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Background: Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender‐nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk. Methods: In the absence of population‐based cancer occurrence information for this population, this article comprehensively examines contemporary, age‐adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care. Results: Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021–2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40–49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure‐time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%–31% vs. 21%–25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. In contrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men. Conclusions: People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs. Minority stress and health care discrimination experienced by lesbian, gay, bisexual, transgender, queer, and gender‐nonconforming (LGBTQ+) individuals can influence cancer occurrence and outcomes. The authors investigated prevalence and disparities in major cancer risk factors and screening by sexual orientation and gender identity and conducted a literature review describing health care challenges faced by LGBTQ+ communities and opportunities for improvement. [ABSTRACT FROM AUTHOR]

Despite decades of declining mortality rates, lung cancer remains the leading cause of cancer death in the United States. This article examines lung cancer incidence, stage at diagnosis, survival, and mortality using population‐based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Over the past 5 years, declines in lung cancer mortality became considerably greater than declines in incidence among men (5.0% vs. 2.6% annually) and women (4.3% vs. 1.1% annually), reflecting absolute gains in 2‐year relative survival of 1.4% annually. Improved outcomes likely reflect advances in treatment, increased access to care through the Patient Protection and Affordable Care Act, and earlier stage diagnosis; for example, compared with a 4.6% annual decrease for distant‐stage disease incidence during 2013–2019, the rate for localized‐stage disease rose by 3.6% annually. Localized disease incidence increased more steeply in states with the highest lung cancer screening prevalence (by 3%–5% annually) than in those with the lowest (by 1%–2% annually). Despite progress, disparities remain. For example, Native Americans have the highest incidence and the slowest decline (less than 1% annually among men and stagnant rates among women) of any group. In addition, mortality rates in Mississippi and Kentucky are two to three times higher than in most western states, largely because of elevated historic smoking prevalence that remains. Racial and geographic inequalities highlight longstanding opportunities for more concerted tobacco‐control efforts targeted at high‐risk populations, including improved access to smoking‐cessation treatments and lung cancer screening, as well as state‐of‐the‐art treatment. Recent declines in lung cancer mortality have outpaced those for incidence, reflecting gains in relative survival that are partly due to recent shifts to earlier stage at diagnosis. Persistent racial and geographic disparities reflect longstanding opportunities for public health intervention to reduce smoking and improve health care access. [ABSTRACT FROM AUTHOR]

Several organizations now recommend that individuals at average risk for colorectal cancer (CRC) begin screening at 45 rather than 50 years of age. We present contemporary estimates of CRC screening in newly eligible adults aged 45 to 49 years between 2019 and 2021. Nationally representative prevalence estimates and population number screened were estimated based on the National Health Interview Survey. A logistic regression model assessed CRC screening prevalence differences by survey year and sociodemographic characteristics. In 2021, 19.7%—that is, fewer than 4 million of the eligible 19 million adults aged 45 to 49 years—were up-to-date on CRC screening. Screening was lowest in those who were uninsured (7.6%), had less than a high school diploma (15.4%), and Asian (13.1%). Additionally, fecal occult blood test and/or fecal immunochemical testing was underused, with only 2.4% (<460 000 people) reporting being up-to-date with screening using this modality in 2021. CRC screening in eligible young adults remains low. Concerted efforts to improve screening are warranted, particularly in underserved populations. [ABSTRACT FROM AUTHOR]

This article discusses the need for changes in the policies and procedures of the Society for Research on Nicotine and Tobacco (SRNT) and its academic journal, Nicotine & Tobacco Research (N&TR). The authors, members of the Health Equity Network (HEN), call for updated definitions of the "tobacco and nicotine industry" to include all entities involved in the manufacturing, marketing, and distribution of commercial nicotine and tobacco products. They also propose prohibiting individuals receiving financial support from the industry from participating in SRNT activities and excluding them from the publication process at N&TR. The authors argue that industry-funded research undermines the integrity of the field and that the tobacco industry has a history of manipulating scientific discourse. They call on SRNT and N&TR to actively reject industry influence and become an anti-racist organization. [Extracted from the article]

