Report: Challenges persist in altering behaviors that increase cancer risk

Issue: July 10, 2013

The Cancer Prevention & Early Detection Facts & Figures 2013 report, released today by the American Cancer Society, emphasizes the profound influential effect that social, economic and legislative risk factors have had on health behaviors that contribute to cancer risk.

Specifically, the report examines tobacco use; obesity, physical activity and nutrition; exposure to ultraviolet radiation; and cancer screening utilization.

“Our report is a striking reminder that we need to do a better job reducing behavioral risk factors that increase cancer risk,” Vilma Cokkinides, PhD, the cancer society’s strategic director of risk factors and screening, said in a press release. “We could eliminate much of the suffering and death from cancer with better, more systematic efforts to reduce tobacco use, improve nutrition and opportunities for physical activity, and expand the use of those screening tests that are proven effective.”

Tobacco use

Heavy smoking decreased significantly between 2005 and 2011, and the findings suggest a long-term trend toward decreased cigarette consumption among tobacco users, according to the report.

The report’s authors observed a slight decline in tobacco use among US adults, from 20.9% in 2005 to 19% in 2011. Smoking prevalence declined in women from 18.1% to 16.5% and in men from 23.9% to 21.6%.

The percentage of high school students who smoke cigarettes declined from 36.4% in 1997 to 18.1% in 2011.

After cigarettes, the most common type of tobacco products high school students used were cigars (13.1%) and smokeless tobacco (7.7%).

Although the results demonstrate a continued decline in tobacco use, some recent trends have also cautioned public health enthusiasm, Michael B. Steinberg, MD, MPH, FACP, told HemOnc Today.

Michael B. Steinberg

“The decline in tobacco consumption has flattened out in recent years compared to previous decades,” said Steinberg, a HemOnc Today Editorial Board member. “In addition, some trends in use patterns may confound our typical reliance on cigarette consumption. For example, people who smoke menthol cigarettes tend to smoke fewer cigarettes per day, yet still have high rates of inhaled carbon monoxide and high levels of nicotine dependence. Also, with increasing cigarette prices, a trend has emerged in smokers ‘butting-out’ and relighting cigarettes. This leads to fewer cigarettes smoked, but can actually increase the risk of lung cancer and [chronic obstructive pulmonary disease].”

Physicians must remember that tobacco use remains the leading cause of preventable death for their patients, Steinberg said.

Also, rates of tobacco use have not declined to the same extent among everyone. Groups that should remain high priorities for tobacco treatment interventions include patients with cardiovascular and pulmonary disease, smokers with cancer, pregnant smokers and smokers with mental health diagnoses, Steinberg said.

“These groups not only suffer disproportionate rates of harm, but also cost our health care system very high — yet avoidable — medical expenses,” Steinberg said. “The overwhelming majority of patients who smoke want to stop and need help in doing so. Physicians need to know that evidence-based guidelines exist for treating tobacco, and educational resources are available for clinicians who want to learn more about these interventions. Treating tobacco dependence is a vital role that physicians need to embrace.”

Obesity and inactivity

Although the report suggests that the increase in obesity prevalence observed for decades has slowed, 35.7% of adults and 18.4% of adolescents in the United States are classified as obese.

White men have a higher prevalence of obesity than white women, and obesity prevalence is significantly higher among black women than black men.

The overall obesity prevalence exceeded 20% during 2011. The highest obesity rate was observed in Mississippi (35%) and the lowest rate was observed in Colorado (20.8%). Obesity rates among high school students varied from 17% in Alabama to only 7.3% in Colorado.

Jeffrey A. Meyerhardt

“The increasing rates of obesity, including higher classes of obesity with BMI >35 kg/m2, is concerning given the multiple diseases that have been implicated to obesity, including multiple types of cancers,” Jeffrey A. Meyerhardt, MD, MPH, associate professor in the department of medicine at Harvard Medical School, told HemOnc Today. “As clinicians, we may not realize the implications of these increases for years. The slowing of the continuing rise is encouraging, but the current obesity prevalence requires more research to better counsel patients on how to obtain a healthy weight and what level of weight loss from the obese state can improve the risks of obesity-associated cancer.

“In addition to increasing risk of developing multiple types of cancers, we are beginning to obtain data that obese cancer patients have higher risks for certain type of cancers to recur,” Meyerhardt added. “Research is needed to better understand if healthy, controlled weight loss in cancer survivors can improve outcomes as well.”

Vaccinations and screenings

HPV vaccination rates continue to lag behind other recommended vaccinations among female adolescents, according to the report.

However, the report’s authors noted HPV vaccination initiation rates improved from 25% in 2007 to 53% in 2011, and 70.7% of individuals who initiated vaccination completed the three-dose series.

Overall, cancer screening rates appear to be lowest among the uninsured and those with fewer years of education.

During 2010, 66.5% of women aged 40 years and older reported receiving a mammogram within the past 2 years. Women without health insurance reported the lowest use of mammograms (31.5%) among any sugroup of the population.

Although 83% of women aged between 21 and 65 years reported receiving a Pap test within the past 3 years, Pap tests were consistently underutilized among women with lower education, those who were recent immigrants and women who were uninsured, according to the report.

In 2010, 59.1% of adults aged 50 years and older reported receiving an endoscopy or fecal occult blood test within the recommended time frame to screen for colorectal cancer. Rates remained low among those with 11 or fewer years of education (43.9%) and among those without health insurance (18.8%). – by Jennifer Southall

For more information:

American Cancer Society. Cancer Prevention and Early Detection Facts and Figures 2013. Atlanta: American Cancer Society; 2013.