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Active oldsters fare better: ACS study underscores the importance of exercising and sitting less

​Older adults with higher physical activity and lower sitting time have better overall physical and mental health, according to a new American Cancer Society study led by Erika Rees-Punia, PhD, MPH, our resident exercise science expert and cancer survivorship researcher.

The study, appearing in the journal CANCER, suggests that higher amounts of regular moderate- to vigorous-intensity physical activity (MVPA) and lower duration of sedentary time is associated with higher global mental and physical health for older cancer survivors and older adults, in general.

With a rapidly aging population and nearly 16.9 million cancer survivors in the U.S. today, there is a need to identify strategies associated with healthy aging and improving quality of life for aging cancer survivors. 

ACS investigators analyzed self-reported aerobic and muscle-strengthening physical activities, sitting time, and mental and physical health among nearly 78,000 participants in our Cancer Prevention Study II Nutrition Cohort. Participants (with an average age of 78 years) included older cancer survivors up to 10 years post-diagnosis, and cancer-free adults.

They found that regardless of cancer history, the differences in mental and physical health between the most and least active, and the least and most sedentary, were clinically meaningful. These findings provide evidence for the importance of engaging in regular moderate- to vigorous-intensity physical activity and decreasing sitting time as a reasonable non-pharmacologic strategy to improve quality of life in older men and women, with or without a prior cancer diagnosis. In fact, the recently published ACS physical activity guidelines recommend that adults get 150-300 minutes of moderate-intensity activity or 75-150 minutes of vigorous-intensity activity through the week, and to limit sedentary behaviors such as screen-based entertainment.

“The findings reinforce the importance of moving more and sitting less for both physical and mental health, no matter your age or history of cancer,” Erika said. “This is especially relevant now as so many of us, particularly cancer survivors, may be staying home to avoid COVID-19 exposure, and may be feeling a little isolated or down. A simple walk or other physical activity that you enjoy may be good for your mind and body.”

Article: Rees-Punia E, Patel AV, Nocera JR, Chantaprasopsuk S, Demark-Wahnefried W, Leach CR, Smith TG, Cella D, Gapstur SM. Self-Reported Physical Activity, Sitting Time, and Mental and Physical Health Among Older Cancer Survivors Compared to Adults Without a History of Cancer, 2020. CANCER; DOI: 10.1002/cncr.33257.  


  • E-cigarette use up among young non-smokers

    Intervention is needed given that long-term consequences of electronic cigarette use are mostly unknown.

    A new ACS study finds that the largest population increase in electronic cigarette users is among younger adults who have never smoked combustible cigarettes. The study appears in the American Journal of Preventive Medicine

    Researchers led by Priti Bandi, PhD, principal scientist, Risk Factors Surveillance Research, assessed trends in the prevalence of e-cigarette use and population count of e-cigarette users in younger (18–29 years), middle-aged (30–49 years), and older (≥50 years.) U.S. adults between 2014 and 2018. The most notable finding was a near tripling of e-cigarette use among younger adults who never smoked combustible cigarettes – from 1.3% to 3.3%.

    This increase suggests rising primary nicotine initiation with e-cigarettes. When combined with a large and growing prevalence and population of never-smokers nationally, this increase represents the largest absolute increase in never-smoking e-cigarette users – from 400,000 in 2014 to 1.35 million in 2014. 

    The authors also note substantial increases in e-cigarette use among near-term quitters (i.e. those who quit combustible cigarettes 1-8 years ago, when e-cigarettes proliferated the U.S. retail market) across all age groups. This trend suggests continued use of e-cigarette devices among those who may have switched from cigarettes previously, potentially for nicotine maintenance. 

    “Urgent efforts are needed to address the potential rise in primary nicotine initiation with e-cigarettes among younger adults. It is also important to aid the transition of e-cigarette users—particularly among younger adults—to non-use of all tobacco or nicotine products given that the long-term consequences of e-cigarette use are mostly unknown,” said Priti.


  • ACS Medal of Honor recipients awarded Nobel Prize in Chemistry

    Developers of the tool for gene editing were awarded our highest honor in 2018.

    Congratulations to American biochemist Jennifer A. Doudna, PhD (left in the smaller photo) and French microbiologist Emmanuelle Charpentier, PhD (right) this year's recipients of the Nobel Prize in Chemistry for their 2012 work on the development of Crispr-Cas9, a method for genome editing. The Oct. 7 announcement marks the first time a science Nobel has been awarded to two women.

    Both scientists were among five individuals awarded the American Cancer Society's highest honor in 2018. Read more about those Medal of Honor awards here.

