The World Health Organization projects that cancer mortality rates are on the rise.  More than 70 percent of the seven and a half million deaths from cancer in 2005 occurred in low and middle-income countries where prevention and treatment are limited.  On the other hand, because of good medical care, millions of other people can now say they are 'cancer survivors,' especially if they are cancer-free for at least five years.  VOA's Melinda Smith looks at one part of the cancer equation that few experts want to talk about: what happens when the disease comes back.

White House spokesman Tony Snow

In the last month, Americans watched as two high profile people acknowledged publicly that their cancers have returned. 

In late March, White House Press Secretary Tony Snow discovered that his cancer had returned after his colon was removed two years ago.  Snow's cancer is considered stage four on a scale of five stages.  With each increase in stage, the chances of a cure are lowered. 

The wife of Democratic presidential candidate John Edwards faces similar odds in her fight against breast cancer.  Now in stage four of the disease, Elizabeth Edwards revealed her cancer has spread.  While it is still treatable, it is not considered curable.

Elizabeth Edwards

In many cases, a combination of chemotherapy, radiation and powerful drugs can prolong life.  But Dr. Michael Fisch of the M.D. Anderson Cancer Center in Houston, Texas says there are no guarantees.

“It is not possible to make an accurate prediction about an individual and whether their cancer will come back or not,” he says.

Cancer death rates in the United States have dropped two years in a row.  That is hopeful news for those cancer survivors who make it past the first five years, and then another five.  But Dr. Michael Fisch says it is not unusual for patients to find the cancer has returned years later.

Dr. Michael Fisch

"That patient's risk of recurrence doesn't go away at five years, or six years or 10 years," adds Dr. Fisch.  "Certainly, the longer things go well for you, the better."

Research has shown that terminally ill patients in advanced stages of the disease often believe their chances of survival are better than they really are.  While doctors say hope can help, it can also lead patients to pursue aggressive treatment that prolongs pain and suffering.  Physicians often estimate end of life will come sooner than the patient thinks it will.  But when the reality of death becomes apparent, most patients say they want to know the truth.