By Sy Mukherjee
May 23, 2019

Good afternoon.

I have some good news and some, well, not-great news. Cancer deaths in the U.S. fell sharply – and I mean really sharply – between 1999 and 2017 among 45 to-64 year-old Americans, according to a new Centers for Disease Control (CDC) report. But deaths attributable to heart disease have risen in recent years among this same cohort.

Heart disease accounts for a staggering one in four American deaths (and there’s about 2.6 million deaths in the country every year); cancer isn’t far behind as the second-leasing cause of death. But what the latest CDC figures confirm is that, while significant progress has been made against cancer, heart disease continues to be a challenge for the medical sector.

“Cancer death rates for middle-aged adults aged 45–64 declined by 19% from 1999 to 2017 (224.9 deaths per 100,000 to 182.6), whereas heart disease death rates declined by 22% from 1999 (164.3) to 2011 (127.9) and then increased 4% from 2011 to 2017 (133.6),” wrote the study authors. “The same trend patterns were observed for both men and women.”

What can we glean from this? For one thing, cancer drug development efforts, as well as movements encouraging earlier detection and prevention strategies, have intensified over the past decade. There are multiple reasons for that (I encourage you to check out my 2018 piece on the diseases we aren’t curing and why) but this could well be one of the driving factors behind the trend, on top of a generally better understanding of cancers and the lifestyle choices that fuel it (a massive decline in the smoking rate, for instance, likely also plays a part).

Things are more difficult with heart disease. While a number of companies have developed new types of “bad cholesterol” busting drugs in recent years, for the most part, heart disease treatment has been in stasis for a very long time.

Complicated factors play into that dynamic, too, such as the widespread availability of cheap generic drugs (which makes it a risky proposition for drug developers to enter the field), the difficulty of changing fundamental lifestyle behaviors, and the huge costs of conducting post-approval cardiovascular outcomes testing.

That’s not to say there hasn’t been significant progress in cardiovascular health. There has. And it’s also not to say there isn’t plenty of work left to be done in cancer treatment. There is. But the CDC’s new report shines a light on the shifting forces driving these public health scourges.

Read on for the day’s news.

Sy Mukherjee
@the_sy_guy
sayak.mukherjee@fortune.com

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