In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities. [ABSTRACT FROM AUTHOR]

Underscreened is defined as no fecal immunochemical test/fecal occult blood test, sigmoidoscopy, colonoscopy, computed tomography colonography, or stool-based DNA test in the past 1, 5, 10, 5, or 3 y, respectively, among adults aged 50-75 y with no history of CRC. CRC = colorectal cancer; CT = computed tomography; FIT = fecal immunochemical test; FOBT = fecal occult blood test.* Up to date is defined as FIT/FOBT, sigmoidoscopy, colonoscopy, CT colonography, or stool-based DNA test in the past 1, 5, 10, 5, or 3 y, respectively. I Background: i Colorectal cancer (CRC) is the second leading cause of cancer death in the United States ([1]). [Extracted from the article]

State‐specific information on lost earnings due to smoking‐attributable cancer deaths to inform and advocate for tobacco control policies is lacking. We estimated person‐years of life lost (PYLL) and lost earnings due to cigarette smoking‐attributable cancer deaths in the United States nationally and by state. Proportions and numbers of cigarette smoking‐attributable cancer deaths and associated PYLL among individuals aged 25 to 79 years in 2019 were calculated and combined with annual median earnings to estimate lost earnings attributable to cigarette smoking. In 2019, estimated total PYLL and lost earnings associated with cigarette smoking‐attributable cancer deaths in ages 25 to 79 years in the United States were 2 188 195 (95% CI, 2 148 707‐2 231 538) PYLL and $20.9 billion ($20.0 billion‐$21.7 billion), respectively. States with the highest overall age‐standardized PYLL and lost earning rates generally were in the South and Midwest. The estimated rate per 100 000 population ranged from 352 (339‐366) in Utah to 1337 (1310‐1367) in West Virginia for PYLL and from $4.3 million ($3.5 million‐$5.2 million) in Idaho to $14.8 million ($10.6 million‐$20.7 million) in Missouri for lost earnings. If age‐specific PYLL and lost earning rates in Utah had been achieved by all states, 58.2% (57.0%‐59.5%) of the estimated total PYLL (1 274 178; 1 242 218‐1 306 685 PYLL) and 50.5% (34.2%‐62.4%) of lost earnings ($10.5 billion; $7.1 billion‐$13.1 billion) in 2019 nationally would have been avoided. Lost earnings due to smoking‐attributable cancer deaths are substantial in the United States and are highest in states with weaker tobacco control policies. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors represent a population with high health care needs. If and how cancer survivors were affected by the first year of the coronavirus disease 2019 (COVID-19) pandemic are largely unknown.Methods: Using data from the nationwide, population-based Behavioral Risk Factor Surveillance System (2017-2020), the authors investigated changes in health-related measures during the COVID-19 pandemic among cancer survivors and compared them with changes among adults without a cancer history in the United States. Sociodemographic and health-related measures such as insurance coverage, employment status, health behaviors, and health status were self-reported. Adjusted prevalence ratios of health-related measures in 2020 versus 2017-2019 were calculated with multivariable logistic regressions and stratified by age group (18-64 vs. ≥65 years).Results: Among adults aged 18-64 years, the uninsured rate did not change significantly in 2020 despite increases in unemployment. The prevalence of unhealthy behaviors, such as insufficient sleep and smoking, decreased in 2020, and self-rated health improved, regardless of cancer history. Notably, declines in smoking were larger among cancer survivors than nonelderly adults without a cancer history. Few changes were observed for adults aged ≥65 years.Conclusions: Further research is needed to confirm the observed positive health behavior and health changes and to investigate the role of potential mechanisms, such as the national and regional policy responses to the pandemic regarding insurance coverage, unemployment benefits, and financial assistance. As polices related to the public health emergency expire, ongoing monitoring of longer term effects of the pandemic on cancer survivorship is warranted. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease 2019 pandemic, US unemployment rates rose to historic highs, and they remain nearly double those of prepandemic levels. Employers are the most common source of health insurance among nonelderly adults. Thus, job loss may lead to a loss of health insurance and reduce access to cancer screening. This study examined associations between unemployment, health insurance, and cancer screening to inform the pandemic's potential impacts on early cancer detection. Methods: Up‐to‐date and past‐year breast, cervical, colorectal, and prostate cancer screening prevalences were computed for nonelderly respondents (aged <65 years) with 2000‐2018 National Health Interview Survey data. Multivariable logistic regression models with marginal probabilities were used to estimate unemployed‐versus‐employed unadjusted and adjusted prevalence ratios. Results: Unemployed adults (2000‐2018) were 4 times more likely to lack insurance than employed adults (41.4% vs 10.0%; P <.001). Unemployed adults had a significantly lower up‐to‐date prevalence of screening for cervical cancer (78.5% vs 86.2%; P <.001), breast cancer (67.8% vs 77.5%; P <.001), colorectal cancer (41.9 vs 48.5%; P <.001), and prostate cancer (25.4% vs 36.4%; P <.001). These differences were eliminated after accounting for health insurance coverage. Conclusions: Unemployment was adversely associated with up‐to‐date cancer screening, and this was fully explained by a lack of health insurance. Ensuring the continuation of health insurance coverage after job loss may mitigate the pandemic's economic distress and future economic downturns' impact on cancer screening. Unemployment is adversely associated with up‐to‐date cancer screening, and this is fully explained by a lack of health insurance. [ABSTRACT FROM AUTHOR]

