The "Annual Report to the Nation on the Status of Cancer" was released this afternoon as has been the case every year since the first report was issued in 1998. And, like many of the reports previously, we are fortunate to continue to see declines in the rates of deaths for many cancers along with a decrease in the frequency of some cancers.
However, the news is not all good.
Unfortunately, the incidence of some cancers continues to increase. And, as explained very clearly in this excellent report, this nation continues to suffer from an epidemic of overweight, obesity and physical activity that the authors suggest-but don't actually say-has the potential to overcome the favorable impact of declining smoking and tobacco use on cancer incidence and deaths. The implication is clear that if we don't do something-and do something quickly-to reverse the trend we will see incidence and deaths from certain cancers continue to increase in the future.
And I would stress the point that it is no longer just being oversized that increases your risk of cancer, but also sitting all day on the job (like I am doing right now) as another factor that plays into your cancer risk, independent of how large or small you may be.
This report-which is authored by researchers from the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute and the North American Association of Central Cancer Registries-is a highly anticipated annual report card on what we are doing "right" as a nation and where we are failing in our efforts to reduce the burden and suffering from cancer.
For the most part, the news has been good. We have seen significant declines in the death rates in a number of cancers, including some common ones. This report is chock full of data, so it isn't possible to represent all of the information in this blog.
- Overall cancer incidence-which means the number of cancers diagnosed in this country in a given year, for all forms of invasive cancer-has decreased in men 0.6% per year every year from 1994 to 2008. For women, overall cancer incidence was decreasing 0.5% each year from 1998 to 2006, but leveled off and did not change form 2006-2008.
- The incidence for prostate and colorectal cancers decreased between 1999 and 2008. Lung cancer incidence continued its downward decline for men and women (the decrease for women is particularly important, since this is a relatively recent observation during the past two years). Breast cancer incidence in women had been declining from 1999 to 2004, but has been stable from 2004 to 2008.
- In children, however, the incidence of cancer has continued to increase: for children ages 0-19 the increase has been 0.6% per year from 1999 to 2008. On the other hand, the death rates in children have declined 1.3% per year for children between the ages of 0-19 from 1999-2008
- Death rates from all cancers combined declined from 1999 through 2008 (the latest year for which information is available). In particular, death rates from the four most common cancers, including prostate, breast, colorectal and lung all continued to drop. According to the report, death rates for 11 of the 17 most common cancers in men and 14 of the 18 most common cancers in women (lung, colon and rectum, kidney, brain, stomach, oral cavity, leukemia, non-Hodgkin's lymphoma and myeloma among both men and women; prostate and larynx among men; and breast, ovary, urinary bladder, esophagus, and gallbladder among women) decreased from 1999-2008, while deaths increased for pancreatic cancer in men and women, liver and melanoma in men, and uterine cancer in women. The report also noted that while cervical cancer deaths had been decreasing for decades, those rates have changed little recently.
So, most of the news is good, and some is not so good. But what is important to know about that "not so good news" is that we actually could do something to make things a bit better. And that is what much of the report is about: how we can take control of our lives and our communities to make our environment healthier, get us active, eating a better diet, getting into shape and decreasing our risks of cancer.
Overweight and obesity is a national urgency, when it comes to our health. 2/3 of us are overweight or obese, especially men 60 and older and women between 40-59. When looking at racial and ethnic groups, non-Hispanic black men and women and Hispanic women are most affected according to the researchers.
When it comes to physical activity, the report points out that our kids are at risk as well as us adults. Many young folks don't get sufficient physical activity in their daily lives, and 53% of men and 60% of women do not meet the "activity test". The American Cancer Society recommends that adults engage in at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity exercise-or an equivalent combination-each week. The US Dietary and Physical Activity Guidelines add the suggestion that adults should engage in muscle strengthening exercise at least 2 days each week involving all major muscle groups.
So how does this impact your risk of cancer, and what are the costs?
The report notes that your risk of cancer varies according to your BMI (which you can easily calculate from information on the American Cancer Society website). This measure of your size takes into account how tall you are and how much you weigh. For each 5kg/m² increase in your BMI, your risk of endometrial (uterine), adenocarcinoma of the esophagus and kidney cancer increases 30-60%. The same increase in size increases your risk of colorectal, pancreatic and postmenopausal breast cancer 13-18%.
Being the careful readers that you are, you are probably asking "how much does 5kg/m² really mean?" Bottom line: 5 kg is 11 pounds. For me, since I am close to 4 m², my risk of cancer would go up considerably if I gained about 43 pounds (fyi, I am about 6'6" tall). If you are 5'10, your "number" would be about 34 pounds.
And then there is the physical activity piece of this puzzle: lack of physical activity by itself has been associated with a 30-40% increase in the risk of colon, postmenopausal breast and endometrial cancers.
There is also a financial toll associated with obesity and limited activity that you should know about. In 2008, per person medical costs in the United States were 42% highter-or $1429-for obese folks compared to those with a normal weight. That's 9.1% of all medical spending. And physical activity-independent of obesity-accounted for 2.4% of total medical expenditures in the last year studied, which was 1995.
So where does that leave us?
Yes, we are making progress. No, not all cancers are declining and some are increasing in frequency and deaths. We have done better in terms of early detection and treatment. We are doing worse in terms of our diets, our weight and our physical activity.
Although the report doesn't come right out and say so, there are clear implications that the rising impact of overweight, obesity and physical activity threaten the gains we have seen from reduced tobacco consumption and smoking.
There are a number of excellent comments in the article that I could use to highlight this critical point and conclusion of this report, but let's try this one:
"Although trends in the prevalence of excess weight and physical activity in the United States seem to be stabilizing or improving, current levels, particularly the unprecedented high levels of obesity among young individuals, are concerning and can impact future disease rates. Unhealthy behaviors among young individuals may lead to unhealthy behaviors in adulthood as well as adverse health profiles and an increased risk of cancer later in life. Continued progress in reducing cancer incidence and mortality will be difficult without success in promoting healthy weight and physical activity, particularly among youth."
So, before we go around congratulating ourselves on our accomplishments in reducing the burden of cancer in our society, let's not forget those many people who have tragically lost their lives to cancer. Let's realize that for our future health, we need to work to do better at what we already know, while continuing to learn more about what we don't know. Too many people fall victims to cancers that we know little about in terms of their causes and control. But we do know that tobacco, obesity, overweight and limited or no physical activity impact the risk of getting certain cancers.
That is something that we can address, something we can do for our health and our communities. So let's join a call to action that our children and grandchildren will benefit from the fruits of our labors and continue to see a reduction in cancer incidence and deaths in the years to come.
This annual report to the nation clearly suggests that if we don't heed the warnings, we will have only ourselves to hold responsible for our inability to address some very fundamental issues about how we choose to live.