Using Science to Reduce the Burden of Cancer

The cancer community has made extraordinary progress during the past two decades in developing and using cancer prevention strategies, early detection interventions, and cancer treatments. Nonetheless, cancer remains the second leading cause of death in the United States, claiming the lives of more than half a million Americans every year.¹

CDC conducts and supports studies, often in collaboration with partners, to develop and apply sound science to reduce the burden of cancer and eliminate health disparities. This research uses many different areas of expertise (behavioral science, economics, epidemiology, health services, medicine, and statistics) to address the public health research needs of CDC programs, health care providers, people affected by cancer, and the larger comprehensive cancer control community.

Annual Report to the Nation on the Status of Cancer

Photo: A man and woman CDC has collaborated with the American Cancer Society, the North American Association of Central Cancer Registries, and the National Cancer Institute since 1998 to create this annual report. It provides an update of cancer incidence (new cases) and death rates and trends in these rates in the United States, as well as an in-depth analysis of a selected topic.

According to the most recent report, published in May, 2011, rates of death in the United States from all cancers for men and women continued to decline between 2003 and 2007. For the first time since cancer statistics have been monitored, lung cancer death rates (the number of people who die from cancer out of every 100,000 people) decreased in women, more than a decade after rates began dropping in men. The incidence rates (the number of people who get cancer out of every 100,000 people) for all types of cancers combined decreased, on average, a bit less than 1% per year between 2003 and 2007.²

Cancer Survivors—United States, 2007

The number of cancer survivors in the United States increased from 3 million in 1971 to 9.8 million in 2001 and 11.7 million in 2007—an increase from 1.5% to 4% of the U.S. population, according to a report published in March, 2011. Cancer survivors largely consist of people who are 65 years of age or older and women. Many people with cancer live a long time after diagnosis; more than a million people were alive in 2007 after being diagnosed with cancer 25 years or more earlier.³

Racial/Ethnic Disparities and Geographic Differences in Lung Cancer Incidence

This report describes lung cancer incidence among racial/ethnic groups by U.S. census region. It identifies the racial/ethnic groups and geographic areas that would most benefit from greater efforts to prevent lung cancer.⁴

The study found that between 1998 and 2006—

The annual incidence rate was highest among blacks (76.1), followed by whites (69.7), American Indians/Alaska Natives (AI/ANs) (48.4), and Asian/Pacific Islanders (A/PIs) (38.4).
Hispanics had lower lung cancer incidence (37.3) than non-Hispanics (71.9).
Incidence varied greatly with age, peaking among persons aged 70–79 years (426.7).
The region with the highest incidence was the South (76.0); the lowest was the West (58.8).
Among whites, the highest lung cancer incidence was in the South (76.3). The highest incidence among blacks (88.9), AI/ANs (64.2), and Hispanics (40.6) were in the Midwest, and the highest incidence among A/PIs was in the West (42.5).

Research Nominated for the Charles C. Shepard Science Award

The Charles C. Shepard Science Award is presented to the best manuscript on original research published by a CDC or ATSDR scientist in a reputable, peer-reviewed journal. CDC's Division of Cancer Prevention and Control submitted the following four papers for consideration.

Fecal Occult Blood Testing Beliefs and Practices of U.S. Primary Care Physicians: Serious Deviations from Evidence-Based Recommendations

Fecal occult blood testing (FOBT) is an important option for colorectal cancer screening. A national survey of clinical practice in 1999–2000 showed serious problems in the way many doctors in the United States implemented FOBT. This study looked at data from a more recent survey (2006–2007) to determine whether doctors' methods of screening for fecal occult blood had improved.

As in the earlier survey, three-quarters of doctors who recommend FOBT performed in-office tests, which are inappropriate for screening. Most doctors still use standard guiaiac tests instead of newer higher sensitivity guaiac tests, or immunochemical tests that do not require restricted diets. Only a minority of doctors use reminder systems, which increase the number of tests that are completed and returned.

The study shows that many doctors continue to use inappropriate FOBT screening methods. Greater efforts to inform doctors about recommended technique and to promote the use of tracking systems are needed.⁵

Medical Costs of Cancer Have Nearly Doubled Since 1987

Little information is available on how cancer costs have changed over time and who pays most cancer-related expenses. A CDC-led study found that the total medical cost of cancer (in 2007 dollars) increased from $24.7 billion in 1987 to $48.1 billion in 2001–2005. The study also found that the percentage of cancer costs paid by private insurance increased from 42% in 1987 to 50% in 2001–2005, while out-of-pocket payments fell from 17% to 8% during the same period.⁶

Cervical Cancer Screening with Both HPV and Pap Testing vs. Pap Testing Alone: What Screening Intervals Are Physicians Recommending?

Photo: Healthcare professionals Guidelines recommend that women who are 30 years or older and have a normal Papanicolaou (Pap) test result, or a normal Pap and negative human papillomavirus [HPV] test results, be screened for cervical cancer every three years instead of every year. Such women have a very low risk of getting cervical cancer in the three to five years after testing.

This study looked at how often doctors in the United States recommend women be screened for cervical cancer, comparing doctors who conduct both HPV and Pap tests to doctors who conduct only Pap tests. For a 35-year-old woman with a normal Pap test result and a negative HPV test result, only 19% of doctors would conduct the next Pap test in three years. Most remaining doctors would conduct the Pap test more frequently.

The findings suggest that the guidelines have not convinced doctors to lengthen the screening intervals when using HPV tests for patients with consistently negative Pap tests. Women are being screened too often, which can lead to unnecessary worry and increased health care costs.⁷

Differences in Non-Hodgkin Lymphoma Survival Between Young Adults and Children

Survival among young adults with non-Hodgkin lymphoma (NHL) has increased over time, but they were more likely to die than children and adolescents, even after accounting for NHL subtype and stage at diagnosis. Increasing survival with NHL depends on receiving the appropriate cancer therapy. Efforts to address survival should include improving enrollment in clinical trials as well as increasing access to care.⁸

References

¹Xu J, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. [PDF-555KB] National Vital Statistics Reports 2010;58(19).

²Kohler BA, Ward E, McCarthy BJ, Schymura MJ, Ries LAG, Eheman C, Jemal A, Anderson RA, Ajani UA, Edwards BK. Annual report to the nation on the status of cancer, 1975–2007, featuring tumors of the brain and other nervous system. Journal of the National Cancer Institute 2011;103(9):714–736.

³Centers for Disease Control and Prevention (CDC). Cancer survivors—United States, 2007. MMWR 2011;60(9):269–272.

⁴Centers for Disease Control and Prevention (CDC). Racial/ethnic disparities and geographic differences in lung cancer incidence—38 states and the District of Columbia, 1998–2006. MMWR 2010;59(44):1434–1438.

⁵Nadel MR, Berkowitz Z, Klabunde CN, Smith RA, Coughlin SS, White MC. Fecal occult blood testing beliefs and practices of U.S. primary care physicians: serious deviations from evidence-based recommendations. Journal of General Internal Medicine 2010;25(8):833–839.

⁶Tangka FK, Trogdon JG, Richardson LC, Howard D, Sabatino SA, Finkelstein EA. Cancer treatment cost in the United States: has the burden shifted over time? Cancer 2010;116(14):3477–3484.

⁷Saraiya M, Berkowitz Z, Yabroff KR, Wideroff L, Kobrin S, Benard V. Cervical cancer screening with both human papillomavirus and Papanicolaou testing vs Papanicolaou testing alone: what screening intervals are physicians recommending? Archives of Internal Medicine 2010;170(11):977–985.

⁸Tai E, Pollack LA, Townsend J, Li J, Steele CB, Richardson LC. Differences in non-Hodgkin lymphoma survival between young adults and children. Archives of Pediatric and Adolescent Medicine 2010;164(3):218–224.