Why is the Cancer Rate High
in the USA?

chillibreeze writer — Sapna Varghese

Cancer: An overview

Cancer is defined as a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread. This happens either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis, the spread of which, if not controlled, can result in death.

Etiology

• External factors such as tobacco, chemicals, radiation, and infectious organisms.
• Internal factors - inherited mutations that occur from metabolism.

Etiological factors may act together or in sequence to commence or promote carcinogenesis. It could take up to nine or more years between exposures or mutations and detectable cancer.

Types

All cancers caused by cigarette smoking and heavy alcohol consumption are considered preventable. As per the American Cancer Society, more than 180,000 cancer deaths in the year 2003 were caused by tobacco use. According to a study by Centers for Disease Control and Prevention (CDC), many of the youth aged between 16-24 years are trying to quit smoking, but often underestimate the rapid progression to tobacco dependence.1 Hence, Public Health Service clinical practice guidelines for treating tobacco use and dependence opine that certain clinical interventions, proven to be effective among adults, be used in youth-based approaches to cessation. Moreover, other components of comprehensive tobacco-control programs also increase smoking cessation and should be implemented at CDC-recommended levels to decrease the usage of tobacco among youths and adults.

According to scientific evidence, approximately one third of the 556,500 cancer deaths that occurred in 2003 were related to nutrition, physical inactivity, obesity and other lifestyle factors and could have been prevented.2 It was recognized that developing effective interventions for the 24% to 28% of U.S. adults who are sedentary requires a better understanding of the factors related to sedentary lifestyles as well as the communication channels to reach various subgroups. Obesity, which demonstrates a chronic energy imbalance, is an independent predictor of an increased cancer risk, especially for carcinomas of the uterine endometrium, kidney and gall bladder. The study by Atienza et al., identified key sociodemographic and health communication characteristics of various empirically based, physically inactive subgroups that differed on sociodemographic and health communication characteristics with high rates of inactivity using signal detection methodology.3 The information presented in this study, could be useful in creating future evidence-based, targeted and tailored intervention strategies.

Additionally, there are some cancers that are related to infectious exposures, e.g, hepatitis B virus (HBV), human papillomavirus (HPV), human immunodeficiency virus (HIV), helicobacter and others and are supposed to be preventable through behavioral changes, vaccines, or antibiotics. The study by Chaturvedi et al., concluded that among patients with AIDS, the lung cancer risk was substantially elevated.4

Furthermore, many of the more than one million skin cancers detected in 2003 could have been prevented if appropriate measures for protection from the sun’s rays had been adopted.2 Between July 2000 and January 2002, the Wisconsin Division of Public Health performed a study in 19 rural townships, where, a high percentage of private drinking water contained traces of arsenic. The study by Knobeloch et al., reported that out of the residents aged over 35 years, those who had consumed arsenic-contaminated water for at least 10 years were significantly more likely to report a history of skin cancer than others. Besides, tobacco use was also considered to be associated with higher rates of skin cancer and appeared to synergize the effect of arsenic on the development of skin cancer.5

Associated risks

The term ‘‘Risk’’ is used by researchers of cancer in numerous ways.

Lifetime risk refers to the probability that an individual, over the course of a lifetime, will develop cancer or die from it. For instance, men have a little less than a 1 in 2 lifetime risk of developing cancer in the USA; whereas, for women the risk is a little more than 1 in 3.

Relative risk is a measure of the strength of the relationship between risk factors and the particular cancer. The risk of developing cancer in persons with a certain exposure or trait to the risk in people who do not have this exposure or trait is what is being compared. This points out that women with a family history are around twice more likely to develop breast cancer than those women without a family history of the disease.

Western Lifestyle – A Health Risk?

A Western lifestyle typically comprises of a high calorie diet, which is rich in fat, refined carbohydrates and animal protein and combined with low physical activity, results in an overall energy imbalance. This is considered to be associated with a multitude of disease conditions, including obesity, diabetes, cardiovascular disease, arterial hypertension and cancer.

