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What's behind the decline in cancer death rates?

As the charts below show, U.S. death rates have been steadily falling for a decade for the leading cancer killers -- lung, breast, prostate and colorectal.

Those trends are heartening signs that we're making headway on detection, prevention, and treatment. But -- you knew a 'but' was coming -- many caveats and controversies are behind the trends:

* Although pancreatic cancer is considered relatively rare, it is climbing in the killer ranking. It rose from the fourth-leading cause of cancer death to No. 3 in 2015. Just five years from now, in 2021, it is expected to be the country's second-leading cancer killer, surpassed only by lung cancer. Partly, that's because pancreatic cancer is becoming more common, but mostly because it is ferociously difficult to detect and treat. Additionally, some believe that certain diabetes drugs are fueling the increase.

* Breast and prostate cancer are now recognized as a spectrum of diverse diseases. At one extreme are slow-growing, indolent tumors that will never become lethal, even if left undetected and untreated. At the other extreme are vicious malignancies that will kill despite early detection and treatment. No wonder the value of screening with the PSA test and mammography is continually and passionately debated. The genetics behind the aggressiveness of these cancers is far from clear, but race, ethnicity, and hormonal factors are parts of the puzzle.

* Smoking is a the biggest risk factor for lung cancer, and the decline in U.S. smoking rates has driven down the lung cancer death rates. Still, people who have never smoked die of lung cancer; think of the shocking death of Dana Reeve at age 44. Recent research shows that nonsmokers account for a rising proportion of lung cancers.

Read more Diagnosis: Cancer here »