    “The work of these two investigators is arguably one of the great technical advances in the past 50 years akin to DNA sequencing. In the same way that our ability to sequence DNA is essential in biomedical research today, genome editing is quickly becoming a powerful and foundational technology in research,” said William Phelps, PHD, our senior vice president, Extramural Research.

    ACS did not fund either of these women, so the number of ACS-funded Nobel Laureates remains at 49. That number is a tribute to the Society’s Research program and the strength of its peer-review process.

    Dr. Charpentier and Dr. Doudna, only the sixth and seventh women to receive the chemistry prize, pioneered early work on Crispr-Cas9, a kind of genetic scissors that allows researchers to alter the DNA of animals, plants and microorganisms with extremely high precision. Since then, it has been used in numerous scientific applications, from genetically modifying crops to developing cures-in-progress for conditions like sickle cell disease and hereditary blindness, according to The New York Times.

    TOP PHOTO: Flanked by American Cancer CEO Gary Reedy (far left) and 2018 American Cancer Society Board Chair Kevin Cullen, MD (far right) are the 2018 recipients of the Medal of Honor. Their names and their award are, from left to right: Vice President Joe Biden, for Cancer Control; Emmanuelle Charpentier, PhD, for Basic Research; Charis Eng, MD, PhD, for Clinical Research; Jennifer A. Doudna, PhD, for Basic Research; and Michael J. Thun, MD, MS, for Cancer Control Science.


  • Thyroid cancer drives increase in cancer incidence among adolescents and young adults

    ​Cancer mortality rates are highest in non-Hispanic Black AYAs, particularly females

    A new ACS report examining cancer in adolescents and young adults (ages 15 to 39) provides updated estimates of the cancer burden in this age group, predicting that 89,500 cases and 9,270 deaths will occur in 2020 in the U.S. The report appears in the American Cancer Society journal CA: A Cancer Journal for Clinicians, and was co-written by ACS researchers Kim Miller, MPH, Rebecca Siegel, MPH, and others. 

    To watch a slideshow of key findings, visit cancer.org.

    The most common types of adolescents and young adults (AYAs) cancers vary substantially by age

    AYAs with cancer are frequently grouped with older or younger patient populations and/or presented in aggregate, masking the wide difference in cancer occurrence within this population. To address this issue, ACS investigators also examined cancer incidence, survival, and mortality among AYAs by race/ethnicity and for smaller age groups (15-19, 20-29, and 30-39). 

    The bar graph above shows the difference in the most commonly diagnosed cancers by age group:

    • Ages 15 to 19: The 3 most common types are thyroid cancer, Hodgkin lymphoma, and brain tumors. Teens have a higher proportion of childhood cancers compared to the older age groups. 
    • Ages 20 to 29: The most common are thyroid cancer, testicular cancer, and melanoma. 
    • Ages 30 to 39: The most common are breast cancer (in females), thyroid cancer, and melanoma.

    Among these cancers, incidence rates are highest in non-Hispanic whites and lowest in Asian/Pacific Islanders (83 vs 54 per 100,000 people) for both sexes. This reflects higher rates in non-Hispanic white AYAs for thyroid cancer, testicular tumors, and melanoma compared to other major racial/ethnic groups. Unlike adults ages 40 and older, however, female breast cancer incidence rates in non-Hispanic Black AYAs are 14% higher than those in non-Hispanic white AYAs (25.9 vs 22.3 per 100,000 population). 

    The authors also note that despite patterns in overall incidence, cancer mortality rates are highest in non-Hispanic Black AYAs, particularly females (12.6 per 100,000 vs 9.2 in non-Hispanic white persons), reflecting substantial survival disparities compared to those who are non-Hispanic white. The largest 5-year cancer-specific survival disparities occur among those who are non-Hispanic Black compared with non-Hispanic whites for acute lymphocytic leukemia (57% vs 71%, respectively) and female breast cancer (78% vs 89%, respectively).

    Thyroid cancer diagnoses have driven the overall increase in incidence rates—especially for women

    Overall, the researchers found that cancer incidence rates increased across all 3 age groups during the past decade. Notably, thyroid cancer was the only common type among each age group’s top 3 types of cancer. Thyroid cancer incidence rates among women in their 20s are 5 times greater than those in men (15 women vs 3 men per 100,000 people).

    By age group, the cancer incidence rate in AYAs increased during the most recent decade (2007-2016) overall but showed signs of stabilizing among men in their 20s. The rise is largely driven by thyroid cancer incidence rates, which rose by approximately 3% annually among those aged 20 to 39 and 4% among those aged 15 to 19 years. Incidence increased for several cancers linked to obesity, including kidney (3% across all age groups), uterine corpus (3% in group aged 20-39 years), and colorectum (0.9%-1.5% in the group aged 20-39 years).  