The Hispanic/Latino population is the second largest racial/ethnic group in the continental United States and Hawaii, accounting for 18% (60.6 million) of the total population. An additional 3 million Hispanic Americans live in Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanic individuals in the United States using the most recent population‐based data. An estimated 176,600 new cancer cases and 46,500 cancer deaths will occur among Hispanic individuals in the continental United States and Hawaii in 2021. Compared to non‐Hispanic Whites (NHWs), Hispanic men and women had 25%‐30% lower incidence (2014‐2018) and mortality (2015‐2019) rates for all cancers combined and lower rates for the most common cancers, although this gap is diminishing. For example, the colorectal cancer (CRC) incidence rate ratio for Hispanic compared with NHW individuals narrowed from 0.75 (95% CI, 0.73‐0.78) in 1995 to 0.91 (95% CI, 0.89‐0.93) in 2018, reflecting delayed declines in CRC rates among Hispanic individuals in part because of slower uptake of screening. In contrast, Hispanic individuals have higher rates of infection‐related cancers, including approximately two‐fold higher incidence of liver and stomach cancer. Cervical cancer incidence is 32% higher among Hispanic women in the continental US and Hawaii and 78% higher among women in Puerto Rico compared to NHW women, yet is largely preventable through screening. Less access to care may be similarly reflected in the low prevalence of localized‐stage breast cancer among Hispanic women, 59% versus 67% among NHW women. Evidence‐based strategies for decreasing the cancer burden among the Hispanic population include the use of culturally appropriate lay health advisors and patient navigators and targeted, community‐based intervention programs to facilitate access to screening and promote healthy behaviors. In addition, the impact of the COVID‐19 pandemic on cancer trends and disparities in the Hispanic population should be closely monitored. [ABSTRACT FROM AUTHOR]

