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 U.S. Department of Health and Human Services.
- Cigarette smoking prevalence among adults has declined steadily since 1992.
- Cigarette smoking prevalence among adolescents has declined since the late 1990s, with 8.8% of high school students in 2017 having smoked cigarettes in the past 30 days.
- Initiation of the use of cigarettes among children and adolescents aged 12-17 started falling more rapidly in 2010, reaching the Healthy People 2020 target of 4.3% in 2013. As of 2016, it is 3.2%.
- The percentage of success in recent cigarette smoking cessation among adult smokers has risen since 2003. In 2017, 7.7% became former cigarette smokers who had quit 6-12 months ago, approaching the Healthy People 2020 target of 8%.
- 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 (2017) of the percentage of female adolescents in grades 9 through 12 who used an indoor tanning device in the past year is 7.5% (5.6% for both sexes), further dropping below the overall Healthy People 2020 target of 14% for both sexes for adolescents.
- Inorganic arsenic is a new measure added to this report in the Arsenic chapter. Inorganic arsenic has been linked to bladder, lung, skin, prostate, liver, and some kidney cancers. We typically take in small amounts of inorganic arsenic in the food we eat (in particular, rice and fish), the water we drink, and the air we breathe. Recent trends for inorganic arsenic exposure have been decreasing.
- 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, esophageal squamous cell, ovarian, prostate, larynx, and stomach cancers, and Hodgkin lymphoma, with smaller but still statistically significant decreases in bladder and brain cancers.
- Trends for distant-stage colon cancer have been decreasing since the late 1980s.
- Since the mid-1980s, colorectal cancer incidence rates have mostly been decreasing through 2011 and reached the Healthy People 2020 target in 2011. Since then the trend has flattened somewhat. 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. Although age-specific trends in incidence and mortality are not generally covered in this report, it should be noted that incidence trends for those under 50 have been rising and are of enough concern that some guideline setting organizations either have or are considering lowering the age to initiate screening.
- 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.
- Since 2002, more females with early-stage breast cancer have been treated with breast-conserving surgery (BCS) and radiation than with mastectomy.
- Between 1990 and 2015, there was a significant increase in receipt of guideline chemotherapy treatment among patients aged 65+ with stage III colon cancer and stages II and III rectal cancer, with 57% receiving guideline therapy in 2015.
Life After Cancer
- The length of cancer survival has increased slowly for all cancers combined. Five-year relative survival for all cancer sites is 69.3% and is approaching the Healthy People 2020 target 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.
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.
- Recent trends show a decline in the mortality of stomach, ovarian, and larynx cancers, and non-Hodgkin and Hodgkin lymphoma, and leukemia, with smaller but still statistically significant decreases in esophagus and kidney and renal pelvis cancers.
Areas of Concern
The nation is losing ground in other important areas that demand attention.
- Although the percentage of smokers making a quit attempt in the past year has been rising since 2005 and was 53.3% most recently, it is still far below the Healthy People 2020 target of 80%.
- Although progress has been made in reducing exposure to secondhand smoke among all populations, non-Hispanic blacks still have higher rates of exposure than other racial/ethnic groups, those living at less than 200% of the federal poverty level still have higher rates of exposure than those living at 200% or greater than the federal poverty level, and those aged 25 years and older with a high school education or less still have higher rates than those with more education.
- 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 aerosol can contain nicotine, ultrafine particles, and other harmful and potentially harmful constituents. A new E-cigarettes measure for 2011-2018 will be added to the Youth Tobacco Use section of this report once data from the Centers for Disease Control and Prevention’s (CDC) and U.S. Food and Drug Administration’s (FDA) National Youth Tobacco Survey become available.
- Tobacco advertising and promotion are causally related to increased tobacco initiation and use. The U.S. Federal Trade Commission reports cigarette and smokeless tobacco advertising and promotion expenditures for the largest cigarette companies and major smokeless tobacco product manufacturers. In 2016, the adjusted combined annual expenditure for advertising and promotion was $8.7 billion for cigarettes and $759.3 million for smokeless tobacco products—amounting to about $26 million every day.
- Although more than 70% of adults reported practicing sun-protective behaviors, more than 35% reported having had one or more sunburns in the past 12 months. Reports of sunburn are even higher among subgroups; in 2015, younger adults were more likely to have been sunburned in the past year than older adults, and non-Hispanic whites were more likely to have been sunburned in the past year compared to other racial/ethnic groups.
- In 2017, more than 57.2% of teens reported having been sunburned during the past 12 months.
- 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 2017, 53.1% of girls and 44.3% of boys, aged 13-17, were up-to-date with the HPV vaccine.
- The Cancer Trends Progress Report has tracked triennial Pap testing since 1987. To accommodate the addition of HPV testing as a recommended approach to cervical cancer screening, the current report tracks the percentage of women who were up to date with cervical cancer screening recommendations. In 2015, 81% of women aged 21-65 were up to date with respect to their cervical screening recommendations, which is below the Healthy People 2020 target of 93%.
- Uptake of lung cancer screening with CT since 2010 has been limited and fairly stable. In 2010 and 2015, only 4.5% and 5.9%, respectively, of adults aged 55-80 years who meet the U.S. 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, and myeloma has been increasing at more than 1% per year, whereas breast, testicular, and oral cancers, leukemia, and adenocarcinoma of the esophagus, are increasing at a slower, but still statistically significant rate. 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 2018 for the top five cancer sites were $19.7, $16.6, $15.3, $14.6, and $14.2 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.
- The proportion of adult cancer survivors who are obese has been rising and is now 32.6%, exceeding the Healthy People 2020 target of 30.5% for all adults. 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.
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 either progress or an area of concern.
- Sun sensitivity is a new variable added to select measures within the UV Exposure and Sun-Protective Behavior section of this report. Sun sensitivity reflects a person’s characteristic skin response (e.g., a burn, a burn and then tan, etc.) after prolonged sun exposure or after a long period or season of being relatively unexposed. Though related to sun sensitivity, skin color and ethnicity are not adequate proxies for sun sensitivity. Recent trends in sun-protective activities have stabilized for those who are not sun-sensitive but have continued to slowly rise for those who are.
- Excess weight or obesity, physical inactivity, and poor nutrition are preventable conditions that are associated with elevated cancer risk. Obesity prevalence continues to increase, with 39.5% of adults estimated to be obese and an additional 31.8% overweight. Despite modest increases over time, only 24% of adults report meeting federal guidelines for aerobic and muscle-strengthening physical activity. In 2017, 28.5% of men met the federal guidelines for aerobic and muscle-strengthening physical activity (which exceeded the Healthy People 2020 target of 20.1%), while only 19.9% of women met the guidelines. Rates among Hispanics, and low-income and low-education groups of any race were well below the Healthy People 2020 target. Overall diet quality has not improved for years; Americans are not meeting recommendations for intake of fruits and vegetables, which have been linked to prevention of several cancer types.
- Genetic testing is a new measure added to this report. Data from 2005-2015 is available for the percentage of females aged 18 years and older with a family history of breast and/or ovarian cancer who had discussed the possibility of getting a genetic test for cancer risk with a doctor or other health professional, with 22.9% of females in 2015 having received genetic test counseling.