De­clin­ing smok­ing rates, rapid di­ag­no­sis, and new­er treat­ments are thaw­ing mor­tal­i­ty rates for can­cer, which on­ly lags be­hind heart dis­ease as the biggest killer in the Unit­ed States — re­searchers sug­gest­ed in a new study on Wednes­day.

The largest-ever one-year de­cline in the US can­cer death rate — dri­ven pri­mar­i­ly by di­min­ish­ing lung can­cer mor­tal­i­ty — was a 2.2% drop from 2016 to 2017, ac­cord­ing to the Amer­i­can Can­cer So­ci­ety (ACS) re­port, which cal­cu­lat­ed an over­all drop of 29% in US can­cer rates from 1991 to 2017.

The de­cline in mor­tal­i­ty over the 26-year pe­ri­od has been large­ly steady due to long-term drops in death rates in the four most com­mon can­cer types: lung, col­orec­tal, breast, and prostate, al­though progress in re­duc­ing col­orec­tal, breast, and prostate can­cers has slowed, the re­searchers found, not­ing that this works out to more than 2.9 mil­lion deaths avoid­ed since 1991 when the mor­tal­i­ty rate was at its peak.

“(T)reat­ment break­throughs have al­so con­tributed, such as those for hematopoi­et­ic and lym­phoid ma­lig­nan­cies in both chil­dren and adults, and more re­cent­ly check­point block­ade im­munother­a­pies and tar­get­ed ther­a­pies for metasta­t­ic melanoma,” they wrote.

Pe­ter Bach, di­rec­tor of Memo­r­i­al Sloan Ket­ter­ing’s cen­ter for health pol­i­cy and out­comes, took is­sue with at­tribut­ing the de­cline in can­cer mor­tal­i­ty to new med­i­cines in the study led by ACS’ Re­bec­ca Siegel.

The study does not test this hy­poth­e­sis, the renowned re­searcher and epi­demi­ol­o­gist wrote on Twit­ter. “Epi­demi­ol­o­gy may be opaque but it is not opin­ion.”

On av­er­age, the death rate has fall­en by 1.5% per year be­tween 2008 and 2017,  Siegel et al cal­cu­lat­ed.

“Nev­er­the­less, progress is slow­ing for can­cers that are amenable to ear­ly de­tec­tion through screen­ing (ie, breast can­cer, prostate can­cer, and CRC), and sub­stan­tial racial and ge­o­graph­ic dis­par­i­ties per­sist for high­ly pre­ventable can­cers, such as those of the cervix and lung,” the au­thors wrote.

“In­creased in­vest­ment in both the eq­ui­table ap­pli­ca­tion of ex­ist­ing can­cer con­trol in­ter­ven­tions and ba­sic and clin­i­cal re­search to fur­ther ad­vance treat­ment op­tions would un­doubt­ed­ly ac­cel­er­ate progress against can­cer.”

In 2016, the Unit­ed States spent near­ly twice as much as 10 high-in­come coun­tries on med­ical care and per­formed less well on many pop­u­la­tion health out­comes, da­ta shows.

And al­though the US has low­er-than-av­er­age mor­tal­i­ty rates for can­cer, it does have high­er than av­er­age rates in the oth­er caus­es of mor­tal­i­ty ver­sus coun­tries that are sim­i­lar in size and wealth (based on GDP and GDP per capi­ta), ac­cord­ing to an analy­sis con­duct­ed by The Pe­ter­son Cen­ter on Health­care and the Kaiser Fam­i­ly Foun­da­tion.

These cat­e­gories ac­count­ed for near­ly 74% of all deaths in the Unit­ed States in 2015, ac­cord­ing to the da­ta com­piled.

“My biggest con­cern, how­ev­er, is that the na­tion is so hy­per-fo­cused on can­cer (as re­flect­ed in (the) dis­pro­por­tion­ate amount of R&D in on­col­o­gy space) that it’s ig­nor­ing the alarm­ing fact that over­all life (US) ex­pectan­cy is in de­cline,” health econ­o­mist Joshua Co­hen wrote in re­sponse to Bach’s com­ments on Twit­ter.

The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) recommended nine drugs for approval this week while also giving thumbs up for six expanded indications, including Novo Nordisk’s approved obesity medication Wegovy for younger people. Wegovy is already approved as an obesity treatment in the EU for adults, and the new indication would allow prescriptions for adolescents aged 12 and older.