Cancer Prevention & Early Detection Facts & Figures 2017-2018 State Cigarette Excise Tax, 2017* WA $3.025 NH MT VT $1.78 ME ND $1.70 $3.08 $2.00 $0.44 MN OR $3.04 $1.32 ID MA $0.57 SD WI NY $3.51 $1.53 $2.52 $4.35 WY MI $0.60 $2.00 RI $3.75 IA PA CT $3.90 NV NE $1.36 $2.60 $1.80 $0.64 OH NJ $2.70 UT IL IN $1.60 $1.70 $1.98 $0.995 CA CO WV DE $1.60 $2.87 $0.84 VA KS MO $1.20 MD $2.00 KY $0.30 $1.29 $0.17 $0.60 DC $2.50 NC TN $0.45 AZ OK $0.62 $2.00 NM $1.03 AR SC $1.66 $1.15 $0.57 MS AL GA $0.68 $0.675 $0.37 TX $1.41 LA $1.08 AK $2.00 FL $1.339 HI $3.20 Below $0.845 per pack (50% of national average) Between $0.845 and $1.69 per pack Above national average of $1.69 per pack *Taxes in effect or increases passed, reported as of April 1, 2017. Source: American Cancer Society Cancer Action Network, 2017. Contents Preface 1 Environmental Cancer Risks 50 References 1 Evaluation and Identification of Carcinogens 51 Highlights, CPED 2017-2018 2 Managing Cancer Risk 51 References 52 Tobacco 3 Adult Tobacco Use 3 Cancer Screening 52 Youth Tobacco Use 7 Breast Cancer Screening 52 Tobacco Cessation 9 Cervical Cancer Screening 56 Comprehensive Tobacco Control Programs 10 Colorectal Cancer Screening 57 References 15 Endometrial Cancer Screening 60 Lung Cancer Screening 61 Overweight and Obesity, Physical Activity, and Nutrition 17 Prostate Cancer Screening 61 Overweight and Obesity 17 Cancer Screening Obstacles and Opportunities to Improve Cancer Screening Utilization 63 Physical Activity 22 American Cancer Society Recommendations Nutrition 24 for the Early Detection of Cancer in Average-risk Community Action 30 Asymptomatic People 64 References 32 References 65 Ultraviolet Radiation and Skin Cancer 35 Special Notes 68 Solar Ultraviolet Exposure 35 Federal Policies 68 UVR Exposure Behaviors 36 Body Mass Index 68 Artificial UVR Exposure (Indoor Tanning) 37 Sample Surveys 68 Prevention Strategies in Skin Cancer 38 Other Statistical Terms 69 Early Detection of Skin Cancer 39 Survey Sources 69 References 40 Infectious Agents 42 Human Papillomavirus 42 Helicobacter Pylori 44 Hepatitis B Virus 46 Hepatitis C Virus 47 Human Immunodeficiency Virus 47 Epstein-Barr Virus 48 References 48 Global Headquarters: American Cancer Society Inc. This publication attempts to summarize current scientific 250 Williams Street, NW, Atlanta, GA 30303-1002 information about cancer. Except when specified, it does not 404-320-3333 ©2017, American Cancer Society, Inc. All rights reserved, represent the official policy of the American Cancer Society. including the right to reproduce this publication or portions thereof in any form. Suggested citation: American Cancer Society. Cancer Prevention & Early For written permission, address the Legal department of the American Cancer Society, 250 Williams Street, NW, Detection Facts & Figures 2017-2018. Atlanta: American Cancer Society; 2017. Atlanta, GA 30303-1002. Preface Prevention and early detection are central to our mission of helping save lives, celebrate lives, and lead the fight for a world without cancer. Much of the suffering and death from cancer could be prevented by more systematic efforts to reduce tobacco use and obesity, improve diet, and increase physical activity and the use of established screening tests.1 In 2017 about 190,500 cancer deaths in the US will be caused by cigarette smoking alone.2 An estimated 20% of all cancers diagnosed in the US are caused by a combination of excess body weight, physical inactivity, excess alcohol consumption, and poor nutrition, and thus could also be prevented.3 Cancer screening tests can also prevent thousands of additional cancer deaths through identification and removal of premalignant abnormalities (colorectal and cervical) and detection of cancers at an early stage when treatment is more effective. However, the use of potentially lifesaving prevention and early detection measures is suboptimal and profoundly influenced by individual behaviors, as well as social, economic, and public policy factors. Since 1992, the American Cancer Society has published Cancer Prevention & Early Detection Facts & Figures (CPED) as a resource to strengthen cancer prevention and early detection efforts at the local, state, and national levels. CPED complements the American Cancer Society’s flagship publication, Cancer Facts & Figures, by disseminating information related to cancer control. Visit cancer.org/research/cancer-facts- statistics.html to access our collection of educational publications, past and present. References 1. World Cancer Research Fund and American Institute for Cancer Research. Policy and Action for Cancer Prevention. Washington DC, 2009. 2. American Cancer Society. Cancer Facts & Figures 2017. Atlanta: American Cancer Society; 2017. 