Background: Annual lung cancer screening (LCS) with low-dose chest computed tomography in older current and former smokers (ie, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States. We estimated the LCS rate and growth at the national and state level between 2016 and 2018.Methods: The American College of Radiology's Lung Cancer Screening Registry was used to capture screening events. Population-based surveys, the US Census, and cancer registry data were used to estimate the number of eligible adults and lung cancer mortality (ie, burden). Lung cancer screening rates (SRs) in eligible adults and screening rate ratios with 95% confidence intervals (CI) were used to measure changes by state and year.Results: Nationally, the SR was steady between 2016 (3.3%, 95% CI = 3.3% to 3.7%) and 2017 (3.4%, 95% CI = 3.4% to 3.9%), increasing to 5.0% (95% CI = 5.0% to 5.7%) in 2018 (2018 vs 2016 SR ratio = 1.52, 95% CI = 1.51 to 1.62). In 2018, several southern states with a high lung-cancer burden (eg, Mississippi, West Virginia, and Arkansas) had relatively low SRs (<4%) among eligible adults, whereas several northeastern states with lower lung cancer burden (eg, Massachusetts, Vermont, and New Hampshire) had the highest SRs (12.8%-15.2%). The exception was Kentucky, which had the nation's highest lung cancer mortality rate and one of the highest SRs (13.7%).Conclusions: Fewer than 1 in 20 eligible adults received LCS nationally, and uptake varied widely across states. LCS rates were not aligned with lung cancer burden across states, except for Kentucky, which has supported comprehensive efforts to implement LCS. [ABSTRACT FROM AUTHOR]

Purpose: There are limited data on the burden of cancer attributable to cigarette smoking by metropolitan areas to inform local tobacco control policies in the USA. We estimated the proportion of cancer deaths attributable to cigarette smoking (or population attributable fraction [PAF]) in 152 U.S. metropolitan or micropolitan statistical areas (MMSAs). Methods: Smoking-related PAFs for cancer mortality in ages ≥ 30 years in 2013–2017 were estimated using cross-sectional age-, sex-, and MMSA-specific cigarette smoking prevalence and cancer mortality data obtained from the Behavioral Risk Factor Surveillance System and the U.S. Cancer Statistics Database, respectively. Results: Overall smoking-related PAFs of cancer ranged from 8.8% (95% CI, 6.3–11.9%) to 35.7% (33.3–37.9%); MMSAs with the highest PAFs were in the South region and Appalachia. PAFs also substantially varied across MMSAs within regions or states. In the Northeast, for example, the PAF ranged from 24.2% (23.7–24.7%) to 33.7% (31.3–36.2%). Conclusion: The proportion of cancer deaths attributable to cigarette smoking is considerable in each MMSA, with as many as 4 in 10 cancer deaths attributable to smoking in the South region and Appalachia. Broad and equitable implementation and enforcement of proven tobacco control interventions at all government levels could avert many cancer deaths across the USA. [ABSTRACT FROM AUTHOR]

Excess sales of cigarettes reported in this study align with findings from Nielsen retail tobacco sales data of increases in tobacco sales from April to June 2020 ([4]). I Findings: i Observed cigarette sales exceeded expected sales for all months after the onset of the COVID-19 pandemic (Figure 1). Observed cigarette sales during the COVID-19 pandemic (March 2020 to June 2021) were compared with expected sales for the same period in the absence of the pandemic using an interrupted time series model (Figure 1 caption). [Extracted from the article]

Background We previously reported that lung cancer incidence between Blacks and Whites younger than 40 years of age converged in women and approached convergence in men. Whether this pattern has continued in contemporary young birth cohorts is unclear. Methods We examined 5-year age-specific lung cancer incidence in Blacks and Whites younger than 55 years of age by sex and calculated the Black-to-White incidence rate ratios (IRRs) and smoking prevalence ratios by birth cohort using nationwide incidence data from 1997 to 2016 and smoking data from 1970 to 2016 from the National Health Interview Survey. Results Five-year age-specific incidence decreased in successive Black and White men born since circa 1947 and women born since circa 1957, with the declines steeper in Blacks than Whites. Consequently, the Black-to-White IRRs became unity in men born 1967-1972 and reversed in women born since circa 1967. For example, the Black-to-White IRRs in ages 40-44 years born between 1957 and 1972 declined from 1.92 (95% confidence interval [CI] = 1.82 to 2.03) to 1.03 (95% CI = 0.93 to 1.13) in men and from 1.32 (95% CI = 1.24 to 1.40) to 0.71 (95% CI = 0.64 to 0.78) in women. Similarly, the historically higher sex-specific smoking prevalence in Blacks than Whites disappeared in men and reversed in women born since circa 1965. The exception to these patterns is that the incidence became higher in Black men than White men born circa 1977-1982. Conclusions The historically higher lung cancer incidence in young Blacks than young Whites in the United States has disappeared in men and reversed in women, coinciding with smoking patterns, though incidence again became higher in Black men than White men born circa 1977-1982. [ABSTRACT FROM AUTHOR]

