Cancer Prevention & Early Detection Facts & Figures 2019-2020 Current* Cigarette Smoking (%), Adults 18 Years and Older by State, 2017 WA NH ME MT ND VT OR MN ID MA SD WI NY WY MI RI IA PA CT NV NE OH NJ UT IL IN CA DE CO WV KS VA MD MO KY DC NC TN AZ OK NM AR SC MS AL GA TX LA AK FL 22% to 26% 18% to 21% PR 15% to 17% HI 9% to 14% *Smoked 100 cigarettes in lifetime and are current smokers (regular and irregular). Source: Behavioral Risk Factor Surveillance System, 2017. Contents Introduction 1 Infectious Agents 32 References 1 Human Papillomavirus 32 Highlights, CPED 2019-2020 1 Helicobacter Pylori 34 Hepatitis B Virus 35 Tobacco 2 Hepatitis C Virus 37 Cigarette Smoking 2 Human Immunodeficiency Virus 38 Other Combustible Tobacco Products 3 Epstein-Barr Virus 38 E-cigarettes (Vaping Devices) 4 References 38 Smokeless Tobacco Products 7 Secondhand Smoke 7 Occupational and Environmental Cancer Tobacco Cessation 8 Risk Factors 40 Reducing Tobacco Use and Exposure 9 Occupational Cancer Risk Factors 41 References 12 Environmental Cancer Risk Factors 41 Conclusions 44 Excess Body Weight, Alcohol, Diet, References 44 and Physical Activity 14 Excess Body Weight 14 Cancer Screening 45 Alcohol 16 Breast Cancer Screening 45 Diet 18 Cervical Cancer Screening 48 Physical Activity 21 Colorectal Cancer Screening 50 Type 2 Diabetes 22 Lung Cancer Screening 53 Community Action 22 Prostate Cancer Screening 53 References 25 Endometrial Cancer Screening 54 Cancer Screening Obstacles and Opportunities to Ultraviolet Radiation 27 Improve Utilization 54 Solar UVR Exposure 27 American Cancer Society Recommendations for the Early Artificial UVR Exposure (Indoor Tanning) 27 Detection of Cancer in Average-risk Asymptomatic People* 55 UVR Exposure and Protective Behaviors 28 References 57 Prevention Strategies in Skin Cancer 29 Special Notes 58 Early Detection of Skin Cancer 30 Glossary 58 References 31 Survey Sources 59 Global Headquarters: American Cancer Society Inc. This publication attempts to summarize current scientific information about cancer. 250 Williams Street, NW, Atlanta, GA 30303-1002 Except when specified, it does not represent the official policy of the American 404-320-3333 ©2019, American Cancer Society, Inc. All rights reserved, Cancer Society. including the right to reproduce this publication or portions thereof in any form. Suggested citation: American Cancer Society. Cancer Prevention & Early Detection For written permission, address the Legal department of the American Cancer Society, 250 Williams Street, NW, Facts & Figures 2019-2020. Atlanta: American Cancer Society; 2019. Atlanta, GA 30303-1002. Introduction Cancer prevention and early detection are central to the modifiable risk factors.3 Furthermore, cancer screening American Cancer Society’s mission to save lives, celebrate tests can prevent thousands of additional cancer cases lives, and lead the fight for a world without cancer. Over and deaths. the past several years, cancer incidence has decreased among men while remaining stable among women; cancer mortality has declined in recent decades.1 References Additional cancer morbidity and mortality could be 1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2019. CA Cancer J Clin. 2019;69: 7-34. prevented by implementing evidence-based interventions 2. Siegel RL, Jemal A, Wender RC, Gansler T, Ma J, Brawley OW. An to reduce cancer risk factors and increase cancer screening assessment of progress in cancer control. CA Cancer J Clin. 2018. uptake.2 An estimated 42% of cancer cases and 45% of 3. Islami F, Goding Sauer A, Miller KD, et al. Proportion and number cancer deaths in the US are attributed to potentially of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68: 31-54. Ultraviolet Radiation Highlights, CPED 2019-2020 • Despite declining use in recent years, 8% of female high school Tobacco students in 2017 reported use of indoor tanning in the past year. • In 1965, 42% of adults were current cigarette smokers, • As of January 1, 2019, only 17 states and the District of Columbia decreasing to 14% in 2017. Prevalence varied widely by state, had a law prohibiting indoor tanning for minors without ranging from 9% in Utah to 26% in West Virginia. exemptions. • Current cigarette smoking among high school students • In 2015, approximately 4% of adults reported using an indoor declined from 29% in 1999 to 8% in 2018 and ranged from tanning device in the past year; use was highest among 4% in Utah and Puerto Rico to 14% in Arkansas, Kentucky, women, younger adults (ages 18-29 years), and those living in and West Viriginia in 2017. the Midwest. • Unchanged since 2009, the federal excise tax is $1.01 per pack. As of December 21, 2018, the average state cigarette excise tax was $1.79 per pack, ranging from 17 cents in