Lessening Cancer Risks: Healthy Living, Preventive Measures, and Public Health Practice

Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.

At the heart of it, cancers are diseases caused by mutations in genes that ultimately fail to control the way our cells would normally function. While the abnormal gene mutations and therefore changes in gene expression within cells results in cancer, environmental exposures, family history, underlying health status, and personal behaviors may be significant risk factors towards developing cancer. Despite the complexity of factors and their interplay that lead to cancer, the evidence unequivocally suggests that there are measures that can be taken to reduce risk. When collectively addressed, these steps can help us to prevent many cancers. Within such a strategy, there are habits to avoid and habits to encourage. Clearly, at the top of the list of habits to avoid is smoking and the use of tobacco products.

Smoking is the leading cause of preventable death. It can cause cancer nearly anywhere in the body. Most notable amongst smoking-related cancers are those of the lungs: nearly 9 out of 10 lung cancer deaths are caused by smoking cigarettes or secondhand smoke exposure. Smokeless tobacco (e.g., chewing, snuff, etc.) is related to cancers of the mouth, throat, esophagus, and pancreas. The message is unarguable: those who smoke can reduce their risk if they quit. Those who don’t smoke should not start.

We should also always be mindful of those everyday measures that can help reduce cancer risk. Skin cancer is the most common type of cancer in the United States and can affect anyone. You can protect yourself from the long-term skin damage that leads to cancer by staying out of the sun as much as possible between 10 a.m. and 4 p.m.; covering up including wearing a hat, longer sleeves, and sunglasses; wearing broad spectrum sunscreen with SPF 15 or higher; and avoiding indoor tanning. And be sure to check your skin regularly. When detected early, most skin cancers can be cured.

As I say often, the long-game for disease prevention and promoting health and wellness is rooted in getting adequate physical activity and maintaining proper nutrition. For adults, regular physical activity lowers risk of cancers of the bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach. Evidence demonstrates that healthy eating across the lifespan can also lower risk of cancers of the breast, colon, and rectum. The consumption of alcohol – even at low levels (less than 1 drink in a day) – can increase risk for some types of cancers. For more information on alcohol and cancer risks, make sure to review the latest Dietary Guidelines for Americans, 2020-2025

Also, in terms of habits to encourage, receiving regular cancer screenings that are appropriate for age and individual risk remains one of the most effective tools for catching cancers early, preventing their further development or spread, and minimizing morbidity and mortality. The Affordable Care Act (ACA) ensures that most health plans must cover a set of preventive services and screening tests at no cost when delivered by a doctor or other provider in a patient’s healthcare network. These screening tests for cancer include:

  • Colorectal cancer screening for adults 45 to 75
  • Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
  • Breast cancer mammography screenings every 2 years for women 50 and over; or as recommended by a provider for women 40 to 49; or women at higher risk for breast cancer
  • Cervical cancer screening for women age 21 to 65

Healthcare coverage, risk of cancer, and therefore recommendations for screening vary for cancers in men. However, especially in June during Men’s Health Month, all men should consider plans for screening tests. Depending upon age and other factors, men may wish to consult with their doctor about prostate cancer screening options. They may also consider conducting regular self-exams for testicular cancer. While there is no standard clinical screening test for testicular cancer, early detection is key to treatment and the prevention of further spread.

Receiving the human papillomavirus (HPV) vaccine is also recommended. Human papillomavirus (HPV) causes about 36,500 cases of cancer each year and can be found in carcinomas of the cervix and squamous cell carcinomas of the vagina, vulva, penis, anus, rectum, and oropharynx. The HPV vaccine may help to prevent infections that can subsequently contribute to these types of cancers, and potentially eliminate 33,700 of these cases. Like the previously mentioned screening tests, the HPV vaccine is also covered under provisions in the ACA. While it’s best to get the vaccine at age 11 or 12, new guidance shows that everyone can get the vaccine through age 26. Some adults between the ages of 27 to 45 may also decide to get HPV immunization after consulting with their physician.

The list of cancer prevention strategies, along with other preventive health measures, may appear complicated, but there are tools available to help individuals approach their preventative care more easily. On ODPHP’s MyHealthfinder site people can find easy-to-use, plain language, preventive health information. There’s also a tool that can provide more personalized information based on age, sex, and pregnancy status. Much of this information is informed by United States Preventive Services Task Force (USPSTF) recommendations. Providers and professionals are encouraged to visit the USPSTF website to learn more about the latest recommendations and preventive care guidance, including the most recent updates to recommendations on cancer screenings and vaccinations.

Organizations seeking better alignment with national priorities and strategies for cancer prevention will also find a wealth of information within the Healthy People 2030 initiative. There, they’ll find data-driven national objectives to improve health and well-being over the next decade, including 10-year targets for several types of cancers and related preventive services. To help track progress toward meeting the national objectives, organizations may wish to create their own Healthy People 2030 Custom List using the national objectives. Here’s an example of a cancer prevention custom list that I recently created. Public health professionals are encouraged to visit the Healthy People 2030 site and build their own custom lists to use in their work. It’s quick. It’s easy. And it’s free to use.

And finally, as with all preventative strategies, it is important that we always keep in mind the social determinants of health (SDOH) and how significantly one’s life circumstances can contribute to risk for many cancers. While access to clinical preventive care and treatment services is critically important to preventing and treating cancers, supporting individuals and communities in the many ways that can improve cancer prevention is equally imperative.

Disadvantaged communities often suffer the worst environmental hazards that negatively impact health, including many exposures that lead to various types of cancer. The Office of Environmental Justice within the Office of the Assistant Secretary for Health is a new federal entity working to address environmental inequities that drive health disparities. Check out their website to learn more. You can also explore issues related to environmental health and other SDOH that can impact cancer risks on the Healthy People 2030 microsite. Several Healthy People objectives are devoted to addressing the built environments that affect our health, including reducing the amount of toxic pollutants released into the environment, the number of days people are exposed to unhealthy air, and health and environmental risks from hazardous sites.

Equitably addressing the environments where people are  – where they live, learn, work, and play –  requires added forethought, effort, and creativity. However, the effort from both a public health and clinical perspective is critical to ensuring healthier, stronger, more resilient individuals and communities.  Making risk reduction integral to our public health approach will help to promote preventative care practices, improve environmental risk factors, and reduce cancer rates as well as contribute to overall health and well-being.

Yours in health,

Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion

In Officio Salutis

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