In May 2018, the American Cancer Society updated its colorectal cancer (CRC) screening guidelines, lowering the age to initiate screening among average‐risk individuals from 50 years to 45 years because of increasing risk in younger generations and a favorable benefit‐to‐harm ratio. Herein, the authors report that past‐year CRC testing among individuals aged 45 to 49 years more than doubled during 2018 in concert with the Society lowering the recommended age for screening. [ABSTRACT FROM AUTHOR]

Introduction: Cigarette excise tax and price increases reduce smoking consumption and prevalence. Studies have previously defined cigarette affordability internationally and have discussed its relevance as a tobacco control policy measure. This study provides the first estimates on cigarette affordability in the United States. Methods: Cigarette affordability was defined as cigarette price in relation to individuals’ income level. Three measures of cigarette affordability were estimated for U.S. states and nationally between 1970 and 2010. Results: In 2010, on average, it took 1.62% of an individual’s annual personal disposable income to purchase 100 packs of cigarettes in a U.S. state (relative income price). An individual who earned the equivalent of the hourly median wage in a U.S. state needed to work 21.4min in an hour to purchase a pack of cigarettes (minutes of labor, MoL50), whereas a relatively poorer individual earning the hourly 25th percentile wage needed to work 32.7min (MoL25). Cigarettes were most affordable in parts of the South and West and were least affordable in Northeastern states. While cigarette prices increased significantly between 1970 and 2008, affordability remained unchanged during this time and cigarettes may have become more affordable since the early 2000s in many states. Conclusions: Cigarette affordability in 2010 varied widely across U.S. states, a result of cigarette price increases not keeping pace with income increases in some parts of the United States, especially in Southern and Western states. In order to maximize the public health gains from cigarette tax increases, state taxation policies may consider affordability in benchmarking excise tax increases. [ABSTRACT FROM PUBLISHER]

Background The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States. This year’s report includes incidence trends for human papillomavirus (HPV)–associated cancers and HPV vaccination (recommended for adolescents aged 11–12 years). Methods Data on cancer incidence were obtained from the CDC, NCI, and NAACCR, and data on mortality were obtained from the CDC. Long- (1975/1992–2009) and short-term (2000–2009) trends in age-standardized incidence and death rates for all cancers combined and for the leading cancers among men and among women were examined by joinpoint analysis. Prevalence of HPV vaccination coverage during 2008 and 2010 and of Papanicolaou (Pap) testing during 2010 were obtained from national surveys. Results Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2000 to 2009. Overall incidence rates decreased in men but stabilized in women. Incidence rates increased for two HPV-associated cancers (oropharynx, anus) and some cancers not associated with HPV (eg, liver, kidney, thyroid). Nationally, 32.0% (95% confidence interval [CI] = 30.3% to 33.6%) of girls aged 13 to 17 years in 2010 had received three doses of the HPV vaccine, and coverage was statistically significantly lower among the uninsured (14.1%, 95% CI = 9.4% to 20.6%) and in some Southern states (eg, 20.0% in Alabama [95% CI = 13.9% to 27.9%] and Mississippi [95% CI = 13.8% to 28.2%]), where cervical cancer rates were highest and recent Pap testing prevalence was the lowest. Conclusions The overall trends in declining cancer death rates continue. However, increases in incidence rates for some HPV-associated cancers and low vaccination coverage among adolescents underscore the need for additional prevention efforts for HPV-associated cancers, including efforts to increase vaccination coverage. [ABSTRACT FROM PUBLISHER]

