COMPETING MORTALITY AND PROGRESS AGAINST CANCER

The decline in ischemic heart disease (IHD) mortality in the United St ates in recent years is thought to have contributed to increases in ca ncer mortality. To estimate the interrelation between these competing causes of death between 1970 and 1988, I constructed a hypothetical po pulation schedule by assuming that age-specific IHD mortality risks ha d not declined. The difference between the actual population and the h ypothetical population represents persons who did not: die from IHD an d were thus available to die from cancer. Using observed age specific cancer risks over the entire interval, 153,207 of the 7,649,058 cancer deaths (2.0%) in persons age 20-85 years occurred in IHD survivors; i n 1988, 24,053 of the 482,490 cancer deaths (5.0%) occurred in IHD sur vivors. Among 55 to 85 year olds in 1988, IHD survivors accounted for 5.5% of the cancer deaths. Alternative assumptions about the susceptib ility of IHD survivors to cancer have little impact on the contributio n of IHD survivors to cancer deaths. Results from a separate analysis demonstrated that the proportional contribution of true cancer risk to the increase in cancer-cases tripled in the interval 1970-1988 compar ed with the interval 1930-1970. These observations indicate that the c ontribution of the IHD mortality decline to the increase in cancer mor tality has been small and does not account for the increasing: age-spe cific risks for cancer among older persons.