Challenges in changing behaviors, factors to reduce cancer risk continue

Coordinated efforts needed to close gaps

An annual report from the American Cancer Society finds continuing challenges in changing behaviors and risk factors in order to reduce suffering and death from cancer. The report, Cancer Prevention & Early Detection Facts & Figures (CPED) 2013, outlines the current prevalence of tobacco use, obesity, physical inactivity, and the use of established screening tests, and emphasizes that social, economic, and legislative factors profoundly influence the individual health behaviors that contribute to cancer risk.

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 the 2013 report.

Tobacco Use

• Cigarette smoking prevalence in US adults declined from 20.9% to 19.0% between 2005 and 2011, with significant declines in both men (23.9% to 21.6%) and women (18.1% to 16.5%) as well as in young adults, Hispanics, and Asians.

• Heavy smoking also declined significantly during that time, reflecting long-term historical trends toward lower cigarette consumption among smokers.

• Smoking among high school students has dropped from a high of 36.4% in 1997 to a new low of 18.1% in 2011.

• Apart from cigarettes, the most commonly used tobacco products among high school students in 2011 were cigars (13.1%) and smokeless tobacco (7.7%).

• The average state cigarette excise tax rate is $1.48, with wide variation between states ranging from 17 cents per pack in Missouri to $4.35 per pack in New York.

• Despite record high revenues from tobacco taxes and the Master Settlement Agreement (MSA) awards, states spent less on tobacco prevention (< 2% of tobacco-related revenue) during 2011-2012 than in any period since the MSA was reached in 1998.

• In part as a response to increasing smoke-free environments, the tobacco industry ramped up marketing expenditures on smokeless tobacco products nearly 120% between 2005 and 2008, potentially expanding the tobacco market.

Overweight and Obesity, Physical Activity, and Nutrition

• An estimated 18.4% of adolescents and 35.7% of adults are obese.

• Increasing rates of obesity observed since the early 1980s appear to have slowed in the past decade, particularly among women and girls.

• Obesity prevalence is higher in men than in women among whites, but substantially higher in women than in men among African Americans and Hispanics

• The percentage of US high school students who were obese in 2011 varied widely across states, from a low of 7.3% in Colorado to a high of 17% in Alabama.

• In 2011, obesity prevalence exceeded 20% in all states and was highest in Mississippi (35.0%) and lowest in Colorado (20.8%).

Ultraviolet Radiation and Skin Cancer

• Individuals who use indoor tanning booths during their teens and 20s increase their risk of melanoma by 75%.

• Thirty-three states have enacted legislation restricting minors' access to indoor tanning facilities.

HPV Vaccination for Cervical Cancer Prevention

• The initiation of the HPV vaccination series among US females 13 to 17 years of age increased from 25.0% in 2007 to 53.0% in 2011, with 70.7% of those who initiated completing the entire three-dose series. Despite these improvements, HPV vaccine coverage among adolescent females lags behind other recommended vaccines.

Cancer Screening

• Mammography use has been relatively stable since 2000. In 2010, 66.5% of women 40 years of age and older reported getting a mammogram in the past two years; women who lack health insurance have the lowest use of mammograms (31.5%).

• In 2010, 83.0% of adult women (21-65 years of age) had received 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 or older reported use of either a fecal occult blood test (FOBT) or an endoscopy to screen for colorectal cancer within recommended time intervals. However, rates remain substantially lower among uninsured individuals (18.8%) and among those with 11 or fewer years of education (43.9%). To date, 28 states and the District of Columbia have passed legislation ensuring comprehensive coverage for the full range of tests.

"Our report is a striking reminder that we need to do a better job reducing behavioral risk factors that increase cancer risk," said lead author Vilma Cokkinides, Ph.D., American Cancer Society strategic director of risk factors and screening. "We could eliminate much of the suffering and death from cancer with better, more systematic efforts to reduce tobacco use, improve nutrition and opportunities for physical activity, and expand the use of those screening tests that are proven effective."