In this article, we provide prevalence data on major cancer-related risk factors, early detection testing, and vaccination among Hispanics using nationally representative surveys. Compared with non-Hispanic whites, Hispanic adults are less likely to be current smokers (13% vs 22%) or frequent alcohol drinkers, but they are more likely to be obese (32% vs 26%) and to have lower levels of mammography use within the past year (46% vs 51%), colorectal screening as per recommended intervals (47% vs 61%), and Papanicolaou (Pap) test use within the past 3 years (74% vs 79%). Within the Hispanic population, the prevalence of these risk factors and early detection methods substantially vary by country of origin. For example, Cuban men (20.7%) and Puerto Rican men (19%) had the highest levels of current smoking than any other Hispanic subgroups, while Mexican women had the lowest levels of mammogram use (44%) and Pap test use (71%). Hispanic migrants have a higher prevalence of hepatitis B virus and Helicobacter pylori, which cause liver and stomach cancer, respectively. Among Hispanic adolescents, tobacco use (eg, 20.8% use of any tobacco products), alcohol use (42.9%), and obesity (23.2%) remain highly prevalent risk factors. Although 56% of Hispanic adolescents initiate human papillomavirus vaccination, only 56% of them completed the 3-dose series. Differences in risk factors and early detection testing among Hispanic groups should be considered in clinical settings and for cancer control planning. CA Cancer J Clin 2012;. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND: National surveys have reported declines in rates of home-based fecal occult blood test (FOBT) screening for colorectal cancer (CRC) in the last decade. However, socioeconomic status (SES) and racial/ethnic differences in FOBT trends and their changes relative to endoscopic CRC screening have not been evaluated. METHODS: Data on adults ages 50 to 64 years from the 2000, 2005, and 2008 National Health Interview Surveys were used. Weighted analyses and multivariate logistic regression were used to study trends in the use of FOBT and endoscopic CRC screening during this period. RESULTS: Between 2000 and 2008, significant declines in FOBT prevalence occurred in higher SES groups, but not in lower SES groups (uninsured and publicly insured, those without a usual source of care, lower educated, lower income, and immigrants to the United States) or Hispanics. Endoscopic CRC screening during the period studied consistently increased in all higher SES subgroups. In contrast, few lower SES subgroups (publicly insured, lower educated, near poor individuals, long-term immigrants) and Hispanics experienced increases in CRC endoscopic screening, and these increases were smaller than those observed in higher SES subgroups. CONCLUSIONS: Socially and economically disadvantaged groups experienced little or no change in FOBT prevalence, and few of these groups experienced contemporaneous increases in CRC endoscopic screening. These trends suggest the continued availability and acceptance of FOBT in these groups. If national CRC screening goals are to be achieved in populations with lower access to colonoscopy, then annual high-sensitivity FOBT should be promoted as an immediately accessible and viable alternative. Cancer 2012. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objectives. We examined the relationship of age at diagnosis and insurance status with stage among cervical cancer patients aged 21 to 85 years. Methods. We selected data on women (n = 69 739) diagnosed with invasive cervical cancer between 2000 and 2007 from the National Cancer Database. We evaluated the association between late stage (stage III/IV) and both insurance and age, with adjustment for race/ethnicity and other sociodemographic and clinical factors. We used multivariable log binomial models to estimate risk ratios (RRs) and 95% confidence intervals (CIs). Results. The proportion of late-stage disease increased with age: from 16.53% (21-34 years) to 42.44% (≥ 70 years). The adjusted relative risk of advanced-stage disease among women aged 50 years and older was 2.2 to 2.5 times that of patients aged 21 to 34years. Uninsured (RR = 1.44; 95% CI = 1.40, 1.49), Medicaid (RR = 1.37, 95% CI = 1.34, 1.41 ), younger Medicare (RR = 1.12, 95% CI = 1.06,1.19), and older Medicare (RR = 1.20, 95% CI = 1.15, 1.26) patients had a higher risk of late-stage disease than did privately insured patients. Conclusions. Screening should be encouraged for women at high risk for advanced-stage disease. [ABSTRACT FROM AUTHOR]