    In contrast to incidence, cancer mortality rates among AYAs for all cancers combined declined in the past decade (2008 through 2017) by 1% across sex and age groups except females aged 30 to 39, among whom rates remained stable due to a flattening of declines in breast cancer mortality. Mirroring incidence, mortality rates increased during the most recent 10 data years (2008-2017) for colorectal and uterine corpus cancers.

    Other highlights from the report include:

    • Cancer incidence rates for all types combined are similar for males and females ages 15 to 19. However, 20- to 29-year-old women have rates that are 30% higher than for men of the same age (55 women vs 42 men per 100,000 people). The incidence rate is nearly double in 30- to 39-year-olds (161 women vs 84 men per 100,000 people.) These differences are mainly because of the higher incidence of breast cancer, melanoma, and thyroid cancer in women.
    • Adolescents (aged 15-19 years) are more likely to be diagnosed with cancers associated with childhood, such as Hodgkin lymphoma, while those aged 20 to 39 years are more likely to be diagnosed with adult cancers, such as breast. 
    • Leukemia continues to be the leading cause of cancer death in ages 15 to 29 years. Among ages 30-39 years, breast (women) and colorectal (men) cancers are the leading cancer causes of death.
    • Melanoma incidence rates during 2007-2016 rapidly declined in ages 15 to 29 (4%-6% annually, on average). However, among ages 30-39 years, rates declined only slightly among men and remained flat among women. 
    • The most commonly diagnosed cancer for males aged 20 to 39 is testicular cancer. The incidence rates per 100,000 people are: 13 for non-Hispanic white men;10 for both Hispanic men and American Indians/Alaskan Natives;2.4 for non-Hispanic Black men.
    • Overall 5-year relative survival in AYAs for all cancers combined (83%-86% across age groups) is similar to that in children (84%), but masks lower survival for several cancer types, such as acute lymphocytic leukemia (ALL; 60% vs 91%, respectively).

    The report notes an increasing body of evidence that tumors in AYAs are molecularly distinct from those in younger or older populations, suggesting differences in etiology and in treatment options. In addition, studies have shown that compared to childhood cancer survivors, AYAs have a higher risk of progression and death from their original cancer. Compared to older cancer patients, AYAs have a higher risk of long-term and late effects including infertility, sexual dysfunction, cardiovascular disease, and other future cancers. However, further research in these areas is needed. 

    The authors say that progress in reducing cancer morbidity and mortality among AYAs could be improved with more equitable access to health care, as AYAs are more likely than other age groups in the U.S. to be uninsured. Increased clinical trial enrollment, expanded research, and improved awareness among clinicians and patients of early symptoms and signs of cancer could also accelerate progress. 

    “Although there has been rapid progress in the scientific understanding of cancer in AYAs over the last decade, several research gaps in etiology, basic biology, treatment, and survivorship remain,” write the authors. “AYAs diagnosed with cancer also continue to face challenges in health care access during early life transitions, which can negatively impact treatment.”


  • September is Childhood Cancer Awareness Month

    ​1 in 389 children in the U.S. will be diagnosed with cancer by age 15; learn what ACS is doing to help

    Cancer doesn’t fight fair at any age, but it’s devastating when it occurs in children. Approximately 1 in 389 children in the U.S. will be diagnosed with cancer by age 15, and it is the leading cause of death in children and teens ages 1-19 in our nation. An estimated 11,050 children 14 and under will be diagnosed with cancer in the U.S. during 2020, and 1,190 will die from it. 

    But the future is hopeful. The death rate for cancer in children ages 0-14 years declined by more than half from 1975 (4.9 per 100,000) to 2017 (2.0 per 100,000), largely due to improvements in treatment and high rates of participation in clinical trials. And ACS continues our efforts to attack childhood cancer on all fronts, leveraging our unique strengths in funding the best research, providing information and support for youth with cancer and their families, and working to improve access to care and the quality of life for childhood cancer patients and survivors.

    This September, ACS is utilizing Childhood Cancer Awareness Month to raise funds for pediatric cancer research, including promotion of our #GoldTogether program and St. Baldrick’s partnership, and to raise awareness of the partnerships we have to make an impact on childhood cancer. 

