Advancing Progress in
Cancer Prevention and
Risk Reduction
__________
Erin Balogh, Megan Snair, and
Sharyl Nass, Rapporteurs
National Cancer Policy Forum
Board on Health Care Services
Health and Medicine Division
Proceedings of a Workshop
NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Contract No.75D30121D11240 (Task Order No. 75D30121F00002) and Contract No. HHSN263201800029I (Task Order No. HHSN26300008) with the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research; American Cancer Society; American College of Radiology; American Society of Clinical Oncology; Association of American Cancer Institutes; Association of Community Cancer Centers; Bristol Myers Squibb; Cancer Support Community; Flatiron Health; Merck & Co., Inc.; National Comprehensive Cancer Network; National Patient Advocate Foundation; Novartis Oncology; Oncology Nursing Society; Partners in Health; Pfizer Inc; Sanofi; and Society for Immunotherapy of Cancer. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-70285-0
International Standard Book Number-10: 0-309-70285-2
Digital Object Identifier: https://doi.org/10.17226/27026
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Advancing progress in cancer prevention and risk reduction: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27026.
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WORKSHOP PLANNING COMMITTEE1 ADVANCING PROGRESS IN CANCER PREVENTION AND RISK REDUCTION
GARNET L. ANDERSON (Co-Chair), Fred Hutchinson Cancer Center
KAREN BASEN-ENGQUIST (Co-Chair), The University of Texas MD Anderson Cancer Center
GWEN DARIEN, National Patient Advocate Foundation
NANCY E. DAVIDSON, University of Washington
NICOLE F. DOWLING, Centers for Disease Control and Prevention
KAREN M. EMMONS, Harvard University
STANTON L. GERSON, Case Western Reserve University
KATRINA GODDARD, Division of Cancer Control and Population Sciences, National Cancer Institute
JULIE R. GRALOW, American Society of Clinical Oncology
CHANITA HUGHES-HALBERT, University of Southern California
BETH Y. KARLAN, University of California, Los Angeles
SCOTT M. LIPPMAN, University of California, San Diego
LAURA MAKAROFF, American Cancer Society
Project Staff
FRANCIS AMANKWAH, Program Officer (until August 2022)
RACHEL AUSTIN, Senior Program Assistant (until June 2022)
LORI BENJAMIN BRENIG, Research Associate
ANNALEE GONZALES, Administrative Assistant (until May 2022)
JACARI JENNINGS, Senior Program Assistant (August 2022–July 2023)
JENNIFER ZHU, Associate Program Officer (from January 2023)
ERIN BALOGH, Co-Director, National Cancer Policy Forum
SHARYL J. NASS, Co-Director, National Cancer Policy Forum; Senior Director, Board on Health Care Services
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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NATIONAL CANCER POLICY FORUM1
ROBERT A. WINN (Chair), Virginia Commonwealth University
PETER C. ADAMSON, Sanofi
JUSTIN E. BEKELMAN, University of Pennsylvania
SMITA BHATIA, The University of Alabama at Birmingham
CHRIS BOSHOFF, Pfizer Inc.
OTIS W. BRAWLEY, Johns Hopkins University
ROBERT W. CARLSON, National Comprehensive Cancer Network
CHRISTINA CHAPMAN, Baylor College of Medicine; Michael E. DeBakey VA Medical Center
GWEN DARIEN, National Patient Advocate Foundation
JAMES H. DOROSHOW, National Cancer Institute
SCOT W. EBBINGHAUS, Merck Research Laboratories
S. GAIL ECKHARDT, The University of Texas at Austin
CHRISTOPHER R. FRIESE, University of Michigan
STANTON L. GERSON, Case Western Reserve University
SCARLETT LIN GOMEZ, University of California, San Francisco
JULIE R. GRALOW, American Society of Clinical Oncology
ROY S. HERBST, Yale University
HEDVIG HRICAK, Memorial Sloan Kettering Cancer Center
CHANITA HUGHES-HALBERT, University of Southern California
ROY A. JENSEN, University of Kansas; Association of American Cancer Institutes
RANDY A. JONES, University of Virginia
BETH Y. KARLAN, University of California, Los Angeles
SAMIR N. KHLEIF, Georgetown University; Society for Immunotherapy of Cancer
SCOTT M. LIPPMAN, University of California, San Diego
ELENA MARTINEZ, University of California, San Diego
LARISSA NEKHLYUDOV, Brigham and Women’s Hospital; Dana-Farber Cancer Institute; Harvard Medical School
RANDALL A. OYER, University of Pennsylvania; Penn Medicine Lancaster General Health; Association of Community Cancer Centers
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
LISA C. RICHARDSON, Centers for Disease Control and Prevention
CLEO A. RYALS, Flatiron Health
RICHARD L. SCHILSKY, ASCO TAPUR Study; University of Chicago
JULIE SCHNEIDER, Oncology Center of Excellence, Food and Drug Administration
SUSAN M. SCHNEIDER, Duke University
LAWRENCE N. SHULMAN, University of Pennsylvania
HEIDI SMITH, Novartis Pharmaceuticals
ROBIN YABROFF, American Cancer Society
National Cancer Policy Forum Staff
TORRIE BROWN, Program Coordinator
CHIDINMA CHUKWURAH, Senior Program Assistant
GRACE MCCARTHY, Christine Mirzayan Science and Technology Policy Graduate Fellow (March–May 2023)
JULIE WILTSHIRE, Senior Finance Business Partner
JENNIFER ZHU, Associate Program Officer
ERIN BALOGH, Co-Director, National Cancer Policy Forum
SHARYL J. NASS, Co-Director, National Cancer Policy Forum; Senior Director, Board on Health Care Services
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by ELLEN R. GRITZ, The University of Texas MD Anderson Cancer Center.
