domingo, 12 de julio de 2015

Meeting the Healthy People 2020 Objectives to Reduce Cancer Mortality

full-text ►

Meeting the Healthy People 2020 Objectives to Reduce Cancer Mortality

CDC. Centers for Disease Control and Prevention. CDC 24/7: Saving Lives. Protecting People.

Preventing Chronic Disease Logo

PCD GIS Snapshots

Meeting the Healthy People 2020 Objectives to Reduce Cancer Mortality

Hannah K. Weir, PhD; Trevor D. Thompson, BS; Ashwini Soman, MBBS, MPH; Bjorn Møller, PhD; Steven Leadbetter, MS; Mary C. White, ScD

Suggested citation for this article: Weir HK, Thompson TD, Soman A, Møller B, Leadbetter S, White MC. Meeting the Healthy People 2020 Objectives to Reduce Cancer Mortality. Prev Chronic Dis 2015;12:140482. DOI:


Healthy People 2020 (HP2020) calls for a 10% to 15% reduction in death rates from 2007 to 2020 for selected cancers. Trends in death rates can be used to predict progress toward meeting HP2020 targets.
We used mortality data from 1975 through 2009 and population estimates and projections to predict deaths for all cancers and the top 23 cancers among men and women by race. We apportioned changes in deaths from population risk and population growth and aging.
From 1975 to 2009, the number of cancer deaths increased among white and black Americans primarily because of an aging white population and a growing black population. Overall, age-standardized cancer death rates (risk) declined in all groups. From 2007 to 2020, rates are predicted to continue to decrease while counts of deaths are predicted to increase among men (15%) and stabilize among women (increase <10%). Declining death rates are predicted to meet HP2020 targets for cancers of the female breast, lung and bronchus, cervix and uterus, colon and rectum, oral cavity and pharynx, and prostate, but not for melanoma.
Cancer deaths among women overall are predicted to increase by less than 10%, because of, in part, declines in breast, cervical, and colorectal cancer deaths among white women. Increased efforts to promote cancer prevention and improve survival are needed to counter the impact of a growing and aging population on the cancer burden and to meet melanoma target death rates.


In the United States, the age-standardized cancer death rate began declining in the early 1990s, largely because of declines in deaths from lung and prostate cancer in men, breast cancer in women, and colorectal cancer in both sexes (1). The age-standardized death rate approximates the population’s risk of dying from cancer and is used to compare risk of death between populations or over time within a population. A decline in the death rate means that the overall risk of dying from cancer in the population has decreased. However, age-standardized rates do not convey the full extent of the cancer burden, as they effectively remove the influence of demographic changes in the population. During this time, the observed number of cancer deaths has continued to increase (2).
The number of cancer deaths is a function of the population’s risk of dying from cancer and the population’s age structure and size. The observed increase in the number of cancer deaths reflects the increased risk of dying from cancer with age, and during the past several decades, the US population has grown, particularly in the older age groups (3). These demographic trends and increasing cancer burden are forecast to continue as the cohort born following World War II enters the age groups most at risk of dying from cancer (4).
In 1971, the US Congress passed the National Cancer Act, which signaled a national effort against cancer (5) and led to the establishment of the Surveillance, Epidemiology, and End Results (SEER) Program in 5 states and 4 metropolitan areas (1). Since then, cancer registries (2) and cancer control programs (6) have been established in all states. More recently, the US Department of Health and Human Services (HHS) issued Healthy People 2020 (HP2020) (7), which included several objectives for reducing cancer mortality. Each objective has a baseline measure and a target to be achieved by 2020. Most of the cancer mortality objectives include a 10% reduction in the age-standardized death rate from 2007 (baseline) to 2020. The colorectal cancer target calls for a 15% reduction in death rates.
Trends in population risk, size, and age structure have been used to predict the future of cancer mortality in other countries (8). To determine whether HP2020 cancer mortality targets are likely to be met, we used mortality data and population estimates and projections to assess the contribution of changes in population risk, growth, and aging on cancer deaths from 1975 to 2020 for all cancer sites and the top 23 cancers by sex and race.


There are no financial disclosures from any of the authors. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Author Information

Corresponding Author: Hannah K. Weir, PhD, Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop F76, Atlanta, GA 30341. Telephone: 770-488-3006. Email:
Author Affiliations: Trevor D. Thompson, Steven Leadbetter, Mary C. White, Centers for Disease Control and Prevention, Atlanta, Georgia; Ashwini Soman, Northrop Grumman Corporation, Atlanta, Georgia; Bjorn Møller, Cancer Registry of Norway, Oslo, Norway.


