Healthy People 2020 Initiative Demonstrates Progress on the Status of Cancer in the US

To help assess the advances the United States has made in decreasing cancer-related deaths, a collective of public health bodies found that monitoring trends in cancer risk, screening test use, and mortality is informative. A report published inCancershows that progress has been made in recent years, but there is more work to be done.

The cancer death rate decreased by 15% overall (range, 4-22), reaching the target set by the Healthy People 2020 initiative. However, some sociodemographic groups failed to meet this target, including males, blacks, and those in rural areas of the United States, according to the report.

Progress achieved by the Healthy People 2020 objectives was highlighted as a special report in theAnnual Report to the Nation on the Status of Cancer, which is published annually by collaborators National Cancer Institute, Center for Disease Control and Prevention, American Cancer Society, and North American Association of Central Cancer Registries.

Investigators evaluated progress among 4 of the most common cancers, including lung cancer, prostate cancer, female breast cancer, and colorectal cancer (CRC) in a companion paper to the report. This effort is known as “Healthy People 2020,” which outlined targets for reducing death rates. The target cancer death rate of 161.4 deaths per 100,000 persons was met for all cancers combined, as well as for lung, prostate, female breast cancer, and CRC, and the target was met in most socioeconomic groups.

“Although interventions to reduce cancer risk factors and promote healthy behaviors and environments have been shown to work, they may need to be equitably applied or adapted to work well in all communities,” Henley et al wrote. “Implementing cancer prevention and control interventions that are sustainable, focused, and culturally appropriate may boost success in communities with the greatest need, ensuring that all Americans can access a path to long, healthy, cancer‐free lives.”

The target for reducing the cancer death rate of 161.4 deaths per 100,000 was met overall but was not met in males, blacks, or people in rural areas, according to the report. However, these groups experienced larger decreases in rates compared with other groups. The cancer death rate declined 15% overall, meeting the improvement goal in many sociodemographic groups.

The target lung cancer death rate of 45.5 deaths per 100,000 persons was met overall, as well as in each sociodemographic group. From 2007 to 2017, there was an overall 28% decrease. However, screening for lung cancer was low in adults at high risk, but this increased from 2010 to 2015 in most groups, with the exception of Hispanics and those withless than or more than a high school education.

The target female breast cancer death rate was 20.7 deaths per 100,000 persons, which was met overall with the exception of black women.

Breast cancer screening rates from 2008 to 2015 increased slightly among Hispanic women but declined among other groups, such as Asian women, women in rural areas, and those with public or no health insurance. The Healthy People 2020 target was to increase breast cancer screening to 81.1%, but this was not met in any group with the exception of those with advanced educational degrees. The screening was lowest among women who had no health insurance.

The target CRC death rate was 14.5 deaths per 100,000 persons, which was met overall and in several sociodemographic groups with the exception of males, blacks, or people in rural areas. Death rates decreased 19% overall, but the biggest decline was among blacks and the smallest among the American Indian/Alaska Native group.

The CRC screening rate increased by ≥35% or more in some groups, including those in the American Indian/Alaska Native, Hispanic, and uninsured groups. The screening rate for CRC increased by about 20% overall between 2008 and 2017 but missed the target of 70.5% overall with the exception of those with advanced educational degrees.

The prostate cancer death rate target was 21.8 deaths per 100,000 persons and was met overall. However, the target was not met in black men, who did experience the largest decrease in rates. The target of increasing the proportion of men who discussed screening with their clinician was 15.9%; this target was met overall with the exception of Asian men, men in metropolitan areas, and those with a college or advanced educational degree.

Targets that were not met in adults included decreasing cigarette smoking to 12%, increasing smoking cessation to 8%, reducing excessive alcohol use to <10%, and reducing obesity prevalence to 30.5%, all of which have been linked to cancer risk. However, in terms of decreasing smoking, Asians and those who had a college or advanced degree met the target in 2008, and Hispanics and those with private health insurance met the target by 2017.

Exposure to secondhand smoke also decreased by 39% overall between periods 2005 to 2008 and 2011 to 2014, and investigators noted that most groups reached the target of 33.8%. Blacks and those with public health insurance did not miss this target, but these groups did decrease >10%.

The target for reducing excessive alcohol usage was 25.4%, which most groups did not reach. Females, Asians, those in rural areas, those with less than a high school education, and those with an advanced educational degree, however, did meet this target. The proportion of adults who drank alcohol in excess changed <10% from 2008 to 2016 among most groups except the American Indian/Alaska Native group.

Healthy People 2020 defined its target for reducing obesity prevalence as 30.5%, but the prevalence increased across all groups between the periods 2005 to 2008 and 2013 to 2016. Obesity was observed in 39% of all adults from 2013 to 2016.

Healthy People 2020 sets targets intended for the overall population to guide health promotion and disease prevention efforts. Sociodemographic groups are also examined with the target-setting method to gauge progress across a number of different groups. More than 1,200 objectives have been defined. In this report, authors selected and analyzed 4 of the most common cancer types, which included lung cancer, breast cancer, pancreatic cancer, and CRC.

Reference:

Hanley SJ, Thomas CC, Lewis DR, et al. Annual Report to the Nation on the Status of Cancer, part II: Progress toward Healthy People 2020 objectives for 4 common cancers [Published Online March 12, 2020].Cancer. doi.org/10.1002/cncr.32801.