She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
Acknowledgments
Support from the many annual sponsors of the National Academies of Sciences, Engineering, and Medicine’s National Cancer Policy Forum is crucial to the work of the forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Nonfederal sponsors include the American Association for Cancer Research; American Cancer Society; American College of Radiology; American Society of Clinical Oncology; Association of American Cancer Institutes; Association of Community Cancer Centers; Bristol Myers Squibb; Cancer Support Community; Flatiron Health; Merck & Co., Inc.; National Comprehensive Cancer Network; National Patient Advocate Foundation; Novartis Oncology; Oncology Nursing Society; Partners in Health; Pfizer Inc; Sanofi; and Society for Immunotherapy of Cancer.
The forum wishes to express its gratitude to the expert speakers whose presentations and discussions helped inform efforts to improve population- and clinic-based cancer prevention. The forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.
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Contents
OVERVIEW OF THE EVIDENCE BASE ON RISK FACTORS FOR CANCER
Examples of Risk Factors for Cancer
Addressing Disparities and the Social Determinants of Health
Examples of Innovations in Cancer Etiology Research to Inform Prevention
POPULATION-BASED CANCER PREVENTION STRATEGIES
Examples of Existing Population-Based Cancer Prevention Interventions
Examples of Innovative Strategies for Population-Based Cancer Prevention
Funding and Long-Term Partnerships for Prevention
CLINIC-BASED CANCER PREVENTION STRATEGIES
Role of the USPSTF in Clinic-Based Cancer Prevention
Examples of Existing Clinic-Based Cancer Prevention Interventions
Examples of Innovative Clinic-Based Prevention Strategies
COMMUNICATING CANCER RISK AND PREVENTION
Communicating the Evidence Base Effectively
Cancer Communication and Equity in the New Information Ecosystem
Fostering Trust and Developing Effective Communication in a Complex Environment
Communicating Evolving Science and Effective Prevention Approaches
POTENTIAL OPPORTUNITIES TO SPUR PROGRESS IN CANCER PREVENTION
Centers for Disease Control and Prevention
Health Resources and Services Administration
Boxes and Figures
BOXES
3 Examples of Evidence Gaps for Cancer Screening
4 A State Medicaid Director’s Perspective on the Opportunities to Improve Cancer Prevention Efforts
FIGURES
2 Multisector framework for interventions based on risk and context
4 Estimated annual number of cancer diagnoses attributed to HPV by sex, cancer type, and HPV type
5 Five objectives for achieving high-quality primary care
6 Model for analysis of population health and health disparities
Acronyms and Abbreviations
| ACO | accountable care organization |
| AICR | American Institute for Cancer Research |
| BMI | body mass index |
| CARE | Clinical Avenues to Reach Health Equity |
| CBO | Congressional Budget Office |
| CCSG | cancer center support grant |
| CDC | Centers for Disease Control and Prevention |
| COVID-19 | coronavirus disease 2019 |
| EHR | electronic health record |
| FDA | Food and Drug Administration |
| FORCE | Facing Our Risk of Cancer Empowered |
| HPV | human papillomavirus |
| HRSA | Health Resources and Services Administration |
| KP | Kaiser Permanente |
| NCI | National Cancer Institute |
| OSU | Ohio State University |
| REACH | Racial and Ethnic Approaches to Community Health |
| SARS-CoV-2 | severe acute respiratory syndrome coronavirus 2 |
| USPSTF | U.S. Preventive Services Task Force |
