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Cancer Prevention Efforts in U.S. a Mixed Bag

Report summarizes risk factors, screening for major cancer sites

While substantial progress has been made in some cancer-control efforts in the past several decades, such as reductions in smoking and increased use of cancer screening, progress in some areas is lagging, according to a new report from the American Cancer Society (ACS).

The areas of most concern include smoking rates among certain populations, obesity, indoor tanning, and low utilization of a new vaccine against human papillomavirus (HPV), which causes cervical and other cancers. In addition, colorectal cancer screening, which not only detects tumors early but also may prevent cancer from developing, is underutilized, particularly among the uninsured.

Every 2 years, researchers at the ACS analyze data on cancer risk factors and screening from the Centers for Disease Control and Prevention (CDC) to strengthen cancer prevention and early detection efforts and to highlight disparate populations. This year the findings were published in Cancer Epidemiology, Biomarkers & Prevention.

Tobacco use remains the single largest preventable cause of disease and premature death in the U.S. Since the release of the Surgeon General’s Report on smoking and health 50 years ago, 20 million deaths have occurred because of tobacco. An estimated 18% of adults (21% of men and 15% of women) were cigarette smokers in 2013 –– a drop from 24% in 1999.

While smoking has declined across all education groups, a wide variation exists in cigarette use by education. Among those with a high school education, 22% smoke compared with only 9% of those with undergraduate degrees and 6% of those with graduate degrees. Among races/ethnicities, the smoking prevalence ranged from 10% in Asians to 23% in American Indians/Alaska Natives. People who identified themselves as gay or lesbian or as bisexual had a higher smoking prevalence (26% and 29%, respectively) than had those who identified themselves as heterosexual (18%). The use of other forms of tobacco, including cigars and e-cigarettes, has increased in recent years.

Obesity, physical inactivity, and poor nutrition are major risk factors for cancer, second only to tobacco use, the ACS says. The World Cancer Research Fund estimates that approximately one-quarter to one-third of all cancers in the U.S. may be attributed to diet and insufficient physical activity, as well as overweight and obesity.

The prevalence of obesity increased rapidly from 1976 to 2002, but has since stabilized. In 2013, more than two-thirds of American adults were overweight or obese. Among women, blacks had the highest obesity prevalence (57%), followed by Hispanics (45%), non-Hispanic whites (33%), and Asians (11%). Among men, Hispanics had the highest obesity prevalence (41%) followed by blacks (38%), non-Hispanic whites (33%), and Asians (11%).

In 2013, 31% of adults reported no leisure-time physical activity during an average week. Half of adults reported meeting recommended levels of aerobic activity (at least 150 minutes of moderate or 75 minutes of vigorous activity per week). In 2013, only 27% of U.S. high school students met recommended levels of physical activity.

Most adults and adolescents in the U.S. do not regularly protect themselves against exposure to ultraviolet radiation when outdoors on sunny days. In 2010, 32% of adults reported always or often using sunscreen when outside for 1 hour or more on a warm, sunny day in the past 12 months, and 37% reported seeking shade, whereas fewer adults used clothing protection, including wearing hats (13%) or long-sleeved shirts (12%). In 2013, only 10% of U.S. high school students used sunscreen routinely, and 20% of young women reported using an indoor tanning device in the previous year.

Although use of the HPV vaccine, which helps prevent cervical and other cancers, has increased during the past 5 years, HPV vaccination remains low, with only 38% of adolescent girls and 14% of adolescent boys receiving a vaccination.

Breast, cervical, and colorectal cancer screening increased during the past several decades, contributing to declining mortality rates in these cancers. Although colorectal cancer screening increased rapidly since the 2000s (from 39% in 2000 to 55% in 2008, primarily through the increased use of colonoscopy), the prevalence of screening has stabilized in recent years and still lags behind that of breast and cervical cancer screening. In 2013, approximately 59% of adults 50 years of age and older received recommended colorectal cancer screening. Approximately 66% of women have received a mammography during the past 2 years, and 81% have received a cervical cancer screening during the past 3 years. Regardless of the type of cancer screening, people without insurance have markedly lower screening uptake; for example, only 22% of uninsured individuals receive recommended colorectal cancer screening.

Source: ACS; April 1, 2015.

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