Report highlights are categorized into one of the three following groups: Making Progress, Areas of Concern, and Other Trends to Consider.
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 US Department of Health and Human Services.
- Cigarette smoking prevalence among adults declined slowly between 1991 and 2011 and then more rapidly between 2011 and 2016.
- Smoking prevalence among adolescents has declined since the late 1990s, with 10.8% in 2015 having smoked cigarettes in the past month. In contrast, any use of e-cigarettes in the past month was 24.1% in 2015.
- Initiation of the use of cigarettes among children and adolescents aged 12-17 started falling more rapidly in 2010, reaching the Healthy People 2020 goal of 4.3% in 2013. As of 2014, it is 3.8%.
- The percentage of success in recent smoking cessation among adult smokers has risen since 2003. In 2016, 7.6% became former smokers who had quit 6-12 months ago, approaching the Healthy People 2020 goal of 8%.
- The rate of secondhand smoke exposure has decreased significantly for all population subgroups since the early 1990s. Also, the proportion of adults reporting a smoke-free home continued to increase in 2015, approaching the Healthy People 2020 target of 87%.
- Adult sun protective behaviors (e.g., using sunscreen, wearing protective clothing, seeking shade) rose from 2005 to 2010 and have been stable since then.
- Female teen indoor tanning has decreased significantly among high school students since 2013. Many states have enacted policies to control the indoor tanning industry, and some are restricting minors’ access to indoor tanning facilities. The most recent estimate (2013-2015) of the percentage of adolescents in grades 9 through 12 who used an indoor tanning device in the past year is 10.6%, dropping below the Healthy People 2020 target of 14%.
- Radon control is a new measure added to this report. The percentage of homes in high radon areas with installed radon mitigation systems has been increasing.
- Colorectal test use rates for adults (home FOBT in the last year or had a sigmoidoscopy in the past 5 years or had a colonoscopy in the past 10 years) aged 50-75 years increased from 58.8% in 2013 to 62.9% in 2015.
- Lung cancer incidence rates in men have continued to fall since 1982 and, for women, since 2006.
- Recent trends show a decline in the incidence of uterine cervical, Hodgkin lymphoma, esophageal squamous cell, larynx, stomach, and ovarian cancers.
- The proportion of patients aged 20 years and older with localized/regional kidney cancer receiving partial nephrectomy has increased from 2000-2014 while the proportion receiving complete nephrectomy has decreased. Partial nephrectomy is now the preferred treatment for patients with early-stage kidney cancer; it may prevent serious side effects like chronic kidney disease.
- The rate of ovarian cancer patients receiving lifesaving chemotherapy has been increasing in the most recent data years (2002-2011). This includes patients in all stages, I through IV.
Life after Cancer
- The length of cancer survival has increased slowly for all cancers combined. Five-year relative survival for all cancer sites is 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 aged 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. For prostate cancer, the declines are evident among all the major racial and ethnic groups. Changes in trends among smaller subpopulation groups 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 has been rising each year since 2005 and was 53.4% most recently, it is still far below the Healthy People 2020 goal of 80%. The percentage who successfully quit remains low, at 7.6% in 2016.
- Although progress has been made in reducing exposure to secondhand smoke among all populations, nonsmokers aged 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 Surgeon General’s Report on E-cigarette Use Among Youth and Young Adults, published in 2016, highlights the concern about the growing use of e-cigarettes by young people. E-cigarette aerosols can contain nicotine, ultrafine particles, and other harmful and potentially harmful constituents. In 2015, the use of e-cigarettes among high school students in the past month exceeded the use of conventional cigarettes.
- As of September 2017, only 11 states provided comprehensive coverage of all 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 US Federal Trade Commission reports cigarette and smokeless tobacco advertising and promotion expenditures for the largest cigarette companies and major smokeless tobacco product manufacturers. In 2014, the adjusted combined annual expenditure for cigarette advertising and promotion was $8.5 billion. In 2014, the five parent companies of the major manufacturers of smokeless tobacco products in the US spent $600.8 million on advertising and promotion.
