Poor Lifestyles Fuel 'Suffering and Death From Cancer'

Kristin Jenkins

May 18, 2017

Although 20% of cancer cases diagnosed in the United States are preventable, high-risk behaviors such as eating the wrong foods, not exercising, smoking cigarettes, drinking too much alcohol, and not using sun protection or following cancer screening recommendations are keeping cancer incidence and mortality rates much higher than they should be, according to a new report from the American Cancer Society (ACS).

Where a person lives as well as race, sex, age, and socioeconomic and insurance status are factors that drive these behaviors, the report notes.

Although some cancer prevention and early detection measures have improved in recent years, "others have either stabilized or worsened," notes lead author Ann Goding Sauer, MSPH. "The bottom line," she emphasized, is that systemic solutions must be ramped up "to further reduce the suffering and death from cancer."

The new report in Cancer Prevention and Early Detection Facts and Figures (CPED) was published online May 18.

CPED has reported on the success of cancer prevention and early detection efforts in the United States since 1992. Reports are published every 2 years in conjunction with the annual ACS Cancer Facts and Figures.

Some Good News, but Some Bad News

The latest CPED report provides a "good news, bad news" perspective.

Although only 15% of US adults were smoking cigarettes in 2015, the report shows that smoking rates varied widely state to state, ranging from 9% in Utah to 26% in Kentucky — the latter rate the same as in the high-flying 1970s.

Not surprisingly, similar patterns were seen in high school students, in whom smoking rates declined significantly, from 29% in 1999 to 9% in 2015. However, smoking prevalence among teenagers varied widely depending on geographic location, ranging from 5% for teens who live in Rhode Island to 19% for those in West Virginia.

The good news is that since 2002, there are more former smokers in the United States than current smokers, 52.8 million vs 6.5 million, respectively.

Raising cigarette prices through higher excise taxes reduces tobacco consumption, the report authors point out. They note that the federal excise tax is $1.01 per pack, and the average state excise tax was $1.69 per pack at the beginning of 2017. However, the state excise tax also varies widely by state, ranging from 17 cents in Missouri to $4.35 in New York.

But the bad news is that, even with these reduced rates of smoking, cigarette smoking alone is expected to cause approximately 190,500 cancer deaths in 2017.

The use of electronic cigarettes (e-cigarettes) has increased rapidly, particularly among youth. From 2011 to 2015, e-cigarette use, or vaping, among high school students jumped from less than 2% to 16%. In 2015, 4% of adults smoked e-cigarettes. Differences were observed with respect to sex, age, and race/ethnicity.

The report confirms that 7 of 10 US adults are overweight or obese, including 35% of men and 40% of women. The prevalence of overweight and obesity in men appears to have plateaued somewhat, but it continues to increase in women, with black women leading the way.

Again, prevalence varied according to geographic location, with the rate of obesity ranging from 54% in the District of Columbia to 71% in West Virginia.

Tragically, the prevalence of obesity among persons aged 12 to 19 years tripled to 21% between 1976 and 2002. This rate was seen across all races/ethnicities and for both sexes and has not changed in recent years, the study authors note.

In 2015, about half of US adults said they were meeting the recommended levels of aerobic physical activity each week, though only 29% reported eating two or more servings of fruit, and only 16% said they were eating three or more servings of vegetables per day. Data from 2011-2014 show that 28% of adults were consuming excessive amounts of alcohol.

Weekly rates of physical activity were markedly lower in high school students than in adults, with only 27% of teens reaching recommended levels. About 1 in 3 (32%) high school students said they ate fruit two or more times per day, and 15% reported consuming vegetables three or more times per day.

Despite public health campaigns urging people to protect themselves from the sun and use sunscreen when heading outdoors, 60% of girls and 52% of boys in high school reported having had a sunburn in the past year. Only 13% of adults reported wearing a long-sleeved shirt, and only 15% said they wear a wide-brimmed hat when outside for more than an hour.

Indoor tanning continues to be popular, particularly in the mid-West (6%) and among women (6%) in comparison with men (2%). The highest rates of indoor tanning are still seen in teenage girls, though rates in this group fell to 11% in 2015, from 25% in 2009. As of January 1, 2017, only 13 states and the District of Columbia had laws prohibiting indoor tanning for minors without exemptions, the study authors note.

Human papillamovirus vaccination rates have increased, but they still lag behind those of other vaccines, with only 52% of girls and 39% of boys having completed two or more doses in 2015.

Better use of screening to identify and remove premalignant abnormalities — as in colorectal and cervical cancers — or to treat disease in the early stages when intervention is more effective could prevent thousands of cancer deaths, the study authors say. Not surprisingly, rates of noncompliance with screening recommendations were highest among uninsured individuals.

In 2015, 50% of women aged 40 years and older reported having had a mammogram in the past year, and 64% reported having had one in the past 2 years. The prevalence of the use of mammography during the past 2 years was lowest among uninsured women, at 31%.

Adherence to recommendations for cervical cancer screening was better – in 2015, 81% of women aged 21 to 65 years had received a Pap test in the past 36 months. The lowest use was seen among women who were uninsured (61%) and among recent immigrants (68%).

In 2015, 63% of adults aged 50 years or older reported having had either a fecal occult blood test/fecal immunochemical test within the past year or having undergone sigmoidoscopy within the past 5 years or colonoscopy within the past 10 years. Again, the prevalence was lowest in those who were uninsured (25%) and in recent immigrants (34%).

No funding for this report or conflicts of interest have been disclosed.

ACS. Cancer Prevention and Early Detection: Facts and Figures 2017-2018. Full text

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