Missouri to Infectious Agents • HPV vaccination among adolescents remains low. In 2017, $4.50 in the District of Columbia and $5.10 in Puerto Rico. 42% of girls and 31% of boys received two doses before their • Among high school students, current e-cigarette use 13th birthday. increased from about 2% in 2011 to 21% in 2018. • In 2017, 53% of girls and 44% of boys ages 13-17 years were up-to-date. Excess Body Weight, Alcohol, Diet, and Physical Activity • Among adults, the prevalence of overweight has remained Cancer Screening • In 2015, 50% of women ages 40 years and older reported relatively stable since the early 1960s, but obesity has having a mammogram within the past year, and 64% reported markedly increased. In 2015-2016, approximately 7 in 10 having one within the past two years. Mammography use in adults were overweight or obese; about 4 in 10 were obese. the past two years was lowest among the uninsured (31%). • From 1971 to 2002, the prevalence of obesity among youth • Among women ages 21-65 years, 83% were up-to-date with ages 2-19 years tripled from 5% to 15%, increasing to 19% in cervical cancer screening in 2015; uptake was lowest among 2015-2016. Among youth, the prevalence of obesity was higher the uninsured (64%) and recent immigrants (70%). in older (ages 12-19 years: 21%) than younger (ages 2-5 years: 14%) children in 2015-2016. • In 2015, 63% of adults ages 50 years and older were up-to- date for colorectal cancer screening. Prevalence was less than • In 2017, approximately 6% of adults reported drinking or equal to 50% among Hispanics, Asians, people with less heavily (>14 drinks per week for males or >7 drinks per than a high school diploma, recent immigrants, and the week for females). uninsured. • In 2017, an estimated 54% of adults and only 26% of high • In 2015, only 4% of eligible former and current smokers school students reported meeting recommended levels of reported having a low-dose computed tomography screening physical activity. for lung cancer in the past year. Cancer Prevention & Early Detection Facts & Figures 2019-2020 1 Tobacco The first US Surgeon General’s Report on Smoking and smoking prevalence was lowest among Asians (7%) Health in 1964 concluded that cigarette smoking caused and highest among American Indians/Alaska Natives lung cancer.1 Since then, other tobacco products, (25%), with the largest gender gap in blacks and including cigars, cigarillos, waterpipes, and smokeless Asians (Table 1A). tobacco, have been causally linked to cancer as well.2 • Smoking prevalence in 2017 was lowest among those About 30% of all cancer deaths in the US3, 4 and as much with a graduate degree (4%) and highest among as 40% in men in some Southern states, are still caused adults with a GED (36%) (Table 1A). by smoking.5 Despite decades of declining smoking prevalence, the burden of smoking-related cancers • In 2017, smoking prevalence was lower among those remains high because the risk of cancer exists even after who self-identified as straight (14%) than among exposure has ceased. Additionally, smoking prevalence people who self-identified as gay or lesbian (18%) or remains high in many segments of the population (e.g., bisexual (22%) (Table 1A). those with low socioeconomic status and/or mental • By state, smoking prevalence was lowest in Utah (9%) illness).6 Tobacco use remains the most preventable and highest in West Virginia (26%) (Cover, Table 1B). cause of death in the US. Figure 1A. Proportion of Cancer Cases and Deaths Cigarette Smoking Attributable to Cigarette Smoking, Adults 30 Years Cigarette smoking increases the risk of several cancers, and Older, US, 2014 including those of the oral cavity and pharynx, larynx, Cases Deaths lung, esophagus, pancreas, uterine cervix, kidney, 82 Lung bladder, stomach, colorectum, liver; and acute myeloid 81 2 74 leukemia. Evidence suggests that smoking may also Larynx 72 increase the risk of fatal prostate cancer and a rare type 50 Esophagus of ovarian cancer.2, 7 The proportion of cases and deaths 50 Oral cavity, pharynx, 49 attributable to smoking varies across cancer sites (Figure nasal cavity, 47 1A).4 Health consequences increase with both duration paranasal sinus 47 Urinary bladder and intensity of smoking. 45 23 Liver Tobacco use in youth is an important public health issue 22 20 Cervix because almost 90% of adults who smoke regularly began 20 smoking before the age of 18; adolescents appear to be Kidney, renal pelvis, 17 more easily addicted to nicotine.8 ureter 17 17 Stomach 17 Adult Cigarette Smoking 15 Myeloid leukemia 15 • The prevalence of current smoking among adults 12 Colorectum decreased from 42% in 1965 to 25% in 1997.9 In 2017, 11 10 an estimated 14% (more than 34 million adults) were Pancreas 10 current smokers (Table 1A).