Curtailing cancer risk factors remains difficult

Challenges linger in the effort to change behaviors and risk factors to reduce incidence and death from cancer, according to an annual report from the American Cancer Society.

The report, “Cancer Prevention & Early Detection Facts & Figures 2013,” outlines the 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.

The highlights of the report encompass several categories:

Tobacco use

Cigarette smoking prevalence in adults in the United States declined from 20.9% to 19% between 2005 and 2011, with significant declines in both men (23.9% to 21.6%) and women (18.1% to 16.5%) and 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 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 monetary awards from the major tobacco companies, states spent less on tobacco prevention (less than 2% of tobacco-related revenue) during 2011-12 than during 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 U.S. 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 2011obesity prevalence exceeded 20% in all states, and was highest in Mississippi (35%) 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%; 33 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 U.S. females ages 13 to 17 increased from 25% in 2007 to 53% in 2011, with 70.7% of those who began treatment going on to complete the entire three-dose series. Despite these improvements, HPV vaccine coverage among adolescent females lags behind other recommended vaccines, according to the report.

Cancer screening

Mammography use has been relatively stable since 2000. In 2010, 66.5% of women ages 40 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% of adult women (ages 21 to 65) had received a Pap test in the past three years. However, under-use of the Pap test persists among women who are uninsured or recent immigrants, and those with low education.

In 2010, 59.1% of adults ages 50 and older reported use of either a fecal occult blood test or an endoscopy to screen for colorectal cancer within recommended time intervals. However, rates remain substantially lower among uninsured individuals (18.8%) and 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,” Vilma Cokkindies, PhD, the study’s lead author and strategic director of risk factors and screening for the American Cancer Society, said in a news release. “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.”

The American Cancer Society estimates that in 2013 about 174,100 cancer deaths will be caused by tobacco use. In addition, about a quarter to a third of the 1.6 million new cancer cases expected to occur in 2013 can be attributed to poor nutrition, physical inactivity, overweight and obesity. Regular use of cervical and colorectal cancer screening tests can prevent the development of cancer through identification and removal of premalignant abnormalities, and can improve survival and decrease mortality by detecting cancer at an early stage when treatment is more effective.

Since 1992, the American Cancer Society has published the CPED report as a resource to strengthen cancer prevention and early detection efforts at the local, state and national levels. This year’s report is available to download at

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