For decades, heart disease has been the nation's top killer. Now cancer has taken its place for Americans 85 and younger.

The reason is that deaths from both diseases are falling, but heart disease mortality has declined more. "It's dropping fast enough that another disease is eclipsing it," said Dr. Walter Tsou, president of the American Public Health Association. "It's good news in some ways and bad in others," because too many people still smoke and are overweight, ensuring that both diseases will continue to cause deaths that could be prevented, said Dr. Teri Manolio, director of epidemiology for the National Heart, Lung and Blood Institute. The news is included in the American Cancer Society's annual statistical report, released Wednesday. In 2002, the most recent year for which information is available, 476,009 Americans under 85 died of cancer; 450,637 died of heart disease. That trend actually began in 1999, but "this is the first time we've looked at this by age," said Ahmedin Jemal, a cancer society epidemiologist and main author of the report. Only 1.6 percent of Americans are 85 or older, but heart disease still claims more lives in that age group than cancer. "This is a situation in which neither one of us wants to be No. 1" because far more deaths could be prevented, said Dr. Rose Marie Robertson, chief scientific officer of the American Heart Association. A third of all cancers are related to smoking, and another third are related to obesity, poor diets and lack of exercise - all factors that also contribute to heart disease. "We want to send the message: Don't smoke, eat right, exercise and maintain normal weight, and see your doctor for normal checkups," said Dr. Harmon Eyre, the cancer society's chief medical officer. Smoking among adults fell dramatically between 1965 and 2000, from 42 percent to 22 percent. Federal goals are to cut the rate to 12 percent by 2010. Heart disease sufferers also have benefited from better surgical techniques and devices and from better drugs to treat heart problems and control factors such as high blood pressure, Eyre said. "There are very effective treatments now, both preventive and once heart disease occurs, to reduce mortality from it," Manolio agreed. Cancer death rates have declined about 1 percent per year since 1999. Deaths from colon cancer and from lung cancer in men are particularly striking. "They're dropping so fast that they exceed the impact of aging," which increases the likelihood of developing cancer, Eyre said. The drop in colon cancer is because of screening, which finds and removes growths called polyps before they turn cancerous. Still, about half of people recommended for testing don't get checked. In women, cancer incidence has leveled off for the first time after several years of rising. "The lung cancer epidemic has peaked in women and we're likely to see stabilization of rates or a decline from this point on," said Dr. Elizabeth Ward, director of surveillance research for the cancer society. Other highlights: - An estimated 1,372,910 new cancer cases and 570,260 cancer deaths are expected this year. Five-year survival rates have risen from 50 percent in the 1970s to 74 percent today. - Lung cancer remains the biggest killer, projected to claim 163,510 lives this year. - Some 232,090 men will be diagnosed with prostate cancer, and it will kill 30,350. - About 211,240 women will be diagnosed with breast cancer, and it will kill 40,410. The report also highlights cancers caused by germs - 1.5 million cases or 26 percent of cancers in developing countries; and 360,000 cases or 7.3 percent of cancers in developed countries such as the United States. These are mostly liver cancer, caused by the hepatitis B and C viruses; cervical cancer, caused by human papillomavirus; stomach cancer, caused by H. pylori bacteria; and AIDS-related cancers, caused by infection with HIV. "Many of them are highly preventable," especially through vaccines for hepatitis and a soon-anticipated vaccine for papillomavirus, Ward said.

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