Cancer

Goal

Reduce the number of new cancer cases, as well as illness, disability, and death caused by cancer.

Overview

Continued advances in cancer research, detection, and treatment have resulted in a decline in both incidence and death rates for all cancers.1 Among people who develop cancer, more than half will be alive in 5 years, yet cancer remains a leading cause of death in the United States, second only to heart disease.2,3 The Cancer objectives for Healthy People 2020 support monitoring trends in cancer incidence, mortality, and survival to better assess the progress made toward decreasing the burden of cancer in the United States. The objectives reflect the importance of promoting evidence-based screening for cervical, colorectal, and breast cancer by measuring the use of screening tests identified in the U.S. Preventive Services Task Force (USPSTF) recommendations.4 The objectives for 2020 also highlight the importance of monitoring the incidence of invasive cancer (cervical and colorectal) and late-stage breast cancer, which are intermediate markers of cancer screening success.

In this era of patient-centered care, effective communication between clinicians and their patients and family members fosters shared knowledge and understanding and leads to medical decisions that align with patient values.5 The objectives for Healthy People 2020 assess whether people understand and remember the information they receive about cancer screening. Research shows patients cite a recommendation from a health care provider as the most important reason for having cancer screening tests.6

Why Is Cancer Important?

Many cancers are preventable by reducing risk factors such as:

Use of tobacco products

Physical inactivity and poor nutrition

Obesity

Ultraviolet light exposure

Other cancers can be prevented by getting vaccinated against human papillomavirus (HPV) and hepatitis B virus.

Screening is effective in identifying some types of cancers in early, often highly treatable stages (see USPSTF recommendations), including:

Breast cancer (using mammography)

Cervical cancer (using Pap test alone or combined Pap test and HPV test)

Colorectal cancer (using stool-based testing, sigmoidoscopy, or colonoscopy)

For cancers with evidence-based screening tools, early detection must address the continuum of care from screening to appropriate follow-up of abnormal test results and referral to cancer treatment.7

Understanding Cancer

Complex and interrelated factors contribute to the risk of developing cancer and to the observed disparities in cancer incidence and death among racial, ethnic, and underserved groups. The most obvious factors are a lack of health care coverage and low socioeconomic status (SES). SES is most often based on a person’s:

Income

Education level

Occupation

Social status in the community

Geographic location (where the person lives)

Studies have found that SES, more than race or ethnicity, predicts the likelihood of an individual’s or group’s access to:

Education

Health insurance and health care services

Safe and healthy living and working conditions, including places free from exposure to environmental toxins

All of these factors are associated with the risk of developing and surviving cancer.

SES also appears to play a major role in:

Prevalence of behavioral risk factors for cancer (like tobacco smoking, physical inactivity, obesity, and excessive alcohol use)

Rates of cancer screenings, with those with lower SES having fewer cancer screenings

Emerging Issues in Cancer

In the past decade, overweight and obesity have emerged as new risk factors for developing certain cancers, including but not limited to colorectal, breast, uterine corpus (endometrial), pancreas, and kidney cancers.8 The impact of the current weight trends on cancer incidence will not be fully known for several decades. Continued focus on preventing weight gain will lead to lower rates of cancer and many chronic diseases.

Cancer survivors often face physical, emotional, social, and financial challenges as a result of their cancer diagnosis and treatment. Survivors are at risk of recurrence of their first cancer and are at greater risk of developing other cancers and other health conditions. Factors that increase these risks for survivors include:

The immediate and long-term effects of cancer and its treatment

Obesity and unhealthy behaviors, such as smoking and lack of physical activity

Genetic changes

In the coming decade, as the number of cancer survivors is expected to increase by more than 30% to 18 million,9,10,11 understanding survivors’ health status and behaviors will become increasingly important.

Questions:

Is there a preferred mode of aerobic testing for cancer survivors who had gynecological cancers?

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