3. World Cancer Research Fund and American Institute for Cancer Research. Continuous Update Project Available from URL: http://www. wcrf.org/int/research-we-fund/continuous-update-project-cup. Cancer Prevention & Early Detection Facts & Figures 2017-2018 1 Highlights, CPED 2017-2018 Tobacco Use • In 2015, only 29% of adults reported eating two • In 2015, 15% of adults were current cigarette smokers. or more servings of fruit and 16% reported eating Smoking prevalence varied widely by state, ranging three or more servings of vegetables per day. About from 9% in Utah to 26% in Kentucky. one in three (32%) high school students consumed fruit two or more times per day and 15% consumed • Current cigarette smoking among high school students vegetables three or more times per day. declined from 29% in 1999 to 9% in 2015. By state, smoking prevalence among high school students in 2015 • About 28% of adults reported excessive alcohol ranged from 5% in Rhode Island to 19% in West Virginia. consumption, according to 2011-2014 data. • Use of electronic cigarettes (e-cigarettes) has increased rapidly, especially among youth. Among high school Ultraviolet Radiation and Skin Cancer students, the prevalence of current e-cigarette use • In 2015, approximately 4% of adults reported using an increased from <2% in 2011 to 16% in 2015. Among indoor tanning device in the past year; use was higher adults, 4% were current e-cigarette users in 2015, among women (6%) than men (2%) and those living with differences by sex, age, and race/ethnicity. in the Midwest (6%) compared to other regions. • Raising cigarette prices by increasing excise taxes • The use of indoor tanning devices among female reduces tobacco consumption. The federal excise tax high school students appears to have declined is $1.01 per pack. As of April 1, 2017, the average state in recent years from 25% in 2009 to 11% in 2015. cigarette excise tax was $1.69 per pack, ranging from However, only 13 states and the District of Columbia 17 cents in Missouri to $4.35 in New York. have a law prohibiting indoor tanning for minors without exemptions as of January 1, 2017. • Since 2002, there have been more former smokers than current smokers in the US. In 2015, there were approximately 52.8 million former and Infectious Agents • HPV vaccination among adolescents lags behind 36.5 million current cigarette smokers. other recommended vaccines, though rates have increased in recent years. In 2015, 63% of girls Overweight and Obesity, Physical Activity, and 50% of boys received at least one dose of and Nutrition the HPV vaccination, and about 52% and 39%, • Based on 2013-2014 physical examination data, respectively, completed two or more doses. approximately seven out of 10 adults were overweight or obese; 38% were obese (men: 35%, women: 40%). The prevalence of obesity among Cancer Screening women continues to rise, while it appears to • In 2015, 50% of women 40 years of age and older have stabilized among men in recent years. reported having a mammogram within the past year, and 64% reported having one within the past two years. • The prevalence of obesity tripled between 1976 and The lowest prevalence of mammography use in the past 2002 among adolescents (ages 12-19 years) and two years occurred among uninsured women (31%). increased across all race/ethnicities and genders. • In 2015, 81% of women 21-65 years of age had • In 2015, the prevalence of adults who were received a Pap test in the past three years, with overweight or obese ranged from 54% in the lowest use among women who are uninsured District of Columbia to 71% in West Virginia. (61%) and recent immigrants (68%). • In 2015, about 50% of adults reported meeting • In 2015, 63% of adults 50 years of age and older recommended levels of aerobic physical activity. reported having either an FOBT/FIT within the An estimated 27% of high school students met past year or sigmoidoscopy within the past recommended levels of physical activity. five years or colonoscopy within the past 10 years. Prevalence was lowest among uninsured individuals (25%) and recent immigrants (34%). 2 Cancer Prevention & Early Detection Facts & Figures 2017-2018 Tobacco Smoking remains the world’s most preventable cause of • Among adults, the proportion of daily smokers death. The first US Surgeon General’s report on smoking decreased from nearly 17% in 2005 to about 11% and health in 1964 helped determine that cigarette in 2015.10 smoking caused lung cancer.1 Since then other tobacco • In 2015, smoking prevalence was two to four products, including cigars, cigarillos, roll-your-own times higher among adults without a high school products, and smokeless tobacco, have been causally diploma than among those with a college degree linked to cancer as well.2 Substantial gains in tobacco (Table 1A, page 4). control have been made since the Surgeon General’s report, yet there have been 21 million deaths in the US due • Smoking prevalence has declined across racial/ to tobacco since 1964.