The nation is making progress toward major cancer-related targets for Healthy People 2020, a comprehensive set of 10-year health objectives sponsored by the U.S. Department of Health and Human Services.
- Cigarette smoking prevalence among adults declined slowly between 1991 and 2011 and then more rapidly between 2011 and 2015.
- Smoking prevalence (excluding e-cigarette use) among adolescents has declined since the late 1990’s.
- Initiation of the use of cigarettes among children and adolescents ages 12-17 has been falling more rapidly since 2010 and, in 2013, reached the Healthy People 2020 goal of 4.3%.
- The percentage of success in recent smoking cessation among adult smokers has risen since 2003. In 2015, 7.3 percent of former smokers had quit 6-12 months ago or had initiated smoking at least 2 years ago and quit anytime during the last 12 months.
- Medicaid enrollees have a higher smoking prevalence than the general population. The 2010 Patient Protection and Affordable Care Act requires all state Medicaid programs to provide 1) tobacco cessation services (both counseling and pharmacotherapy) to pregnant women (section 4107) and 2) coverage of cessation medications approved by the U.S. Food and Drug Administration for all enrollees (section 2502). In 2000, 34 states provided Medicaid coverage of smoking cessation aids. Under the 2010 Patient Protection and Affordable Care Act, all states are required to provide coverage.
- The rate of secondhand smoke exposure has decreased significantly for all population subgroups since the early 1990s, and the proportion of adults reporting a smoke-free home has risen. The proportion of adults reporting a smoke-free work environment has also risen.
- Adult sun protective behaviors (e.g., using sunscreen, wearing protective clothing, seeking shade) rose from 2005 to 2010 and have been stable since then, though young adults, especially young men, show much lower levels of these behaviors.
- Female teen indoor tanning has decreased significantly among high school students since 2009. Many states have enacted policies to control the indoor tanning industry, and some are restricting minors’ access to indoor tanning facilities. Still, more than one in ten female teens and adult young women has engaged in indoor tanning within the past 12 months.
- Radon control is a new measure added to this report. The percentage of homes in high radon areas with installed radon mitigation systems is increasing.
- Colorectal cancer incidence rates have decreased steadily, with slight exceptions, since the mid-1980s, and these declines have accelerated in recent years. The declines in colorectal cancer incidence can be attributed to increased screening, which not only contributes to reduced incidence through the identification and removal of precancerous lesions but also improves the detection of cancer at an earlier stage.
- Lung cancer incidence rates in men have continued to fall since 1982 and, for women, since 2006.
- Prostate cancer incidence rates have been declining since 2000, with a large drop in 2012, the same year that the U.S. Preventive Services Task Force recommended against population-based prostate specific antigen (PSA) screening for prostate cancer.
- Recent trends in the incidence of Hodgkin lymphoma, esophageal squamous cell, larynx, stomach, and ovarian cancers have been declining.
Life after Cancer
- The length of cancer survival has increased slowly for all cancers combined. Five-year relative survival for all cancer sites is almost 69% and is approaching the Healthy People 2020 goal of 71.7%. Improving survival reflects real changes due to improved early detection and treatment, which can extend life. However, the artefactual lengthening of survival associated with detecting cancers earlier, resulting in people living longer with a diagnosis of cancer without necessarily extending life, will also contribute to improved survival
- The proportion of adult cancer survivors who are current smokers continues to decline, with the greatest improvement seen among survivors ages 18-44.
- The proportion of adult cancer survivors who report no physical activity in their leisure time continues to decline for both men and women.
End of Life
- The rate of death from cancer continues to decline among both men and women in all major racial and ethnic groups.
- Mortality for the most common types of cancer (colorectal, female breast, lung, and prostate) continues to fall. For colorectal and lung cancer these declines are evident among both sexes and all major racial and ethnic groups except American Indians and Alaska Natives. For breast cancer, recent declines are evident except among Hispanics and American Indians and Alaska Natives. For prostate cancer, the declines are evident among all the major racial and ethnic groups. Changes in trends among smaller subpopulations are more difficult to determine.
- Death rates from cancers of the stomach, ovary, and larynx and non-Hodgkin and Hodgkin lymphoma are all falling at greater than 1% per year. Death rates from leukemia and cancers of the kidney and renal pelvis and esophagus are also falling, but at rates of less than 1% per year.
Areas of Concern
The nation is losing ground in other important areas that demand attention.
- Although the percentage of smokers attempting to quit smoking each year has recently risen and is now at 53.5 percent, successful quitting percentages have been low (6.9% in 2012) and recently have shown only slight improvement.
- Although progress has been made in reducing exposure to secondhand smoke among all populations, nonsmokers age 3 and older living below the poverty level and black non-Hispanics are more likely to be living in homes where someone smokes regularly.
