Cancer death rates in the United States have fallen continuously from 1991 through 2018, adding up to a total decrease of 31% over that period, according to a new report from the American Cancer Society. Overall mortality dropped by 2.4% between 2017 and 2018—the largest drop since rates began to fall in the early 1990s.

The decline is largely attributable to a reduction in lung cancer deaths—survival has increased for people with all stages of non-small-cell lung cancer. Between 1991 and 2018, an estimated 3.2 million cancer deaths were averted thanks to smoking cessation, earlier detection and better treatment. Five-year survival is highest for prostate cancer (98%), melanoma of the skin (93%) and female breast cancer (90%) and lowest for cancers of the pancreas (10%), liver (20%), esophagus (20%) and lung (21%). Survival rates for most cancers are lower for Black people compared with white people, but the disparity has narrowed.

However, the report authors caution that the impact of COVID-19—which has led to a decrease in cancer screening and delays in diagnosis and treatment—is not yet known and could halt the decline.