Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 3-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Progress was mixed for this focus area. Two objectives met or exceeded their targets, several objectives or subobjectives moved toward their targets, one moved away, and five showed no change. Several subobjectives could not be assessed.

Objectives that met or exceeded their targets. Two objectives met or exceeded their targets: mammography screening (3-13) met its target, and the prostate cancer death rate (3-7) exceeded its target. Many efforts to increase the use of mammography during the 1990s and early 2000s included new Medicare coverage; endorsement of screening by professional associations and health plans; inclusion of mammography as a quality of care measure in managed care; new State laws requiring health insurance coverage; new programs to provide screening services to uninsured, low-income women; and promotion of mammography by health agencies and cancer advocacy groups.^{1, 2, 3, 4}

Reasons for having achieved the prostate cancer target are uncertain. The U.S. Preventive Services Task Force (USPSTF) has found inconclusive evidence that prostate cancer screening improves health outcomes and has reported the balance of benefits and harms as uncertain.^{5, 6} Researchers have hypothesized that the reduction in the prostate cancer death rate could be due to increased screening, increased use of androgen deprivation therapy, and/or increased use of surgery or radiation.⁷ Ongoing clinical trials in the United States and Europe may help explain the reduction.^{8, 9, 10}

Objectives that moved toward their targets. Death rates for many other cancers also decreased, including lung, female breast, cervical, and colorectal (3-2 through 3-5). Efforts to control tobacco use during the 1980s and 1990s were responsible for much of the declines in lung and all-site cancer death rates (3-1) since 2000.^{11, 12, 13} Due to the time lag between tobacco interventions and reductions in death rates,^{11, 12, 13} current tobacco control activities are unlikely to contribute to achieving death-rate objectives before 2010. However, previously recorded declines in tobacco use are likely to produce further reductions in death rates by 2010. Although screening for lung cancer is of unknown benefit,⁶ screening for colorectal, cervical, and breast cancers is effective.⁶ Increases in screening during the 1990s¹⁴ and improvements in treatment have contributed to the declines in death rates from those cancers.^{6, 15, 16, 17}

Increased delivery of high-quality screening and treatment services is likely to lead to further declines by 2010.^{6, 15, 16, 18, 19} Increases in survival (3-15) were likely due to both increased and earlier detection of cancers and improved care.^{16, 17, 20}

Progress was made toward two cancer screening targets—Pap test ever received (3-11a) and colorectal cancer endoscopic screening (3-12b)—and cancer registries (3-14). The progress in screening was due to the same kinds of efforts that contributed to attainment of the mammography objective.^{1, 2, 3, 4} The increase in the number of statewide cancer registries with 95 percent data was due to the efforts of those registries established by the Centers for Disease Control and Prevention (CDC), the North American Association of Central Cancer Registries, and the National Cancer Institute (NCI).²¹

Continued progress toward the targets depends on implementation of effective interventions^{6, 18, 22} by a wide range of organizations, including Comprehensive Cancer Control (CCC) coalitions (see Opportunities and Challenges), and progress in related Healthy People 2010 focus areas. In the coming years, focusing on interventions that increase colorectal cancer screening will be particularly important.^{6, 14, 18, 22} Since the lowest levels of screening for colorectal, cervical, and breast cancers are among uninsured persons and adults with limited access to health care,¹⁴ improvements will depend in part on increasing access to quality health services.

Objectives that moved away from their targets. One objective moved away from its target: the FOBT home kit screening rate among adults aged 50 years and older (3-12a). This decline appeared to relate to changes in choices of colorectal cancer screening tests rather than a decrease in overall colorectal cancer screening. Between 1996 and 2003, the USPSTF and other organizations changed screening guidelines to recommend not just FOBT and sigmoidoscopy but also colonoscopy and double-contrast barium enema or a combination of the tests.⁶ The choice of screening method depends on availability, insurance coverage, and patient and provider preferences. Findings from cancer surveillance sources indicate that the use of other recommended tests increased more than FOBT declined.²³ A number of organizations have adopted colorectal cancer screening as a priority (see Opportunities and Challenges). Broader implementation of effective interventions should result in increased screening using one or more of the recommended tests within their recommended time intervals.^{18, 22, 24, 25}

Objectives that demonstrated no change. Oropharyngeal cancer (3-6) and death rates from melanoma (3-8) were unchanged. Also unchanged was the proportion of adults practicing skin cancer prevention (3-9b), the proportion of primary care providers providing counseling for exercise (3-10h), and the use of Pap tests within the previous 3 years by women over age 18 (3-11b). Screenings for oropharyngeal cancer and melanoma are of unknown benefit.⁶ Because tobacco use and alcohol abuse increase risk of oropharyngeal cancer,^{13, 26} future progress will depend in part on efforts to address tobacco use (Focus Area 27) and alcohol abuse (Focus Area 26) (see Opportunities and Challenges). Many State CCC coalitions⁴ are promoting skin cancer prevention. Given the known effectiveness of interventions in school settings,^{22, 27} many organizations, including CDC, are working with school systems. To increase physician counseling for physical activity, reimbursement for counseling may be effective.^{22, 28} To achieve the Pap test target, CCC and other partners will need to implement effective interventions²² that have demonstrated success in the past,^{1, 2, 3, 4} particularly for populations having the least access.^{14, 29} Because about 60 percent of cervical cancers occur in women not screened in the previous 5 years,²⁹ programs focused on providing services for women who are rarely screened are particularly important.

Objectives that could not be assessed. Sun protective behaviors in adolescents (3-9a) remained developmental because only one behavior, the use of SPF 15 sunscreen, was measured. The objective became measurable with the addition of a question on other sun protective behaviors (for example, seeking shade) to the Youth Risk Behavior Surveillance System in 2005.

Although baseline data were available for primary care provider counseling (3-10h), progress could not be measured for subobjectives 3-10a through g. With completion of an NCI primary care provider survey in 2006–07, tracking data for all subobjectives are anticipated by the end of the decade.

<<  Previous—Modifications to Objectives and Subobjectives   |   Table of Contents  |  Next—Progress Toward Elimination of Health Disparities  >>