Subgroups among the uninsured and even the insured may be at increased risk for not receiving and utilizing effective clinical smoking cessation services. Data for this study came from 18 to 64 year old smokers in the 2005 National Health Interview Survey. Long-term uninsured (greater than or equal to one year) smokers were less likely to receive physician advice to quit than those continuously-insured in the past year. Being long-term and short-term uninsured (less than one year) was negatively associated with dependence treatments' use in quit attempts compared to the continuously-insured, even though the prevalence of quit attempts were similar between these groups. Intermittent-uninsurance (spell of uninsurance in past year) did not influence cessation services delivery or use. Even though Medicaid-insured smokers were more likely to be advised to quit than those privately-insured, they were less likely to use dependence treatments, especially if they had a spell of uninsurance in the past year. Provisions in the Affordable Care Act of 2009 that ensure coverage of effective cessation services for previously-uninsured individuals and Medicaid-insured smokers may increase access and potentially improve population cessation rates. [ABSTRACT FROM AUTHOR]

In this article, the American Cancer Society provides an overview of female breast cancer statistics in the United States, including trends in incidence, mortality, survival, and screening. Approximately 230,480 new cases of invasive breast cancer and 39,520 breast cancer deaths are expected to occur among US women in 2011. Breast cancer incidence rates were stable among all racial/ethnic groups from 2004 to 2008. Breast cancer death rates have been declining since the early 1990s for all women except American Indians/Alaska Natives, among whom rates have remained stable. Disparities in breast cancer death rates are evident by state, socioeconomic status, and race/ethnicity. While significant declines in mortality rates were observed for 36 states and the District of Columbia over the past 10 years, rates for 14 states remained level. Analyses by county-level poverty rates showed that the decrease in mortality rates began later and was slower among women residing in poor areas. As a result, the highest breast cancer death rates shifted from the affluent areas to the poor areas in the early 1990s. Screening rates continue to be lower in poor women compared with non-poor women, despite much progress in increasing mammography utilization. In 2008, 51.4% of poor women had undergone a screening mammogram in the past 2 years compared with 72.8% of non-poor women. Encouraging patients aged 40 years and older to have annual mammography and a clinical breast examination is the single most important step that clinicians can take to reduce suffering and death from breast cancer. Clinicians should also ensure that patients at high risk of breast cancer are identified and offered appropriate screening and follow-up. Continued progress in the control of breast cancer will require sustained and increased efforts to provide high-quality screening, diagnosis, and treatment to all segments of the population. CA Cancer J Clin 2011;. © 2011 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Several states in the US have passed laws mandating coverage of colorectal cancer (CRC) screening tests by health insurance plans. The impact of these state mandates on the use of colorectal cancer screening has not been evaluated among an age-eligible target population with access to care (i.e., health care insurance coverage). Methods: We collected information on state mandates implemented by December 31, 2008 and used data on insured adults aged 50 and 64 years from the Behavioral Risk Factor Surveillance System between 2002 and 2008 to classify individual-level exposure to state mandates for at least 1 year. Multivariate logistic regression models (with state- and year- fixed effects, and patient demographic and socioeconomic characteristics) were used to estimate the effect of state mandates on recent endoscopy screening (either flexible sigmoidoscopy or colonoscopy during the past year). Results: From 1999-2008, twenty-two states in the US, including the District of Columbia passed comprehensive laws requiring health insurance coverage of CRC screening including endoscopy tests. Residence in states with CRC screening coverage mandates in place for at least 1 year was associated with a 1.4 percentage point increase in the probability of utilization of recent endoscopy (i.e., 17.5% screening rates in those with mandates versus 16.1% in those without, Adjusted OR = 1.10, 95% CI: 1.02 - 1.20, p = 0.02). Conclusions: The findings suggest a positive, albeit small, impact of state mandates on the use of recent CRC screening endoscopy among the target eligible population with health insurance. However, more research is needed to evaluate potential effects of mandates across health insurance types while including controls for other system-level factors (e.g. endoscopy and primary care capacity). National health insurance reform should strive towards a system that expands access to recommended CRC screening tests. [ABSTRACT FROM AUTHOR]

