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CANCER
Halting the Cancer Burden

At A Glance 2009

The Burden of Cancer

Every year, cancer claims the lives of more than half a million Americans. Cancer is the second leading cause of death in the United States, exceeded only by heart disease. According to United States Cancer Statistics: 2005 Incidence and Mortality, which tracks cancer incidence for about 96% of the U.S. population and mortality for the entire country, more than 559,000 Americans died of cancer, and more than 1.34 million had a diagnosis of cancer in 2005. The financial costs of cancer are overwhelming. According to the National Institutes of Health, cancer cost the United States an estimated $228 billion in medical costs in 2008.

Racial and Ethnic Differences

Cancer does not affect all races equally in the United States. African Americans are more likely to die of cancer than people of any other racial or ethnic group. In 2005, the age-adjusted death rate per 100,000 people for all types of cancer combined was 224 for African Americans, 183 for whites, 125 for American Indians/Alaska Natives, 124 for Hispanics, and 111 for Asians/Pacific Islanders.

Effective Cancer Prevention Measures

The number of new cancer cases can be reduced, and many cancer deaths can be prevented. A person’s cancer risk can be reduced by adopting a healthy lifestyle, avoiding tobacco use (see Tobacco At A Glance 2009), getting the human papillomavirus (HPV) vaccine, increasing physical activity, achieving and maintaining optimal weight, improving nutrition (see Obesity At A Glance 2009), and avoiding sun exposure.

Making cancer screening, information, and referral services available and accessible to all Americans can lower the high rates of cancer and cancer deaths. Screening for cervical and colorectal cancers decreases incidence of these diseases by finding precancerous lesions so they can be treated before they have a chance to become cancerous. Screening for cervical, colorectal, and breast cancers also helps find these diseases at an early, often highly treatable stage.

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CDC’s Leadership in Detecting, Preventing, and Controlling Cancer

CDC is a leader in the fight to prevent and control cancer throughout the United States. With Fiscal Year 2008 (FY 2008) funding of $290 million, CDC’s Division of Cancer Prevention and Control (DCPC) works with national organizations, state health agencies, and other key groups to develop, implement, and promote effective cancer prevention and control practices.

Our comprehensive and collaborative approach to addressing the nation’s cancer burden includes the following activities:

• Monitoring. CDC helps states, U.S. territories, tribes, and tribal groups collect data on cancer incidence and deaths, risk factors, and the use of screening tests. Public health professionals use these data to identify and track cancer trends, strengthen cancer prevention and control activities, and prioritize use of resources.
   
• Conducting research and evaluation. CDC conducts and supports studies, often in collaboration with academic partners, to develop and promote application of sound science to reduce the burden of cancer and eliminate health disparities. This research uses many different areas of expertise (behavioral science, economics, epidemiology, health services, medicine, and statistics) to address the public health research needs of CDC programs, health care providers, people affected by cancer, and the larger cancer control community.
   
• Building capacity through partnerships. CDC works with many partners to translate research into public health programs, practices, and services. CDC helps states, U.S. territories, tribes, and tribal groups apply scientific advances to develop strong cancer control programs for the people who most need them.
   
• Educating. CDC develops communications campaigns and materials to inform health professionals, policy makers, the media, and the public about the importance of cancer prevention and control.

CDC’s Cancer Programs

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides clinical breast exams, mammograms, pelvic exams, and Pap tests to women in need, such as those who are uninsured, have low incomes, or have health insurance that does not pay for screening. The program also provides diagnostic follow-up for abnormal screening results and referrals for treatment if cancer is diagnosed. Since its inception in 1991, the NBCCEDP has provided more than 7.8 million breast and cervical cancer screening exams to over 3.2 million women. In 2008, the NBCCEDP congressional appropriation of $182 million funded all 50 states, the District of Columbia, 5 U.S. territories, and 12 American Indian/Alaska Native tribes or tribal groups to provide clinical screening and diagnostic services to medically underserved women.

The National Comprehensive Cancer Control Program (NCCCP) is an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation, and palliation. In 2008, the NCCCP appropriation of $22.4 million supported programs in all 50 states, the District of Columbia, 7 U.S. territories, and 7 tribes or tribal groups to assess the burden of cancer, set priorities, and develop and implement comprehensive cancer control (CCC) programs. Since 1998, the number of programs participating in the NCCCP has increased from 6 to 65, and grantees have released 56 CCC plans.

The National Program of Cancer Registries (NPCR) collects data on cancer occurrence; the type, extent, and location of cancers; and the type of initial treatment. In 2008, the NPCR appropriation of $46 million supported central cancer registries in 45 states, the District of Columbia, Puerto Rico, and the U.S. Pacific Island jurisdictions. CDC also collaborates with the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program to publish cancer data in the United States Cancer Statistics: Incidence and Mortality reports.

