), and colorectal cancer (thanks to increased screening), you may have noticed pancreatic cancer has held steady over the past 100 years. While pancreatic cancer takes decades to develop like other cancers, it’s noticeably symptomless, and we haven’t found an effective way to screen for it in the early stages. By the time someone has become yellow in the face, the cancer has likely already metastasized.25
Pancreas Protein Hunt
The lack of progress on pancreatic cancer has at last changed in 2026, with the release of a new drug, daraxonrasib. Cancers rely on breaking RAS proteins, which switch cell growth on and off, to turn growth permanently on. Despite being identified over forty years ago, there hasn’t been an effective way to target RAS to prevent growth until now. The new medicine binds to RAS proteins, including the KRAS that drives pancreatic cancer, and stops the cancer reproduction. In the final phase of testing, the drug reduced the risk of death by 60% compared with chemotherapy,26 unheard of in a cancer where chemotherapy only manages to shrink tumors in about 10% of patients.
Cancer Vaccines
Cancers usually take decades to develop, and in most cases, are killed or contained by the immune system killing off the mutated cancer cells. There has long been a search to find a way to improve the body’s ability to remove cancer with vaccines, and in 2026, the first successful Phase 3 trial was completed.27 The target was skin cancer (melanomas), which are known to have a wide variety of proteins, making them difficult to isolate for the immune system to target. This trial succeeded by sequencing the DNA of that specific cancer, creating a custom mRNA vaccine for the peptides in that cancer, and then administering their personal vaccine about six weeks later. The precise numbers from Phase 3 aren’t available yet, but Phase 2 reduced risk by nearly 50%.28
A different vaccine approach, this time focusing on the specific pancreatic KRAS proteins, is in early trial stages.29
What You Should Do
Lung Cancer: If you don’t smoke, don’t start. If you smoke, quit. If quitting is hard, switch to vaping or heated tobacco. There was concern about vaping health impacts initially, but by now, it’s clear from carcinogen exposure studies that it’s better than regular cigarettes.30
Stomach Cancer: Use refrigerators and clean water. Ok, that’s pretty straightforward for most. If in Japan, decline the barium scan until you’ve had an ABC test to see if you’re at risk.
Colorectal Cancer: Get regular stool tests–annually for FIT or every three years for stool DNA tests from 45 years old. Colonoscopies don’t appear to show significant benefit over regular stool tests.
Other Cancers: Follow the S-Tier intervention of walking 12k steps daily to reduce cancer mortality risk by up to half31 and eat whole grains to reduce cancer mortality by another 15%32 and nuts to reduce cancer risk by 15%.33
