While there has been substantial progress in some cancer control efforts in the past several decades, like reductions in smoking and increased utilization of cancer screening, progress in some areas is lagging, according to a new report. Among the areas of most concern: smoking rates among certain populations, obesity, indoor tanning, and low utilization of a new vaccine against human papillomavirus (HPV), which causes cervical and other cancers. Additionally, colorectal cancer screening, which not only detects tumors early but also may prevent cancer from developing, is underutilized, particularly among the uninsured.

Every two years, researchers from the American Cancer Society analyze data for cancer risk factors and screening from the Centers for Disease Control and Prevention (CDC) to strengthen cancer prevention and early detection efforts and highlight disparate populations. This year the findings are published in Cancer Epidemiology, Biomarkers & Prevention as well as in a standalone consumer publication Cancer Prevention & Early Detection Facts & Figures.

Tobacco use

Tobacco use remains the single largest preventable cause of disease and premature death in the United States. Since the release of the Surgeon General’s Report on Smoking and health 50 years ago, there have been 20 million deaths due to tobacco. An estimated 17.8% of adults (20.5% of men; 15.3% of women) were cigarette smokers in 2013, a drop from 23.5% in 1999.

While smoking has declined across all education groups, there is wide variation in cigarette use by education. Among those with a high school education, 22% smoke compared to only 9.1% of those with undergraduate degree and 5.6% of those with a graduate degree. Among race/ethnicities, smoking prevalence ranged from 9.6% in Asians to 22.7% in American Indians/Alaska Natives (22.7%).People who identified themselves as gay or lesbian (25.8%) or bisexual (28.6%) had higher smoking prevalence than those who identified as straight (17.6%). The use of other forms of tobacco, including cigars and e-cigarettes, has increased in recent years.

Overweight and obesity, physical activity, and nutrition

Obesity, physical inactivity, and poor nutrition are major risk factors for cancer, second only to tobacco use. The World Cancer Research Fund estimates that about one quarter to one third of all cancers in the United States can be attributed to diet and insufficient physical activity, as well as overweight and obesity.

The prevalence of obesity increased rapidly from 1976 to 2002, but has since stabilized. In 2013, more than two thirds of American adults were overweight or obese. Among women, blacks had the highest obesity prevalence (57.4%) followed by Hispanics (45.2%), non-Hispanic whites (33.3%), and Asians (11.3%). Among men, Hispanics had the highest obesity prevalence (40.9%) followed by blacks (37.5%), non-Hispanic whites (32.8%), and Asians (10.8%).

In 2013, 30.5% of adults reported no leisure-time physical activity during an average week. About half (50.1%) of adults reported meeting recommended levels of aerobic activity (at least 150 minutes of moderate or 75 minutes of vigorous activity per week). In 2013, just 27.1% of U.S. high school students met recommended levels of physical activity.

In 2013, only 15.1% of adults reported consuming the recommended three or more servings of vegetables and 29.8% reported eating two or more servings of fruits daily.

UV radiation

Most adults and adolescents in the United States do not regularly protect themselves against exposure to UV radiation when outdoors on sunny days. In 2010, 32.1% of adults reported always or often using sunscreen when outside for an hour or more on a warm, sunny day in the past 12 months, and 37.1% reported seeking shade, while fewer adults used clothing protection, including wearing hats (12.8%) or long-sleeved shirts (11.5%). In 2013, only 10.1% of U.S. high school students used sunscreen routinely and 20.2% of young women reported using an indoor tanning device in the previous year.

Prevention and early detection

Although use of the human papillomavirus (HPV) vaccine, which helps prevent against cervical and other cancers, has increased in the past 5 years, HPV vaccination remains low with only 37.6% of adolescent girls and 13.9% of adolescent boys receiving vaccination.

Breast, cervical and colorectal cancer screening increased in the past several decades, contributing to declining mortality rates in these cancers.  Although colorectal cancer screening increased rapidly since the 2000’s (from 38.6% in 2000 to 54.5% in 2008, primarily through increased use of colonoscopy), screening prevalence has stabilized in recent years and still lags behind that for breast and cervical cancers. According to the 2013 data, approximately 58.6% of adults 50 years and older have received recommended colorectal cancer screening.  Approximately 65.9% of women have received mammography in the past two years and 80.8% of women have received cervical cancer screening in the past three years. Regardless of the cancer screening type, people without insurance have markedly lower cancer screening uptake; for example, 21.9% of uninsured receive recommended colorectal cancer screening.

Article: Prevalence of Major Risk Factors and Use of 3 Screening Tests for Cancer in the United States; Stacey A. Fedewa, Ann Goding Sauer, Rebecca L. Siegel, and Ahmedin Jemal; Cancer Epidemiol Biomarkers Prev; 24(4); 637–52