Cancer prevention efforts in United States are a mixed bag

Although substantial progress has been made in some cancer control efforts in the past several decades, such as reductions in smoking and increased utilization of cancer screening, progress in some areas is lagging, according to a new report. The report was published in Cancer Epidemiology, Biomarkers & Prevention (2015;24[4];637-652).

Among the areas of most concern: 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 from the American Cancer Society analyze data for cancer risk factors and screening from the Centers for Disease Control and Prevention (CDC) to strengthen cancer prevention and early detection efforts and highlight disparate populations.

Tobacco use remains the single largest preventable cause of disease and premature death in the United States. Since the release of the Surgeon General's Report on Smoking and health 50 years ago, there have been 20 million deaths due to tobacco. An estimated 17.8% of adults (20.5% of men; 15.3% of women) were cigarette smokers in 2013, a drop from 23.5% in 1999.

Obesity, physical inactivity, and poor nutrition are major risk factors for cancer, second only to tobacco use. The World Cancer Research Fund estimates that about one-quarter to one-third of all cancers in the United States can 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.

In 2013, 30.5% of adults reported no leisure-time physical activity during an average week. Approximately half (50.1%) of adults reported meeting recommended levels of aerobic activity (at least 150 minutes of moderate or 75 minutes of vigorous activity per week).

Most adults and adolescents in the United States do not regularly protect themselves against exposure to UV radiation when outdoors on sunny days. In 2010, 32.1% 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 37.1% reported seeking shade, while fewer adults used clothing protection, including wearing hats (12.8%) or long-sleeved shirts (11.5%). In 2013, only 10.1% of US high school students used sunscreen routinely and 20.2% of young women reported using an indoor tanning device in the previous year.

Although use of the human papillomavirus (HPV) vaccine, which helps prevent against cervical and other cancers, has increased in the past 5 years, HPV vaccination remains low with only 37.6% of adolescent girls and 13.9% of adolescent boys receiving vaccination.

Breast, cervical, and colorectal cancer screening increased in the past several decades, contributing to declining mortality rates in these cancers. Although colorectal cancer screening increased rapidly since the 2000s (from 38.6% in 2000 to 54.5% in 2008, primarily through increased use of colonoscopy), screening prevalence has stabilized in recent years and still lags behind that for breast and cervical cancers.

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