- Although 70% of adults reported practicing sun protective behaviors, more than 35% reported having had one or more sunburn in the past 12 months. Reports of sunburn are even higher among subgroups; in 2015, 46% of non-Hispanic white adults and adults ages 18-24 reported at least one sunburn in the past year.
- In 2015, more than 55% of teens reported having been sunburned during the past 12 months. This report will continue to include this relatively new measure and any changes over time.
- Young adults ages 18-24, especially young men, show lower levels of sun-protective behaviors (e.g., using sunscreen, wearing protective clothing, seeking shade) than adults aged 25 and older.
- Excess weight or obesity, physical inactivity, and poor nutrition are preventable conditions that are associated with elevated cancer risk. Despite modest increases over time, only 22% of adults report meeting federal guidelines for aerobic and muscle-strengthening physical activity. In 2016, 26.1% of men met the federal guidelines for aerobic and muscle-strengthening physical activity (which exceeded the Healthy People goal 20.1%), but only 18.7% of women met the guidelines.
- Alcohol consumption, which can increase the risk of some cancers, has risen slightly since the mid-1990s.
- 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 aged 13-17, these levels are still low. In 2016, 55% of girls and 43.6% of boys, aged 13-17, received 2+ doses of the HPV vaccine.
- More progress is needed to reach Healthy People 2020 targets for cancer screening tests that can identify breast and colorectal cancer at early stages. In 2015, the breast cancer screening rate was 71.6% (below the Healthy People 2020 target of 81.1%), and the rate of colorectal cancer screening was 62.9% (below the target of 70.5%).
- In 2012, the US Preventive Services Task Force recommended Pap testing every 3 years; women aged 30 and older 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 added PAP/HPV co-testing every 5 years. In 2015, 81% 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. The rate of cervical cancer screening was 78.7% (below the target of 93.0%).
- Early detection of lung cancer is a new section added to this report. In 2015, only 5.5% of adults aged 55-80 years who meet the US Preventive Services Task Force criteria for lung cancer screening had a CT scan to check for lung cancer within the past year.
- The incidence of some cancers, including cancer of the thyroid, liver and intrahepatic bile duct, melanoma, myeloma, and leukemia, has been increasing at more than 1% per year, whereas the incidence of other cancers, including testicular, oral cancers, and adenocarcinoma of the esophagus, are increasing at less than 1% 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.
- Breast cancer incidence rates among women have been slowly increasing since 2004.
Life after Cancer
- Estimates of national expenditures for cancer care in 2017 for the top five cancer sites were $19.3, $16.3, $14.8, $14.3, and $13.9 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 US 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.
- 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% for blacks and 89.2% for whites.
- A growing proportion of cancer survivors aged 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.
- The proportion of adult cancer survivors who are obese has been rising and is now 31%. The proportion of obese cancer survivors is now greater than the Healthy people 2020 goal of 30.5%, and is slightly above the rate in the rate of obesity in the overall adult population.
End of Life
- Recent trends in the death rates for thyroid, liver, brain, and corpus and uterine cancers have been increasing.
Other Trends to Consider
While this report provides trends in cancer rates, and factors that influence cancer rates, for some trends it is not possible to characterize the direction of the trend as progress or an area of concern. For example, the recent US Preventive Services Task Force recommendation for prostate cancer screening supports individualized decision making about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision. Thus, although we report trends in prostate cancer screening, it is not possible to characterize any direction as positive or negative. In this section, we note several of these types of trends.
- Early detection of prostate cancer is a new section added to this report. In 2015, 35.7% of men aged 50 and older had a prostate-specific antigen (PSA) test within the past year.
- Since the mid-1980s, colorectal cancer incidence rates have decreased steadily, with slight exceptions, and reached the Healthy People 2020 target in 2011. 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. Despite the long-term decline in incidence, starting in 2012 age-adjusted rates flattened, due to a rise among younger adults.
- Prostate cancer incidence rates have been declining since 2000, with a large drop in 2012, the same year that the US Preventive Services Task Force recommended against population-based prostate specific antigen (PSA) screening for prostate cancer.