In a press release, the American Cancer Society calls its projection of more than 2 million new U.S. cancer cases in 2024 “a bleak milestone.” The report cites the nation’s growing population as a factor. What else could be involved?
This statistic is alarming. It’s a number we haven't seen. More people are living longer, often well beyond 75 or 80, and cancer rates rise as age increases, so that can be part of it. And a large part of what might be driving this increase is also more diagnoses in younger Americans. Colorectal cancer and breast cancer are some of those cited. We’re starting to see more people diagnosed at an age mark where we didn’t previously see cancer diagnoses that commonly. People 50 and older might be diagnosed at similar rates now as before, or even at somewhat lower rates, but below 50, we’re starting to see higher rates of diagnoses.
Are increases in screening driving up these diagnosis rates?
That’s a really good point. With COVID, we saw a bit of a backlog with cancer screening. Restrictions were in place on elective procedures because of the virus. It’s safe to say that part of the diagnosis increase might be the return to screening. The upside is that screening is doing great work to detecting cancer. But there are risk factors, like obesity, that are also on the increase and this could be part of the driving factor as well.
The report spotlights colorectal cancer rates for Americans in their 50s and younger. It says rates are increasing in people under age 55. What do you make of that?
The guideline for colorectal cancer screenings was moved in 2021 from 50 to 45 years old for average-risk populations. I worked on helping to inform this change with the American Cancer Society with support of the CU Cancer Center. The change in the guideline is going to take several years for that change to fully catch on with people in the way we need it to, but we’re already starting to see some people start their screening at age 45. We still have a lot of work to do on awareness of the need to start screening earlier.
To a certain extent, people are being diagnosed sometimes even well before 45 years old. There’s no guideline for screening before then unless you have a family history or symptoms or a genetic syndrome. Colorectal cancer does happen among young adults, even teenagers, and we don’t know why. There has to be more money and more resources devoted to understanding the causation. Until we get behind exploring the “why,” we really can’t address the issue.
Excess body weight crops up several times in the report as a factor in increased cancer rates. What should people know about weight gain as it relates to cancer?
Gaining weight increases your cancer risk and your chances of dying younger. There are specific cancers that are linked to obesity: Pancreatic cancer, kidney cancer, post-menopausal breast cancer, and, to a certain extent, colorectal cancer. I think we are more sedentary these days. So when we talk about 2 million new cancer cases, I think there are a lot of parallels to the obesity piece.
Obesity and a sedentary lifestyle are things we definitely have to take into consideration. Ultimately, having more weight means we have more cells, and the more cells that you have, the more chances you have of something going wrong with those cells. It's not just about cancer. A healthier lifestyle helps prevent a number of chronic diseases.
What does the report tell us about health disparities?
Mortality rates are twice as high in prostate, stomach, and uterine cancers for Black individuals and for liver, stomach, and kidney cancers in the Native American population. Black Americans and Native Americans are at exceptionally increased risk for colorectal cancer. Also, I’m from rural Colorado, and I know that rural populations don’t get screening at the same rates as people on the Front Range. We need to be doing right by all of Colorado by addressing issues related to access for all these communities.
The report indicates that the overall cancer death risk has declined by about 33% over the last 30 years. What's your take on factors behind that trend?
I’m someone who is super-excited about all things prevention, and the tools we have for prevention and early screening have really blossomed. For lung cancer screening, we now have low-dose CT tests. For breast screening, we have digital mammography and ultrasound. For colorectal screening, we have stool tests. And there are cancer vaccines.
Thinking about the future, doing good science will help us add to the arsenal of cancer screening tools, whether that’s multicancer early-detection blood tests or better imaging technology. The past has shown us that when do this work on prevention and early detection, when we've had great public awareness campaigns around doing this work, when we normalize having a discussion about cancer and cancer prevention, we can do great things together.
I also think identifying patient needs and implementing evidence-based intervention to address them are key – for example, deploying and supporting patient navigation. We have brilliant people at the CU Cancer Center who are really committed to getting great, safe, evidence-based prevention tools to patients sooner.
You are program director of the Colorado Cancer Screening Program. Tell me what the program is and your mission.
Our program aims to reduce disparities in access to cancer screening among Colorado communities, focused on support for rural health centers and safety-net clinics and hospitals. We’re based at the CU Cancer Center, staffed mostly with faculty and staff from the Colorado School of Public Health. We’ve been in existence for 17 years with funding from the Amendment 35 tobacco tax’s Cancer, Chronic Disease, and Cardiovascular Grant Program.
Reports like this one released this week from the American Cancer Society show us that our work in cancer screening may be catching cancer more often and earlier but it also means we have a lot more work to do. Two million cases are a lot and we are aiming to help reduce those numbers and when someone does have cancer to catch it early and give people the best chance for survival.
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