  1. Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, et al. Annual report to the nation on the status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 2014;120(9):1290–314. CrossRef PubMed
  2. US Cancer Statistics Working Group. United States cancer statistics: 1999–2011 incidence and mortality web-based report. US Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2013. Accessed October 10, 2014.
  3. Vincent GK, Velkoff VA. The next four decades: the older population in the United States: 2010 to 2050. Current Population Report P25-1138. Washington (DC): US Census Bureau; 2010. Accessed October 6, 2014.
  4. Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Yancik R, et al. Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on US cancer burden. Cancer 2002;94(10):2766–92. PubMed
  5. The National Cancer Act of 1971, Pub. L. 92-218, 85 Stat. 1828. (Dec 23, 1971). Accessed January 16, 2015.
  6. Major A, Stewart SL. Celebrating 10 years of the National Comprehensive Cancer Control Program, 1998 to 2008. Prev Chronic Dis 2009;6(4):A133. PubMed
  7. About Healthy People. Washington (DC): US Department of Health and Human Services; 2012. Accessed October 22, 2014.
  8. Bray F, Møller B. Predicting the future burden of cancer. Nat Rev Cancer 2006;6(1):63–74. PubMed
  9. National Vital Statistics System (NVSS). Centers for Disease Control and Prevention. Accessed October 10, 2014.
  10. 2008 National population projections. US Census Bureau. Accessed October 22, 2014.
  11. Canadian Cancer Society. Canadian Cancer Statistics 1999. Toronto (ON): 1999. Accessed January 16, 2015.
  12. Møller B, Fekjaer H, Hakulinen T, Sigvaldason H, Storm HH, Talbäck M, et al. Prediction of cancer incidence in the Nordic countries: empirical comparison of different approaches. Stat Med 2003;22(17):2751–66. CrossRef PubMed
  13. Age adjustment using the 2000 projected US population. Bethesda (MD): National Center for Health Statistics, Centers for Disease Control and Prevention; 2001. Accessed May 15, 2014.
  14. Møller B, Fekjaer H, Hakulinen T, Tryggvadóttir L, Storm HH, Talbäck M, et al. Prediction of cancer incidence in the Nordic countries up to the year 2020. Eur J Cancer Prev 2002;11(Suppl 1):S1–96. PubMed
  15. Yang W, Williams JH, Hogan PF, Bruinooge SS, Rodriguez GI, Kosty MP, et al. Projected supply of and demand for oncologists and radiation oncologists through 2025: an aging, better-insured population will result in shortage. J Oncol Pract 2014;10(1):39–45. CrossRef PubMed
  16. Trogdon JG, Tangka FK, Ekwueme DU, Guy GP Jr, Nwaise I, Orenstein D. State-level projections of cancer-related medical care costs: 2010 to 2020. Am J Manag Care 2012;18(9):525–32.PubMed
  17. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 2011;103(2):117–28. CrossRef PubMed
  18. Kochanek KD, Arias E, Anderson RN. How did cause of death contribute to racial differences in life expectancy in the United States in 2010? NCHS Data Brief 2013;(125):1–8. PubMed
  19. Jemal A, Thun MJ, Ries LA, Howe HL, Weir HK, Center MM, et al. Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst 2008;100(23):1672–94. CrossRef PubMed
  20. Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 2010;116(3):544–73. CrossRef PubMed
  21. Cho H, Mariotto AB, Schwartz LM, Luo J, Woloshin S. When do changes in cancer survival mean progress? The insight from population incidence and mortality. J Natl Cancer Inst Monogr 2014;2014(49):187–97. CrossRef PubMed
  22. Weir HK, Thompson TD, Soman A, Møller B, Leadbetter S. The past, present, and future of cancer incidence in the United States: 1975 through 2020. Cancer 2015;121(11):1827–37.CrossRef PubMed
  23. Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, et al. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012;118(9):2338–66. CrossRef PubMed
  24. Polednak AP. Surveillance and interpretation of trends in US age-specific incidence rates for primary liver cancer, in relation to the epidemic of hepatitis C infection. J Registry Manag 2013;40(3):115–21, quiz 144–5. PubMed
  25. Vollmer RT. Revisiting overdiagnosis and fatality in thyroid cancer. Am J Clin Pathol 2014;141(1):128–32. PubMed
  26. Morris LG, Sikora AG, Tosteson TD, Davies L. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid 2013;23(7):885–91. CrossRef PubMed
  27. Jemal A, Saraiya M, Patel P, Cherala SS, Barnholtz-Sloan J, Kim J, et al. Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992-2006. J Am Acad Dermatol 2011;65(5, Suppl 1):S17–25.e1, 3. PubMed
  28. The Surgeon General’s call to action to prevent skin cancer. Washington (DC): US Department of Health and Human Services, Office of the Surgeon General; 2014. Accessed October 10, 2014.
  29. White MC, Peipins LA, Watson M, Trivers KF, Holman DM, Rodriguez JL. Cancer prevention for the next generation. J Adolesc Health 2013;52(5, Suppl):S1–7. CrossRef PubMed
  30. Brown ML, Klabunde CN, Cronin KA, White MC, Richardson LC, McNeel TS. Challenges in meeting Healthy People 2020 objectives for cancer-related preventive services, National Health Interview Survey, 2008 and 2010. Prev Chronic Dis 2014;11:E29. CrossRef PubMed

No hay comentarios: