Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.

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Global cancer statistics, 2012

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the most affluent counties, mortality rates in the poorest counties were 2-fold higher for cervical cancer and 40% higher for male lung and liver cancers during 2012-2016. Some states are home to both the wealthiest and the poorest counties, suggesting the opportunity for more equitable dissemination of effective cancer prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21551

Cancer statistics, 2019.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2014, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2015, were collected by the National Center for Health Statistics. In 2018, 1,735,350 new cancer cases and 609,640 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2005-2014) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2006-2015) declined by about 1.5% annually in both men and women. The combined cancer death rate dropped continuously from 1991 to 2015 by a total of 26%, translating to approximately 2,378,600 fewer cancer deaths than would have been expected if death rates had remained at their peak. Of the 10 leading causes of death, only cancer declined from 2014 to 2015. In 2015, the cancer death rate was 14% higher in non-Hispanic blacks (NHBs) than non-Hispanic whites (NHWs) overall (death rate ratio [DRR], 1.14; 95% confidence interval [95% CI], 1.13-1.15), but the racial disparity was much larger for individuals aged <65 years (DRR, 1.31; 95% CI, 1.29-1.32) compared with those aged ≥65 years (DRR, 1.07; 95% CI, 1.06-1.09) and varied substantially by state. For example, the cancer death rate was lower in NHBs than NHWs in Massachusetts for all ages and in New York for individuals aged ≥65 years, whereas for those aged <65 years, it was 3 times higher in NHBs in the District of Columbia (DRR, 2.89; 95% CI, 2.16-3.91) and about 50% higher in Wisconsin (DRR, 1.78; 95% CI, 1.56-2.02), Kansas (DRR, 1.51; 95% CI, 1.25-1.81), Louisiana (DRR, 1.49; 95% CI, 1.38-1.60), Illinois (DRR, 1.48; 95% CI, 1.39-1.57), and California (DRR, 1.45; 95% CI, 1.38-1.54). Larger racial inequalities in young and middle-aged adults probably partly reflect less access to high-quality health care. CA Cancer J Clin 2018;68:7-30. © 2018 American Cancer Society.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21442

Cancer statistics, 2018

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2017) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2018) were collected by the National Center for Health Statistics. In 2021, 1,898,160 new cancer cases and 608,570 cancer deaths are projected to occur in the United States. After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted. Long-term declines in mortality for the 4 leading cancers have halted for prostate cancer and slowed for breast and colorectal cancers, but accelerated for lung cancer, which accounted for almost one-half of the total mortality decline from 2014 to 2018. The pace of the annual decline in lung cancer mortality doubled from 3.1% during 2009 through 2013 to 5.5% during 2014 through 2018 in men, from 1.8% to 4.4% in women, and from 2.4% to 5% overall. This trend coincides with steady declines in incidence (2.2%-2.3%) but rapid gains in survival specifically for nonsmall cell lung cancer (NSCLC). For example, NSCLC 2-year relative survival increased from 34% for persons diagnosed during 2009 through 2010 to 42% during 2015 through 2016, including absolute increases of 5% to 6% for every stage of diagnosis; survival for small cell lung cancer remained at 14% to 15%. Improved treatment accelerated progress against lung cancer and drove a record drop in overall cancer mortality, despite slowing momentum for other common cancers.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21654

Cancer Statistics, 2021.

Cancer incidence and deaths in the United States were projected for the most common cancer types for the years 2020 and 2030 based on changing demographics and the average annual percentage changes in incidence and death rates. Breast, prostate, and lung cancers will remain the top cancer diagnoses throughout this time, but thyroid cancer will replace colorectal cancer as the fourth leading cancer diagnosis by 2030, and melanoma and uterine cancer will become the fifth and sixth most common cancers, respectively. Lung cancer is projected to remain the top cancer killer throughout this time period. However, pancreas and liver cancers are projected to surpass breast, prostate, and colorectal cancers to become the second and third leading causes of cancer-related death by 2030, respectively. Advances in screening, prevention, and treatment can change cancer incidence and/or death rates, but it will require a concerted effort by the research and healthcare communities now to effect a substantial change for the future.

https://cancerres.aacrjournals.org/content/canres/74/11/2913.full.pdf

Projecting Cancer Incidence and Deaths to 2030: The Unexpected Burden of Thyroid, Liver, and Pancreas Cancers in the United States

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Characteristics and Practices of Adults Who Use Tanning Beds in Private Residences