Ongoing Initiatives

Colorectal cancer. CDC and its partners promote colorectal cancer screening by supporting education and research programs. CDC established a 3-year demonstration program at five sites to increase screening among low-income men and women who have inadequate or no health insurance coverage for colorectal cancer screening. These programs also provide diagnostic follow-up and patient navigation and support services; conduct public education and outreach; create standards, policies, and procedures; develop partnerships; collect and track data; and evaluate program effectiveness. CDC also educates Americans about the importance of regular screening, beginning at age 50, through its Screen for Life: National Colorectal Cancer Action Campaign.

Prostate cancer. CDC provides the public, health care providers, and policy makers with information to make informed decisions about the potential risks and benefits of prostate cancer screening and to improve quality of life after diagnosis. CDC produced three versions of Prostate Cancer Screening: A Decision Guide—one in English, one in Spanish, and one specifically for African American men.

Skin cancer. CDC conducts research and promotes education designed to expand knowledge about skin cancer prevention and control. As part of the NCCCP, CDC funded programs in nine states to implement skin cancer activities outlined in the states’ CCC plans. These states are increasing awareness and educating children and adolescents, as well as establishing school policies based on the recommendations of Guidelines for School Programs to Prevent Skin Cancer. CDC also promotes and disseminates Shade Planning for America’s Schools, a manual that helps schools create and maintain a physical environment that supports sun safety by ensuring adequate shade.

Hematologic cancers. CDC funds efforts to improve awareness and understanding of hematologic cancers, which are cancers of the blood and bone marrow. These efforts provide the public and people affected by hematologic cancers with resources to understand these diseases better, receive optimal treatment, and find community support networks.

Cancer survivorship. Because of advances in detecting and treating cancer, more people are living longer after a cancer diagnosis, and survivors often face a range of health challenges. CDC works with national, state, and local partners and tribal groups to create and implement successful strategies to help the millions of people who live with, through, and beyond cancer. For example, DCPC and the Lance Armstrong Foundation worked together to develop A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies.

Lung cancer. To prevent and control lung cancer, CDC collects data on diagnoses and deaths in the United States; supports programs in states, U.S. territories, tribes, and tribal groups to prevent and control tobacco use and promote a healthy diet; and implements public health interventions and counter-marketing strategies to reduce smoking. CDC also maintains a Web site (http://www.cdc.gov/cancer/lung) to increase awareness of and provide resources for preventing and controlling lung cancer. The site presents information about disease burden, risk factors, and risk modification, as well as screening recommendations, a review of CDC’s activities in lung cancer control, and links to additional resources.

Ovarian cancer. CDC works with academic and medical institutions, state health departments, and advocacy groups to conduct research to improve early detection and treatment of ovarian cancer. Cancer registries funded in Maryland, California, and New York collaborate with the NPCR to evaluate care and outcomes for patients with ovarian cancer. The NCCCP also funds ovarian cancer projects in California, Florida, Michigan, New York, Pennsylvania, Texas, and West Virginia to develop health messages for health care providers and consumers.

Gynecologic cancers. CDC collaborated with the Office on Women’s Health in the U.S. Department of Health and Human Services to create the Inside Knowledge: Get the Facts About Gynecologic Cancer campaign to raise awareness of the five main types of gynecologic cancer—cervical, ovarian, uterine, vaginal, and vulvar. This campaign supports the Gynecologic Cancer Education and Awareness Act of 2005. Educational materials that focus on symptoms, risk factors, and screening (when recommended) are available for health care providers and consumers at http://www.cdc.gov/cancer/knowledge.

Cervical cancer. In 2008, CDC completed the first large-scale study to assess the burden of HPV-associated cancers (cervical, vaginal, vulvar, anal, penile, oropharyngeal) in the United States. The findings from this study will allow researchers and public health officials to monitor the effect of the HPV vaccine and changes in the HPV-associated disease burden.

Future Directions

To help ensure that people are healthy at every stage of life, CDC is committed to

• Collaborating with partners, policy makers, and other individuals and groups working to ease the burden of cancer in the United States and abroad.
   
• Expanding the use of information technology in cancer surveillance, particularly in cancer registries.
   
• Improving the cost-effectiveness of the NBCCEDP.
   
• Defining CDC’s role in managing chronic diseases, including cancer, during catastrophic disasters.
   
• Expanding CDC’s role in addressing public health strategies to increase survivorship in underserved populations and improve end-of-life support for cancer patients and their families, friends, and caregivers.
   
