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Cancer

Cancer

Goal

Reduce the number of new cancer cases, as well as 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, yet cancer remains a leading cause of death in the United States, second only to heart disease.2,3 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 this era of patient-centered care, effective communication between clinicians and their patients and family members fosters shared knowledge and understanding and leads to medical decisions that align with patient values.5 The objectives for Healthy People 2020 assess whether people understand and remember the information they receive about cancer screening. Research shows patients cite a recommendation from a health care provider as the most important reason for having cancer screening tests.6

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 (HPV) and hepatitis B virus.

Screening is effective in identifying some types of cancers in early, often highly treatable stages (see USPSTF recommendations), including:

  • Breast cancer (using mammography)
  • Cervical cancer (using Pap test alone or combined Pap test and HPV test)
  • Colorectal cancer (using stool-based testing, sigmoidoscopy, or colonoscopy)

For cancers with evidence-based screening tools, early detection must address 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 and to the observed disparities in cancer incidence and death among racial, ethnic, and underserved groups. The most obvious factors are 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 and health care services
  • 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 but not limited to colorectal, breast, uterine corpus (endometrial), pancreas, 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.

Cancer survivors often face physical, emotional, social, and financial challenges as a result of their cancer diagnosis and treatment. Survivors are at risk of recurrence of their first cancer and are at greater risk of developing other cancers and other health conditions. Factors that increase these risks for survivors include:

  • The immediate and long-term effects of cancer and its treatment
  • Obesity and unhealthy behaviors, such as smoking and lack of physical activity
  • Genetic changes

In the coming decade, as the number of cancer survivors is expected to increase by more than 30% to 18 million,9,10,11 understanding survivors’ health status and behaviors will become increasingly important.

References

1Ryerson AB, Eheman CR, Altekruse SF, Ward JW, Jemal A, Sherman RL, et al. Annual Report to the Nation on the Status of Cancer, 1975-2012, Featuring the Increasing Incidence of Liver Cancer. Cancer. 2016;122:1312-37.

2National Cancer Institute, Surveillance Research Program. Cancer Statistics Review 1975–2013: Age-adjusted SEER incidence and US death rates and 5-year relative survival rates [table]. Bethesda (MD): National Cancer Institute; no date. Available from: http://seer.cancer.gov/csr/1975_2013/results_single/sect_01_table.05_2pgs.pdf

3Heron M, Hoyert DL, Murphy SL, Xu J, Kochanek KD, Tejada-Vera B. Deaths: Final data for 2006. Nat Vital Stat Rep. 2009 Apr 17;57(14). Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf [PDF - 1.71 MB]

4Agency for Healthcare Research and Quality. Guide to Clinical Preventive Services, 2014 [Internet]. Rockville (MD): AHRQ; 2014. Available from: http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/index.html

5Epstein RM, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. Bethesda (MD): National Cancer Institute; 2007. NIH Publication No. 07-6225.

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, Manos MM. 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, Taylor B, Rehm J, Murray CJL, 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.

9National Cancer Institute, Surveillance Research Program. Surveillance epidemiology and end results [Internet]. Bethesda (MD): NCI; no date [cited 2017 February 20]. Available from: http://seer.cancer.gov

10De Moor JS, Mariotto AB, Parry C, Alfano CM, Padgett L, Kent EE, et al. Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomarkers Prev. 2013;22:561–70.

11Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 2011;103:117–28.

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