- The 2016 Surgeon General’s Report on E-cigarette Use Among Youth and Young Adults highlights the concern about the growing use of e-cigarettes by young people. E-cigarette aerosols contain nicotine, ultrafine particles, and other harmful and potentially harmful constituents. The Cancer Trends Progress Report includes e-cigarette use for the first time and, based on the Youth Risk Behavior Surveillance System (YRBSS), indicates that in 2015 the use of e-cigarettes among high school students in the past month exceeded the use of conventional cigarettes.
- As of June 2015, only nine states provided coverage of nine evidence-based cessation treatments (medications, individual and group counseling) for all Medicaid enrollees.
- Tobacco advertising and promotion are causally related to increased tobacco use. The U.S. Federal Trade Commission reports cigarette and smokeless tobacco advertising and promotion expenditures. In 2013, the adjusted combined annual expenditure for cigarette advertising and promotion was $8.9 billion, representing a decline in expenditures in recent years but, a still high rate of expenditures overall. In 2013, the five parent companies of the major manufacturers of smokeless tobacco products in the United States spent $503.2 million on advertising and promotion.
- Excess weight or obesity, physical inactivity, and poor nutrition are preventable conditions that are associated with elevated cancer risk. Despite modest increases over time, fewer than 25% of adults report meeting federal guidelines for aerobic and muscle-strengthening physical activity. In 2015, 24.9% of men met the federal guidelines for aerobic and muscle-strengthening physical activity (which exceeded the Healthy People goal 20.1%), but only 17.9% of women met the guidelines.
- Alcohol consumption, which can increase the risk of some cancers, has risen slightly since the mid-1990s.
- More progress is needed to reach Healthy People 2020 targets for cancer screening tests that can identify breast, cervical, and colorectal cancer at early stages. Recent trends in screening rates have been flat or declining for these three cancers. In 2015, the breast cancer screening rate was 71.6 percent (below the Healthy People 2020 target of 81.1 percent); the rate of cervical cancer screening was 78.7 percent (below the target of 93.0 percent); and the rate of colorectal cancer screening was 62.9 percent (below the target of 70.5 percent).
- In 2012, the US Preventive Services Task Force (USPSTF) recommended Pap testing every 3 years; women ages 30+ who want to test less often were also offered the alternative of Pap/HPV co-testing every 5 years. While we have been tracking triennial Pap testing for some time, this report (for the first time) added PAP/HPV co-testing every 5 years. In 2015, 81 percent of women reported being compliant with at least one of the two screening regimens. Trends in triennial Pap testing have been falling slightly since 2000, and this decline has not been compensated for by the addition of women having the newer PAP/HPV co-testing regimen.
- Most cervical cancer can be prevented through HPV vaccination and effective screening. Although this report shows the HPV vaccination trend is rising for both girls and boys ages 13-17, these levels are still low. Only 42 percent of girls and 28 percent of boys aged 13-17 years received the three-dose HPV vaccine series in 2015.
- Unexplained cancer-related disparities remain among population subgroups. For example, although there have been improvements in overall 5-year survival for both black and white women, a disparity of almost 10 percentage points has persisted. The 5-year relative survival for women diagnosed with cancer in 2008 was 80.9 percent for blacks and 89.2% for whites.
- The incidence of some cancers, including thyroid cancer, myeloma, and leukemia, has been increasing at more than 1.5 percent per year, whereas the incidence of other cancers, including breast, testicular, and oral cancers and melanoma and non-Hodgkin lymphoma, is increasing at less than 1.5 per year. For some cancers, e.g. thyroid cancer, the increase is associated with the earlier detection of thyroid tumors, some of which may prove to be relatively indolent.
Life after Cancer
- Estimates of national expenditures for cancer care in 2016 for the top 5 cancer sites were $18.9, $15.9, $14.3, $14.0, and $13.6 billion for female breast, colorectal, prostate, lymphoma, and lung, respectively. Even for patients with health insurance, out-of-pocket costs for cancer care often pose a significant financial burden. As the U.S. population ages and newer technologies and treatments become available, national expenditures for cancer will continue to rise, and cancer costs may increase at a faster rate than overall medical expenditures.
- A growing proportion of cancer survivors age 20 and older are obese. Efforts are needed to help cancer survivors adopt or maintain a healthy lifestyle after cancer, which has the potential to reduce both cancer- and non-cancer-related morbidity.
- Cancer survivors ages 18-44 are more likely to be current smokers than both older cancer survivors and adults ages 18-44 without a cancer history.
End of Life
- Recent trends in the death rates for thyroid, pancreas, liver, and corpus and uterine cancers have been increasing.