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Cancer

Cancer

Goal

Reduce the number of new cancer cases, as well as the illness, disability, and death caused by cancer.

Overview

Continued advances in cancer research, detection, and treatment have resulted in a decline in both incidence and death rates for all cancers.1 Among people who develop cancer, more than half will be alive in 5 years.2 Yet, cancer remains a leading cause of death in the United States, second only to heart disease.3 The cancer objectives for Healthy People 2020 support monitoring trends in cancer incidence, mortality, and survival to better assess the progress made toward decreasing the burden of cancer in the United States. The objectives reflect the importance of promoting evidence-based screening for cervical, colorectal, and breast cancer by measuring the use of screening tests identified in the U.S. Preventive Services Task Force (USPSTF) recommendations.4 The objectives for 2020 also highlight the importance of monitoring the incidence of invasive cancer (cervical and colorectal) and late-stage breast cancer, which are intermediate markers of cancer screening success.

In the coming decade, as the number of cancer survivors approaches 12 million,5 understanding survivors’ health status and behaviors will become increasingly important.

Why Is Cancer Important?

Many cancers are preventable by reducing risk factors such as:

  • Use of tobacco products
  • Physical inactivity and poor nutrition
  • Obesity
  • Ultraviolet light exposure

Other cancers can be prevented by getting vaccinated against human papillomavirus and hepatitis B virus.

Screening is effective in identifying some types of cancers (see USPSTF recommendations), including:

  • Breast cancer (using mammography)
  • Cervical cancer (using Pap tests)
  • Colorectal cancer (using fecal occult blood testing, sigmoidoscopy, or colonoscopy)

In an era of patient-centered care, it is critical to assess whether people understand and remember the information they receive about cancer screening. Research shows that a recommendation from a health care provider is the most important reason patients cite for having cancer screening tests.6

For cancers with evidence-based screening tools, early detection must include the continuum of care from screening to appropriate follow-up of abnormal test results and referral to cancer treatment.7

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Understanding Cancer

Complex and interrelated factors contribute to the risk of developing cancer. These same factors contribute to the observed disparities in cancer incidence and death among racial, ethnic, and underserved groups. The most obvious factors are associated with a lack of health care coverage and low socioeconomic status (SES). SES is most often based on a person’s:

  • Income
  • Education level
  • Occupation
  • Social status in the community
  • Geographic location (where the person lives)

Studies have found that SES, more than race or ethnicity, predicts the likelihood of an individual’s or group’s access to:

  • Education
  • Health insurance
  • Safe and healthy living and working conditions, including places free from exposure to environmental toxins

All of these factors are associated with the risk of developing and surviving cancer.

SES also appears to play a major role in:

  • Prevalence of behavioral risk factors for cancer (like tobacco smoking, physical inactivity, obesity, and excessive alcohol use)
  • Rates of cancer screenings, with those with lower SES having fewer cancer screenings

Emerging Issues in Cancer

In the past decade, overweight and obesity have emerged as new risk factors for developing certain cancers, including colorectal, breast, uterine corpus (endometrial), and kidney cancers.8 The impact of the current weight trends on cancer incidence will not be fully known for several decades. Continued focus on preventing weight gain will lead to lower rates of cancer and many chronic diseases.

References

1Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010 Feb 1;116(3):544-73.

2National Cancer Institute, Surveillance Research Program. Cancer Statistics Review 1975–2006: Age-adjusted SEER incidence and US death rates and 5-year relative survival rates. Bethesda, MD: National Cancer Institute. Available from: http://seer.cancer.gov/csr/1975_2006/results_merged/topic_survival.pdf [PDF - 460 KB]

3Heron M, Hoyert DL, Murphy SL, et al. Deaths: Final data for 2006. Nat Vital Stat Rep. 2009 Apr 17; 57(14). Hyattsville, MD: National Center for Health Statistics. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf [PDF - 1.71 MB]

4Agency for Healthcare Research and Quality (AHRQ). U.S. Preventive Services Task Force, Topic index: A-Z. [Internet]. Rockville, MD: AHRQ. Available from: http://www.ahrq.gov/clinic/uspstfix.htm

5National Cancer Institute (NCI), Surveillance Research Program. Surveillance epidemiology and end results [Internet home page]. Bethesda, MD: NCI. Available from: http://seer.cancer.gov

6Schueler KM, Chu PW, Smith-Bindman R. Factors associated with mammography utilization: A systematic quantitative review of the literature. J Womens Health. 2008 Nov;17(9):1477–98.

7Zapka JG, Taplin SH, Solberg LI, et al. A framework for improving the quality of cancer care: The case of breast and cervical cancer screening. Cancer Epidemiol Biomarkers Prev. 2003 Jan;12(1):4-13.

8Danaei G, Ding E, Mozaffarian D, et al. The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009 Apr 28;6(4):e1000058.

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