Fulfilling the Potential of Cancer Prevention and Early Detection (2003) / Chapter Skim
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1. Introduction
1. Introduction
Pages 15-29
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This report of the National Cancer Policy Board reviews the evidence that such a dramatic impact is possible and calls for a national strategy to ensure that the promise of cancer prevention and early detection is realized. The National Cancer Policy Board was established in March 1997, at the Institute of Medicine (IOM)
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In the preparation of this report, the Board listened to presentations made by representatives of federal agencies at its quarterly meetings and commissioned six background papers on cancer prevention and early detection.1 Several of the report's chapters were based on these commissioned papers. The six papers and their authors are as follows: · Quantifying the Contribution of Risk Factors to Cancer Incidence and the Estimated Reduction in Cancer Burden Through Selected Risk Factor Modifications, Graham A
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As described in detail below, the report's chapters provide reviews of the evidence regarding the associations between the selected health behaviors and cancer, interventions to bring about improvements in health behaviors, and opportunities to improve the delivery of preventive services and improve population health. Chapter 2 examines estimates of the reductions of cancer incidence and mortality rates that are achievable through major favorable shifts in the distribution of modifiable risk factors in the U.S.
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This chapter provides background information on the burden of cancer and defines the terms cancer prevention and early detection as used in this report. information dissemination, surveillance, facilitation of stateTHE BURDEN OF CANCER Cancer ranks second only to heart disease as the leading cause of death in the United States (Table 1.1)
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. Accordingly, the burden due to these four cancers must be reduced if total cancer incidence and mortality rates are to be affected.
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Patients may be burdened with pain and other physical symptoms, anxiety and depression, decreased functional status, disrupted life routines, impaired well-being, disability, overwhelming medical bills, and the many ordeals of obtaining treatment. Family members, friends, and other caregivers who aid in the coping process may also suffer from the disease.
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Incidence mortality data obtained from the National Center for Health Statistics. SOURCE: Adapted from ACS, 2002a.
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In the United States, people are more likely to die from cancer if they are poor, have limited education, or both. For example, the probability that a 65-year-old man will die from lung cancer is 547.9/100,000 if his annual family income is less than $10,000, but the risk decreases to 273.6/100,000 if his annual family income exceeds $25,000 (National Center for Health Statistics, 1998~.
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bHispanic is not mutually exclusive from white, black, Asian/Pacific Islanders, and American Indian. NOTE: Incidence data are from NCIS 11 SEER areas; mortality data are from the National Cancer Center for Health Statistics and include all states, except data for Hispanics.
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for the Following Stage at Diagnosis: Localized Regional Distant 97 89 91 84 Esophagus White African American Lung and bronchus White African American Melanoma of the skin White African American Oral cavity and pharynx White African American Ovary White African American Pancreas White African American Prostate White African American Stomach White African American Urinary bladder White African American Uterine cervix White African American Uterine corpus White African American 81 79 64 66 59 28 14 49 42 96 95 82 73 95 91 17 17 100 98 56 58 94 87 92 86 97 22 15 9 7 12 12 21 16 59 35 45 29 79 76 6 2 2 2 2 13 Not calculated 23 16 28 25 Not calculated 32 Not calculated 30 19 25 49 41 50 37 66 41 2 3 o 15 7 29 13 NOTE: Based on data from cancer registries of NCI's SEER program. SOURCE: Greenlee et al.
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. Hispanics, Asians and Pacific Islanders, and American Indians have lower incidences of lung cancer and lower rates of mortality from lung cancer than African Americans and whites (Table 1.3)
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(Table 1.3~. African Americans have the highest prostate cancer incidence rates and death rates in the world (Parkin et al., 1997~.
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. A personal history of colorectal polyps, or chronic inflammatory bowel disease, or a family history of hereditary colorectal cancer syndrome place individuals at higher risk for colorectal cancer (ACS, 2002a)
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One-third of cancer deaths are thought to be related to nutrition and other lifestyle factors including body weight, physical activity, and food choices (Byers et al., 2002~. Secondary Prevention Until the ability to prevent the occurrence of cancer (primary prevention)
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Primary prevention through elimination of risk factors such as smoking and poor nutrition is the most effective way to reduce the burden of cancer. Secondary prevention, the early detection of cancer at its most treatable stage, can also be effective for selected cancers.
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