Emerging Issues

Occasionally, survey questions are refined to allow for more specific and accurate collection of data. The questions on the National Health Interview Survey used to produce the baseline estimates of mammography and Pap smear were revised in the 1999, 2000, and 2005 questionnaires. The questions for estimating use of FOBT home kit were revised in 2005 from the baseline of 2000. For example, in 1999, 2000, and 2003, women who responded that their most recent mammogram was "2 years ago" were considered to have received the screening within the recommended 2-year interval. In 2005, women who responded similarly were further asked whether the mammogram was "more than 1 year but not more than 2 years" or "more than 2 years" ago.

Therefore, the proportions of adults receiving breast and cervical cancer screenings within the recommended interval may be overestimated for 1999, 2000, and 2003. The proportion of adults receiving colorectal cancer screening with an FOBT home kit may be overestimated for 2000 and 2003. The change in the survey methodology implemented in 2005 is expected to lead to lower, more accurate estimates for that year and subsequent data years.

Since the publication of the Healthy People 2010 objectives, both USPSTF and TFCPS have provided new guidance on evidence-based practices in cancer prevention and control.^{6, 22} USPSTF has revised several of its earlier recommendations, added recommendations for new services (for example, in colorectal cancer screening), and initiated a new round of reviews for future additional updates. TFCPS continues to add to its recommendations on community interventions related to cancer. Future efforts to achieve the cancer targets will need to incorporate updated recommendations from these sources.

A key question for attaining reductions in death rates is which investments made now will reap the greatest reduction in cancer deaths in the next 5 years. The NCI-sponsored Cancer Intervention and Surveillance Modeling Network^{15, 16} has modeled the effects of differing interventions on death rates. For example, investigators have found that the biggest impact for reducing the colorectal cancer death rate (3-5) in the short term is to rapidly increase the use of the current USPSTF-recommended cancer screening tests.¹⁵ Investigators have also estimated that approximately 50 percent of the reduction in the breast cancer death rate in recent years is due to increased use of new treatments.

Although no treatment objectives are included in the cancer focus area, death rates are affected by changing treatment practices.^{15, 16, 17} The Institute of Medicine has noted substantial gaps between what is known about quality care and what is practiced in many communities. The National Quality Forum (NQF) has initiated a process to develop national consensus performance measures for monitoring the use of recommended cancer treatments.³⁹ The resulting changes in treatment performance will need to be noted when interpreting progress toward the cancer death rate objectives. NQF performance measures may also be considered in the future as national cancer control objectives.

To address the challenge of measuring perceived quality of life in cancer and other chronic diseases, the National Institutes of Health (NIH) has funded the Patient-Reported Outcomes Measurement Information System initiative. Under this initiative, a collaborative relationship between NIH and individual research teams has been established to develop and test a large bank of items measuring patient-reported outcomes, design a computerized system that allows for efficient assessment of patient-reported outcomes in clinical research involving a wide range of chronic diseases, and create a publicly available system that can be added to and modified periodically and that allows clinical researchers to access a common repository of items and computerized adaptive tests. Once these measures are validated, their use in future disease surveillance efforts can provide new ways to measure changes in quality of life.

Progress toward the Healthy People 2010 cancer objectives has been facilitated by the Nation's investment in research to identify and deliver new research-tested interventions for cancer prevention and control. In addition to this investment, progress also has been aided by improved coordination of a wide range of efforts to promote the adoption of evidence-based interventions for the prevention, screening, diagnosis, and treatment of cancer.

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