An annual report from the American Cancer Society highlights that long-term favorable trends have stalled for several factors that have been responsible for declining cancer death rates in the U.S. The report, Cancer Prevention & Early Detection Facts and Figures 2008 (CPED), points out that drops in smoking appear to have leveled off and that mammography rates have been stable or slightly declining since 2000 after increasing for more than a decade. Although rates of colorectal cancer screening are increasing, these life-saving tests are still not reaching a substantial part of the population. The report also notes the role of access to care, pointing out that individuals without health insurance are much less likely to receive mammography and colorectal cancer screening than those with health insurance and are more likely to be diagnosed at an advanced stage of cancer, when treatment is more expensive and survival rates are much lower.
Earlier this year, we reported that death rates from cancer in the United States have dropped by 18.4 percent among men and 10.5 percent among women since mortality rates began to decline in the early 1990s, translating into more than half a million cancer deaths avoided in the United States, said Otis W. Brawley, MD, national chief medical officer of the American Cancer Society. If we want these gains to continue, we need comprehensive, systematic efforts to reduce tobacco use, to address the epidemic levels of obesity in this country, and to make sure all Americans have access to and receive established cancer screening tests.
CPED, published annually since 1992, is the most comprehensive annual report on factors that affect cancer risk, including behavior and early detection. It details the challenges and opportunities in preventing cancer and cancer death, and outlines lifestyle changes and medical care changes that have the potential to prevent about half of cancer deaths. Below are highlights from this years report.
- About 20.8% of adults and 23% of high school students currently smoke. The prevalence of smoking in high school students leveled off from 2003-2005 after declining from 1997 to 2003.
- Between 1997 and 2004, the percentage of adults who smoke decreased in both men and women, but in the past two years, these rates are essentially unchanged at 23.9% in men and 18.0% in women, as of 2006.
- Currently, 25 states have a state excise tax less than $1.00 per pack of cigarettes. These low-taxing states are mostly concentrated in the southeast and central US and include several tobacco-growing states.
- Although 43 states and the District of Columbia have increased their cigarette taxes since 2000, only 23 states have laws requiring that a portion of their excise taxes be dedicated to health, cancer control, or tobacco control programs.
- In 2008, states allocated a total of $717.2 million for tobacco control programs; however, for every dollar spent on tobacco control, the tobacco industry spends nearly $24.
- Only 51.2% of women aged 40 and older reported having a mammogram within the past year. The American Cancer Society recommends annual mammograms for women starting at age 40.
- Mammography rates appear to be stable or slightly declining after increasing for over a decade. In 2005, 66.5% of women reported having a mammogram in the past 2 years, which was 4 percentage points lower than 2000 levels.
- The lowest prevalence of mammography use occurred among women who lack health insurance, followed by immigrant women who have lived in the US for less than 10 years.
- Although utilization is improving, colorectal cancer screening prevalence continues to lag behind use of other cancer screening tests. Between 2000 and 2005, the use of colorectal cancer screening among U.S. adults aged 50 and older increased from 42.5% to 46.8%.
- Hispanics, immigrants who had been in the U.S. for less than 10 years, and the uninsured were the least likely to have had a colorectal cancer screening test.
Obesity and Overweight
- Approximately two-thirds of adults are overweight or obese; the rise in obesity appears to have leveled-off between 2003-2004 and 2005-2006, with 34% of men and 36.4% of women meeting the criteria for obesity in 2005-2006.
- In the past 20 years, overweight prevalence among U.S. adolescents aged 12 to 19 more than tripled, from 5% to 17.1%. Increases have occurred across race, ethnicity, and gender
- In 2006, the prevalence of obesity across states ranged from 18.3% in Colorado to 31.5% in Mississippi.
Nutrition and Physical Activity
- In 2005, 35.8% of U.S. youth were physically active for at least 60 minutes on more than five days per week, and 33% attended physical education classes daily.
- In 2005, 37.2% of U.S. high school students reported watching three or more hours of television per day.
- About one in five (20.1%) U.S. high school students ate vegetables and fruits five or more times per day in 2005.
- Only 24.3% of adults reported eating five or more servings of vegetables and fruit daily in 2005. Across states, prevalence of consuming five or more servings of vegetables and fruit ranged from 15.7% in Oklahoma to 32.2% in the District of Columbia.
- In 2006, 23.9% of adults reported no leisure-time physical activity. The percentage of adults reporting no leisure-time physical activity ranged from 14.2% in Minnesota to 31.2% in Mississippi.
UV radiation and protection behaviors
- More than two-thirds (68.7%) of youth reported getting sunburned during summer months. Sunburn rates were higher in youth with the most sensitive skin type (84.5%) and in girls (71.5%).
- In a national 2004 survey, about one-third of adolescents aged 11 to 18 years reported using sunscreen always or often during the past summer and only 20% protected themselves always or often by seeking the shade; even fewer (10%) used protective clothing (long sleeves or pants) regularly.
- In a national 2005 survey of adults, 28.3% reported always or often using sunscreen when outside for an hour or more on a sunny day, and 43.4% reported seeking shade.
The report notes that, despite stalls in some favorable trends, marked progress has been achieved by some high priority advocacy efforts. At the time of publication, twenty-nine states, the District of Columbia, and Puerto Rico had implemented or enacted statewide smoking bans that prohibit smoking in workplaces, and/or restaurants and/or bars, and 2,791 municipalities had passed some form of smoke-free legislation (Iowa became the thirtieth state to enact a statewide smoking ban earlier this month). The rate of colorectal cancer screening has increased in part due to expanded coverage by Medicare and private health insurance. These changes came about as a direct result of advocacy efforts, including legislation enacted in 22 states and the District of Columbia to ensure that private health insurance plans cover the full range of colorectal cancer screening tests.
Last April, President George W. Bush signed into law legislation to reauthorize and expand the National Breast and Cervical Cancer Early Detection Program (H.R. 1132), which included increased funding targets over the next five years, said Dr. Brawley. These and other efforts must continue in order to continue the decline in cancer death rates overall and make sure that the benefits of early detection and treatment are available to all members of the population.
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