The American Cancer Society’s annual report on cancer statistics has been published, and it brings with it more “good news” about the progress against cancer. However, there are also some notable areas of concern that should lead us to reinforce our focus on what we need to do to continue to reduce the burden and suffering from cancer in the United States—and make even more progress.

The good news is that the decline in the rate of deaths from cancer continues to improve: from 1991 (when the cancer death rate in this country was at its peak) until 2017 (the most recent year for which data is available) there was a decline of 29% in the cancer death rate. That translates into 2.9 million fewer deaths from cancer than would have been expected had the rate of cancer deaths not changed from 1991.

And while all most other non-cancer related causes of deaths were increasing or remaining stable, the rate of deaths from cancer declined by a remarkable 2.2% from 2016 to 2017, continuing a long string of declines over many years. This was in fact the largest single-year drop in cancer mortality since rates began falling in the early 1990s, and in fact the largest drop ever recorded, since before then mortality rates were rising.

The report also notes an accelerated decline in the rate of deaths from lung cancer: 5% per year in men from 2013 through 2017 and almost 4% per year over the same time period for women.

And it’s not just lung cancer. There has been a stunning reversal in deaths from melanoma, with an average 7% drop in the death rate each year from 2013 to 2017. And that’s for a cancer where almost no significant progress in treating advanced disease had occurred for decades prior to the first approval of a new generation of treatments for melanoma in 2011.

As someone who has followed melanoma care for years this progress is nothing short of astonishing, although not enough when we realize that too many men and women still die from this largely preventable disease.

However, there are some clouds in the sky and we must ask ourselves why we are having difficulty making the changes we need to make that would accelerate this progress even more than we have seen to date.

Lung cancer is a good example: Almost 1 in 4 cancer deaths are from lung cancer. And yet the tobacco industry continues to contribute to its toll as well as to deaths from a dozen other cancers. Meanwhile lung cancer screening rates remain pitifully low among those at risk (current and former heavy smokers) and many lung cancer patients do not have access to the most effective treatments.

Cervical cancer is a similar story: HPV vaccine is effective in reducing the risk of cervical cancer. Yet many young women have not been vaccinated, and many women who should be getting screened aren’t. The result is 10 premature deaths from cervical cancer every week in women between the ages of 20 and 39. And when the data is looked at more carefully, there are wide discrepancies in cervical cancer incidence between states, gaps that may increase even further in the future depending on the uptake of HPV vaccination.

Some cancers that were rapidly increasing in incidence in past reports have shown signs of improvement: thyroid cancer diagnoses are stabilizing in women and have slowed in men (probably related to better guidance regarding diagnostic procedures); a decline in the occurrence of primary melanoma especially in young women and people over age 65 (where it had been increasing); and a stabilization of liver cancer rates in men and a slowing of the increase in women.

Unfortunately, there are some cancers where we are seeing a slowing in long-term declines in death rates: breast, colorectal, and prostate for example. We have effective screening and treatment strategies for breast and colorectal cancer.  Unfortunately, too few are able to take advantage of these opportunities to reduce the impact of these two cancers. For prostate cancer, we need a better early detection test.

And we can’t ignore the fact that substantial disparities exist regarding cancer outcomes in this country. The gaps in cancer deaths between non-Hispanic whites and several other racial/ethnic groups cannot be ignored. We also can’t ignore the reality that outcomes in some regions of the country and between urban and rural populations are significant. Some of this has to do with availability of care due to location, some has to do with access and affordability, and some has to do with habits, beliefs and circumstances that are different from one part of our nation to another.

This report confirms that we continue to make progress against cancer. At the same time, imagine if we could focus not only on cutting edge research to produce new effective treatments for cancer, but if we could also remove the barriers and undertake initiatives that would improve the health of our country and reduce the risk of getting cancer in the first place.

We have made progress and our hope is that progress will continue, eventually making cancer a story for the history books. But let there be no mistake that if we could focus our efforts on continuing to improve knowledge, research, access and equity we would all share the gift of millions of more lives saved from the devastation of cancer. And that gift would be priceless.