ACS report outlines gaps and opportunities that contribute to cancer mortality

American Cancer Society researchers say coordinated efforts needed to close gaps in preventive behavior

An annual report from the American Cancer Society says much of the suffering and death from cancer could be prevented by more systematic efforts to reduce tobacco use, improve diet and physical activity, reduce obesity, and expand the use of established screening tests. The report, Cancer Prevention and Early Detection Facts and Figures (CPED), outlines gaps and opportunities that contribute to cancer mortality, and says social, economic, and legislative factors profoundly influence individual health behaviors. Since 1992, the American Cancer Society has published CPED as a resource to strengthen cancer prevention and early detection efforts at the local, state, and national levels.

Below are highlights of this year's report.

• Cigarette smoking prevalence in US adults declined modestly between 2005 and 2010. An estimated 19.3% of adults (men: 21.5%, women: 17.3%) smoked cigarettes in 2010. But the declines have not extended to all subgroups.
• Light or intermittent smoking (less than 10 cigarettes/day) in daily smokers increased significantly between 2005 (16%) and 2010 (22%), whereas heavy smoking declined from 13% to 8%, reflecting long-term historical trends toward lower smoking intensity.
• In 2009, data from the Youth Risk Behavior Survey (YRBS) showed that 19.5% of high school students reported current cigarette smoking (smoking on at least one day in the past 30 days) and 7.3% reported frequent smoking (smoking on 20 or more days in the past 30 days).
• While the YRBS found no change in current smoking prevalence among high school students between 2003 and 2009, other more recent surveys found that smoking declined significantly among teen student smokers between 2010 and 2011 and among adolescent smokers 12 to 17 years of age between 2008 and 2010.
• Tobacco industry marketing expenditures for smokeless tobacco products increased by 120% between 2005 and 2008, while they declined by 24% for cigarettes. The majority of these expenditures went toward price discounts that are intended to offset tobacco price increases.
• A recent study by the American Cancer Society Cancer Action Network(ACS CAN), the Society's nonprofit, nonpartisan advocacy affiliate, found that the passage of comprehensive smoke-free legislation by states currently without such laws could result in more than 624,000 fewer deaths over the long term and save $1.32 billion in treatment costs over five years.

Overweight and Obesity, Physical Activity, and Nutrition

• Currently, an estimated 18% of adolescents and 35.7% of adults are obese. Increasing rates of obesity observed since the early 1980s appear to have slowed or leveled off since 2003. Obesity rates in men and women have now converged.

• In 2010, the prevalence of obesity among adults exceeded 20% in all states; the state with the highest obesity prevalence was Mississippi (34.6%), according to self-reported surveys.

HPV Vaccination for Cervical Cancer Prevention

• To prevent cervical cancer, vaccination against two types of human papillomavirus (HPV) that cause 70% of cervical deaths is recommended for adolescent girls. The initiation of the HPV vaccination series among US females 13 to 17 years of age increased from 25% in 2007 to 48.7% in 2010, and one in three completed the entire three-dose series.

• Mammography usage has not increased since 2000. In 2010, 66.5% of women 40 years of age and older reported getting a mammogram in the past year. Women who lack health insurance reported the lowest use of mammograms (31.5%).
• In 2010, 76.4% of adult women reported having a Pap test in the past three years. However, there is persistent underuse of the Pap test among women who are uninsured, recent immigrants, and those with low education.
• In 2010, 59.1% of adults 50 years of age and older reported being screened for colon cancer using either a recommended stool test or an endoscopy test within recommended time intervals. However, rates remain substantially lower in uninsured individuals and those with lower socioeconomic status. To date, 28 states and the District of Columbia have passed legislation ensuring coverage

"With increased efforts toward more fostering of and support for cancer prevention and early detection activities, we can reduce incidence, death, and suffering from cancer," said Vilma Cokkinides, PhD, co-author of the report. "The price and availability of healthy foods, incentives and opportunities for regular physical activity in schools and communities, advertising content, as well as the availability of insurance coverage for screening tests and treatment for tobacco addiction all influence individual choices. Improved collaboration among government agencies, private companies, nonprofit organizations, health care providers, policy makers, and the American public can lead to continued improvements, and more favorable trends that reduce the risk of death from cancer and other chronic diseases."