Diagnosis and Survival Rates

Regular screening examinations by a health care professional can directly contribute in the detection of malignancies typical of affluent societies, such as cancer of the breast, colon, rectum, cervix, prostate, uterus (endometrial carcinoma), testes, oral cavity and skin at earlier stages, when treatment is more likely to be successful. Self-examination for cancers of the breast and skin could also lead to detection of tumors at earlier stages. The study conducted by Mai et al., revealed that lifetime recreational physical activity could safeguard against colon cancer among postmenopausal women who have never used hormone therapy.6 Hebert et al., points out that information from a number of studies indicates that disparities exist in esophageal cancer incidence between racial groups and between geographical locations within South Carolina. Besides, these disparities are continuing to rise.7 The five-year survival rates for those cancers detected by screening are roughly 82%. If all these cancers were diagnosed at a localized stage through regular cancer screenings, five-year survival would soar to approximately 95%.2

Expenditure Impact

In the year 2002, according to the National Institutes of Health, the overall costs of cancer stood at $171.6 billion, that is,

• Direct medical costs, which is the total of all health expenditure - $60.9 billion.
• Indirect morbidity costs, that is, the cost of lost productivity due to illness - $15.5 billion.
• Indirect mortality costs, which is the cost of lost productivity due to premature death - $ 95.2 billion.

Among the reasons, which prevent many Americans from receiving optimal health care, the foremost are lack of health insurance and barriers such as the rising health costs.2

Management Options

There are several treatment options for cancer, such as surgery, radiation, chemotherapy, hormones, as well as immunotherapy.

Conclusions

A sedentary lifestyle, definitely contributes to the development of particular types of cancer and hence the focus should be on behavior alteration for both individuals and communities at large. For instance, obesity, which is, clearly, regarded as a risk factor for various serious health problems in adults, including heart disease, hardening of the arteries, high cholesterol, high blood pressure, certain types of cancer, strokes, diabetes, muscle and bone disorders and gallbladder disease, is certainly preventable. The most obvious parameters that should be the focus of initial epidemiological data collection and assessment are a combination of genetic factors, environmental influences, especially, those related to diet, and the harmful changes associated with smoking and excessive alcohol consumption. Stakeholders such as governments and regulatory bodies, doctors and health educators in developed countries like the USA, could work together in order to encourage and help people alter their behavior to avoid the types of cancers that are preventable in some way or the other.

Therefore, to sum up, further research is needed in the future to reinforce current studies addressing health beliefs and social support. Intervention and innovative approaches that focus on the interplay among psychological, educational, and communication barriers are essential. These should be adapted and applied across various racial/ethnic and socioeconomic groups in order to reach entire populations with a high-risk profile for invasive cancer. The necessity of having adequate, well-trained staff, procuring supplemental reporting sources, and attaining compliance with national data standards should never be underestimated.

References

1. Centers for Disease Control and Prevention (CDC). Use of cessation methods among smokers aged 16-24—United States, 2003. MMWR Morb Wkly Rep.2006; 55(50):1351­–1354.
2. American Cancer Society. Cancer Facts & Figures 2003. 2003;1-52.
3. Atienza AA, Yaroch AL, Masse LC et al. Identifying sedentary subgroup: the National Cancer Institute’s health Information National Trends Survey. Am J Prev Med. 2006;31(5):389–390.
4. Chaturvedi AK, Pfeiffer RM, Chang et al. Elevated risk of lung cancer among people with AIDS. AIDS. 2007;21(2):207–213.
5. Knobeloch LM, Zicrold KM, Anderson HA. Association of arsenic-contaminated drinking water with prevalence of skin cancer in Wisconsin’s Fox River Valley. J Health Popul Nutr. 2006;24(2):206–213.
6. Mai PL, Sullivan-Halley J, Ursin G et al. Physical activity and colon cancer risk among women in the California Teachers study. Cancer Epidemiol Biomarkers Prev. 2007;16(3):517–525.
7. Hebert JR, Adams SA, Hurley D et al. Esophageal cancer disparities in South Carolina: early detection, special programs, and descriptive epidemiology. J S C Med Assoc. 2006;102(7):201–209.

 

 

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