According to Chen et al., 1 6% of U.S. adult women reported never having been screened for cervical cancer. These women were young ( < 21 years) or old ( ‡ 70 years), less educated, uninsured, Hispanic, widowed, and never married. Besides the focus on the never screened women, this study offers many insights into the successes, failures, and gaps of cervical cancer screening over the past two decades. Additionally, it gives public health professionals who develop and use survey measures issues to consider in finding the right balance between keeping the survey consistent to allow for interpretation of trends and flexibility to allow measurement of emerging technologies and new practices. One important success not fully appreciated in the article by Chen et al. is that for the first time, in 2012, cervical cancer screening guidelines are consistent among the three national organizations (www.cdc.gov/cancer/cervical/pdf/ guidelines.pdf for table), including consensus that women <age 21 years no longer need to be screened. Chen’s Behavioral Risk Factor Surveillance System (BRFSS) analysis foreshadows this sentinel event by documenting that the percentage of young women <21 years who report never being screened increased from 35% in 1993 to 54.3% in 2010. This could be a result of concern over the increased adverse pregnancy outcomes associated with screening before the recommended age or the aggressive treatment of preclinical lesions that have a long latency period and a strong likelihood of regression. We expect that the decline that we are seeing now will continue to be observed in future surveys. A lower proportion of women reported screening in the past year (from 64.5% in 1993 to 54.1% in 2010); this finding may signal the wave of the future because of the call by all three organizations for an end to annual cervical cancer screening. Additionally, the Chen et al. article highlights that screening continues among women with a hysterectomy when recommendations for this have been consistent for 10 years. Why do half of women who have had a hysterectomy report having had a Pap test within the past 3 years? Surely, we cannot expect that all these women have had a supracervical hysterectomy or a history of treatment for cervical intraepithelial neoplasia (CIN2) and still require a Pap test. The aim of measuring screening failure is to avoid harm for women at lowest risk and target resources for women at highest risk of getting cervical cancer. Over half of cervical cancers in the United States occur among women who have never been screened. There has remained a constant proportion of women who have never received a Pap test since the 1990s—approximately 6%. Who are the elderly women > 70 years of age who have never had a Pap test? Chen et al. could identify only characteristics currently collected, which do not include language spoken, country of birth, in BRFSS, or specific Hispanic subgroups, all characteristics of women who have been reported to be less likely to get screened. Additional measures not addressed include newer technologies, such as human papillomavirus (HPV) testing and HPV vaccination status. HPV and Pap testing together (cotesting) has been an approved option in screening since 2003 according to some organizations. By 2012, all organizations now either strongly recommend or include cotesting as an option for women ‡ 30 years of age. If both tests are negative, women can now extend the screening interval to 5 years, a response option that needs to be incorporated with in surveys that measure current screening behaviors and practices. Questions on HPV vaccination status would address the interpretation of screening behaviors. There is concern that vaccinated girls and women may have a false sense of security and, thus, not follow recommended screening guidelines. Although current guidelines remain the same for vaccinated and nonvaccinated women, it is anticipated that in the future screening fully vaccinated girls can occur later and less often. In the United States, self-reported state and national surveys are heavily relied upon to measure screening prevalence and gaps for cervical cancer screening, largely because a nationwide population-based screening program does not exist. Long-standing national and statebased surveillance systems face a tough challenge in being responsive to changes in communications technology, population diversity, and newer technologies while still allowing measurement of trends. The same issues are salient and relevant to the international setting. The World Health Organization Global Monitoring Framework currently proposes an indicator to measure that women between the ages of 30 to 49 years have been screened for cervical cancer at least once. With international efforts focused on cervical cancer in lowand middle-income countries, we may need to leverage existing surveillance systems that ask standardized core sets of questions for cervical cancer screening, whether the screening method is using the HPV test, Pap test, or visual inspection with acetic acid (VIA). Clearly, cervical

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Cervical cancer screening measures need to evolve to continue to tell the story.

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Prevention and control of skin cancer

https://stacks.cdc.gov/view/cdc/47601/cdc_47601_DS1.pdf

Meg Watson

Papers

Characteristics and Practices of Adults Who Use Tanning Beds in Private Residences

Cervical cancer screening measures need to evolve to continue to tell the story.

Prevention and control of skin cancer

Indoor tanning among New Jersey high school students before and after the enactment of youth access restrictions.

Communicating During an HIV Outbreak Among People Who Inject Drugs—West Virginia 2019