Objective: To describe the prevalence and correlates of the use of sunless tanning products among US adolescents and their association with UV radiation exposure behaviors, including indoor tanning, sunburn experiences, and use of sunscreen while outdoors. Design: Telephone-based, random-digit-dialed, crosssectional survey conducted from July 1 through October 30, 2004. Setting: Telephone-accessible households with resident adolescents living with parents or caregivers in the mainland United States. Participants: Nationally representative, populationbased sample of 1600 adolescents aged 11 to 18 years and their caregivers. Main Outcome Measure: Prevalence of recent (pastyear) use of sunless tanning products and UV radiation exposure behaviors. Results: The prevalence of self-reported use of sunless tanning products in the past year among US adolescents was 10.8%. Adolescent users of these products were more likely to be older and female, to perceive a tanned appearance as desirable, to have a parent or caregiver who used sunless tanning products, and to hold positive beliefs or attitudes about these products. Use of sunless tanning products was independently associated with indoor tanning and higher frequency of sunburn but not with use of sunscreen. Conclusions: Among US adolescents, 10.8% used sunless tanning products in the past year; this practice was associated with risky UV radiation exposure-related behaviors. Adolescents, therefore, must be educated about these products and the importance of avoiding indoor tanning and practicing sun-protective behaviors. [ABSTRACT FROM AUTHOR]

This study presents nationally representative trends (1998–2004) and patterns in skin cancer risk behaviors, including sunburns, sun protection, and indoor tanning behaviors, and attitudes regarding ultraviolet radiation exposure among parents of U.S. adolescents. Data were from the American Cancer Society Sun Surveys I and II, telephone-based random digit dialed cross-sectional surveys of U.S. adolescents and their parents conducted in the summers of 1998 and 2004. Between 1998 and 2004, use of sunscreen, wide-brimmed hats and composite use of three to five behaviors increased significantly; concurrently, indoor tanning use increased significantly and sunburn prevalence changed a little. In 2004, 47% reported summer sunburns and more than half of those received painful sunburns. Parents continued to report low compliance with recommended behaviors; sunscreen use was most frequently reported, but many followed inappropriate application practices. About 13% practiced indoor tanning in the past year. Parents reported high levels of positive attitudes toward sun protection benefit, but at the same time, significant proportions reported positive tan appeal and outdoor sun exposure attitudes. The low rates and mixed progress in safe ultraviolet radiation exposure behaviors demand more attention for primary skin cancer prevention among parents of adolescents that focuses on changing beliefs about tanning appeal and promotes comprehensive ultraviolet radiation exposure protection. [ABSTRACT FROM AUTHOR]

The article discusses the prevalence of youth and adult smoking in the U.S. Based on the result of separate surveys, 20% of high school students and 20.5% of adults are smoking. It notes that the increased prevalence of youth smoking is attributed to the tobacco industry's promotional efforts while trends in adult smoking is strongly associated to socioeconomic status. Meanwhile, tobacco control initiatives in the U.S. which include increases in excise taxes and cessation programs are explored.

The article discusses the relationship of health insurance with the utilization of cancer care in the United States. According to the author, the lack of health insurance in some part of the US is related to the fact that not all population benefited the progress in cancer prevention, and treatment. Data about the relationship of health insurance to the cancer utilization is presented. The author suggests that the all Americans could be part of the progress if health insurance is addressed.

The article reports on tobacco control in the United States. An improvement in controlling tobacco use results from policies that increase tobacco excise taxes, smoke free laws and counteradvertising. Tobacco dependence was also reduced though enhanced smoking cessation programs. These approaches were found to be effective ways to reduce the use of tobacco thus preventing diseases caused by smoking which includes cancer.