Cancer Prevention, Early Detection Continues to Be Suboptimal in the United States

Jill Murphy, Associate Editor

A recent article from the American Cancer Society reports a mixed picture, with historic lows in smoking prevalence but suboptimal obesity, cancer screening, and HPV vaccination levels.

A recent article from the American Cancer Society (ACS) found that cancer prevention and early detection measures show mixed progress, with substantial racial and ethnic, socioeconomic, and geographic disparities continuing to exist, according to the press release. All data was compiled prior to the COVID-19 pandemic.

This study is one of the only sources that looks at major modifiable cancer risk factors, including tobacco use, obesity, diet and physical activity, HPV vaccination, ultraviolet radiation exposure, environmental exposure, and screening test use, according to the press release.

An estimated 608,570 cancer deaths are expected to occur in the United States in 2021, with about 45% attributable to modifiable risk factors such as excess body weight or physical inactivity. Cigarette smoking alone accounts for approximately 30% of cancer deaths.

The article reports a mixed picture, with historic lows in smoking prevalence but suboptimal obesity, cancer screening, and HPV vaccination levels. Furthermore, racial or ethnic and socioeconomic status disparities persisted across most major modifiable cancer risk factor and preventive outcomes, according to the press release.

While analyzing tobacco use, cigarette smoking in 2019 reached a historic low (14.2%) because 61.7% of all persons who ever smoked quit, also known as a quit ratio. The quit ratio has improved across most subpopulations since 1965, although it is lower among people who are Black, American Indian or Alaskan Native, poor, lower educated, lesbian, gay, or bisexual, and residents of Southern states.

Only 71.7% of the patients reported receiving advice to quit from a physician, although approximately 1 in 3 used evidence-based cessation treatments for tobacco dependence in 2018 to 2019, with significantly lower levels among those who were Hispanic, younger, and Southern residents.

“While historical gains in smoking cessation have led to steep declines in lung cancer mortality in the past decade, substantial progress can still be made by improving cessation outcomes among socially vulnerable groups,” said study lead Priti Bandi, PhD, in the press release. “Much can be achieved by expanding tobacco cessation coverage in state Medicaid programs and equitably implementing effective tobacco control policies within and across U.S. states.”

The prevalence of cancer screenings was suboptimal in 2018, specifically among uninsured adults. Modifiable risk factors also play a major role in this issue, with approximately 18% of cancer cases in the United States attributable to a combination of excess body weight, insufficient physical activity, unhealthy diet, and consumption of alcoholic beverages, according to the study.

Obesity levels still remained high in 2017 to 2018, and the prevalence of obesity was 42.4% whereas the prevalence of overweight individuals was 30.7%. Obesity prevalence was disproportionately higher among Black (56.9%) and Hispanic (43.7%) women and lowest among Asian men (17.5%) and women (17.2%).

Approximately 25.6% of adults in 2018 reported no leisure physical activity, and the disparity by education was vast, ranging from nearly 48.2% of people less than a high school education compared to 14.5% of college graduates, according to the study authors.

In terms of diet, most adults do not meet the guidelines for healthy eating. In 2019, 12.3% of adults reported consuming 3 or more servings of vegetables per day and about 26.2% of adults reported eating 2 or more servings of fruit per day.

In 2018, an estimated 5.1% of adults were classified as heavy drinkers, defined as 7 or more drinks per week for women and 14 or more drinks per week for men. Heavier alcohol consumption increased with higher levels of education among women, whereas the prevalence among men was highest (7.1%) in those who had less than a high school diploma and lowest (4.2%) among the college educated.

HPV vaccination data for adolescents in 2019 remains underutilized, and over 40% were not up to date. In adults between 19 and 26 years of age, 52% of women and 31.7% of men reported ever having received 1 or more dose of the HPV vaccine, according to the press release.

“More work is needed in order to further reduce cancer risk factors and improve cancer screening,” the study authors said in the press release. “Immediate actions are needed to increase smoking cessation in health disparate populations, stem the tide of obesity epidemic, and improve screening and HPV vaccination coverage.”

REFERENCE

Cancer prevention and early detection continues to be suboptimal in the United States. American Cancer Society. Published May 19, 2021. Accessed May 24, 2021. http://pressroom.cancer.org/CPEDFF2021