• Expanding the colorectal cancer screening demonstration project to include additional states, territories, and tribes.

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Success Stories

Massachusetts: Registry Collects Data to Guide Research and Programs

In 2007, the Massachusetts Cancer Registry conducted a study to identify and compare invasive cancer cases among four racial and ethnic groups in the state—white non-Hispanics, black non-Hispanics, Asian non-Hispanics, and Hispanics. The study used data from 2000–2004 to analyze incidence rates, mortality rates, median ages, stage at diagnosis, and tumor size at diagnosis. The cancer registry is funded by CDC and operates out of the Massachusetts Department of Public Health (DPH).

Study results showed that the incidence of prostate cancer was 1.6 times higher among black non-Hispanic males than white non-Hispanic males, and the incidence of stomach cancer was 1.8 times higher. Mortality rates for lung cancer, prostate cancer, and all cancers combined also were higher (range: 1.2–2.8 times higher). Black non-Hispanic males also were significantly more likely to receive a diagnosis of prostate cancer at a later stage.

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Black non-Hispanic females were significantly more likely than white non-Hispanic females to receive a cancer diagnosis at a later stage—42% vs. 32% for breast cancer and 41% vs. 24% for uterine cancer. For both breast and uterine cancer, black non-Hispanic females also were more likely than white non-Hispanic females to have a large tumor size at diagnosis.

Although the study focused on larger population groups living in Massachusetts, it also assessed the most common cancers reported among Chinese, Vietnamese, Korean, Haitian, Puerto Rican, Portuguese-speaking, Latin American, and Dominican populations living in the state.

Public health officials in Massachusetts can use the results of this study to conduct further research to identify and understand the complex interaction of factors that affect people’s health, including genetics, environment, and access to health care. They also can use this information to develop interventions to prevent and control cancer and focus these efforts on populations most at risk.

Maine: Comprehensive State Plan Addresses Colorectal Cancer

The Maine Cancer Consortium is a statewide comprehensive cancer control (CCC) partnership working to reduce cancer incidence, deaths, and health care costs among state residents. To help achieve this goal, the consortium has updated its CCC plan to reflect emerging needs and new issues in cancer prevention, detection, and care.

The 2006–2010 Maine Comprehensive Cancer Control Plan includes objectives and strategies designed to specifically address colorectal cancer. Examples include the following:

• A social marketing campaign designed to increase awareness about the benefits of colorectal cancer screening for all residents aged 50 years or older. In 2005 and 2006, two television commercials reached more than 15 million people in the state.
   
• A Colon Cancer Community Action Kit distributed to more than 60 community coalitions.
   
• Seven community mini-grants to increase colon cancer screening awareness at local levels.

Other state activities designed to raise awareness about colorectal cancer include events in two communities in 2007 that featured the Colossal Colon, an oversized interactive replica of the human colon.

Cherokee Nation: Reducing Health Disparities Among American Indians

The Cherokee Nation was the first tribal nation to develop a CCC plan for its population. The goal of this data-driven, systematic plan is to reduce cancer incidence and deaths among the members of the Cherokee Nation. The plan was released in October 2006 as part of the first Cherokee Nation Cancer Summit.

In addition to promoting the CCC plan, the summit was designed to increase awareness about cancer disparities among the members and leaders of the affected American Indian communities, as well as among health professionals and others interested in eliminating these disparities.

The summit drew a diverse group of representatives from throughout the state and region, including key Cherokee Nation and state partners, cancer survivors, researchers, health care providers, legislators, and members of different tribes.

Releasing the CCC plan at the summit increased its credibility and made people more aware of the high rates of cancer incidence and death among American Indians, including members of the Cherokee Nation. As a result of the summit, the Cherokee Nation enhanced its partnership with the University of Oklahoma-Tulsa by giving the university’s College of Medicine $1.5 million. The money helped to fund a new clinic that will provide expanded medical services, including care for cancer, for members of the Cherokee Nation.

The Cherokee Nation also began working with the Oklahoma Society of Clinical Oncologists on an initiative to increase the participation of American Indians in clinical trials in Oklahoma and surrounding states. The Cherokee Nation Web site (http://www.cherokee.org) will serve as the central site for information about this initiative.

[A text description of this chart is also available.]

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Related Materials

• Cancer—At A Glance 2009 (PDF–3.Mb)
• Cancer—Success Stories (PDF–779Kb)
• CDC's Cancer Prevention and Control Web Site
• Preventing and Controlling Cancer
• State and Program Examples (90K–PDF)

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Page last reviewed: February 12, 2009
Page last modified: February 12, 2009
Content source: National Center for Chronic Disease Prevention and Health Promotion