    The #GoldTogether Movement

    #GoldTogether for childhood cancer is a national Relay For Life program that specifically raises funds to support childhood cancer research, support services, and awareness, as well as, cancer prevention efforts. It also increases awareness of childhood cancer, the impact it has on survivors and their families, and available support services. 

    With more than 200 teams, the #GoldTogether movement connects and empowers children and families impacted by cancer. It creates a community within the Relay For Life community where children and families can share their stories and learn more about caregiver resources and new research, treatments, and support services that may positively impact their lives. 

    To date, #GoldTogether has raised $1,000,000 for childhood cancer. New this year is the #GoldTogether Champion Campaign. During the month of September and throughout the year, #GoldTogether Champions will virtually unite to make a greater impact and secure better outcomes for kids with cancer. Champions will utilize their social media to raise awareness and raise funds to support childhood cancer. To support #GoldTogether, become a champion and start or join a team, visit relayforlife.org/goldtogether

    ACS and the St. Baldrick’s Foundation 

    ACS and the St. Baldrick’s Foundation, the largest private funder of childhood cancer research grants, are engaged in a partnership to raise funds that can amplify our impact on childhood cancer and support the most promising research. ACS and the St. Baldrick’s Foundation will work together to fund and manage a grant-making program to invest in the most creative biological and clinical laboratory studies that have the greatest potential to quickly deliver new and improved care for children.

    The goal is to raise $11 million to fund this innovative research. Requests for applications were initiated on July 1, 2020 when the campaign reached the point of $4.1 million raised.  Grants will be funded beginning July 1, 2021. All additional dollars raised in 2020 will go towards the applications that will be funded in 2021. Together we will focus on innovative projects that have the greatest potential to bring novel advances to childhood cancer patients. To learn more, visit cancer.org/stbaldricks.

    Partnering to increase pediatric cancer research

    ACS is leading and funding research that helps us better understand childhood cancers and develop effective therapies that do not compromise the quality of life of the child and his or her family during and following treatment. As of March 1, 2020, we are supporting 60 active, multi-year research grants, for a total of $34,000,000 specific to childhood cancer. Learn more about what we’re doing to save lives and prevent suffering from cancer at every age and every stage at cancer.org/childhood.

    ACS CAN actively engaged in advancing policy

    ACS CAN supports policies that advance the childhood cancer agenda and seek to improve access to quality care, and plays an important role as convener, bringing the childhood cancer community together to focus on issues that can make the greatest impact.

    ACS CAN is working to advance the Palliative Care and Hospice Education and Training Act (PCHETA), S. 2080, PCHETA, which will improve palliative care training for health providers, establish a national campaign to educate patients, and expand NIH research to improve the delivery of palliative care. Palliative care is vital to childhood cancer patients, survivors, and their families because it provides an extra layer of support, regardless of the stage of cancer or time since diagnosis, and involves team-based comprehensive care. Expanded access to palliative care will help improve the quality of life for more childhood cancer patients and survivors.  

    Resources


  • Colorectal cancer: Black men have the highest incidence rate

    ​African Americans are 20% more likely to get colorectal cancer and 40% more likely to die from it than other groups

    Following the devastating news of the death of the world's beloved Black Panther, Chadwick Boseman, from colorectal cancer, many were left asking why – and how. 

    What most don't know is that Chadwick Boseman sat at the intersection of where colorectal cancer rates are among the highest and rising the fastest. He was a young man. And he was a Black man.

    Colorectal cancer affects far too many in this country and disproportionately impacts the Black community. African Americans are 20% more likely to get colorectal cancer and 40% more likely to die from it than other groups. Black men have the highest incidence rate.

    "Colorectal cancer is the second deadliest cancer in the country," said Durado Brooks, MD, our vice president of prevention and early detection. "This disease is ravaging the Black community and it is as important as ever that everyone has access to and is receiving the recommended screenings. Even during the coronavirus pandemic, necessary screening tests remain available to prevent the disease or find it at an early, more treatable stage."

    In addition, rates of colorectal cancer in younger age groups is rising. In 2020, 12% of colorectal cancer cases will be diagnosed in people under 50 – about 18,000 cases. Since the mid-1980's adults age 20-39 have experienced the steepest increase in colorectal cancer rates.

    The American Cancer Society recommends that people with average risk begin regular screening at age 45.

    Those with higher risk should consider – with their physician – earlier screening. Higher risk factors include:

    • Family history of colorectal cancer or certain types of polyps
    • Personal history of colorectal cancer or certain types of polyps
    • Personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease)
    • Known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)
    • Personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer

    In addition, anyone with concerning abdominal or gastro-intestinal symptoms such as a change in bowel habits that lasts for more than a few days; rectal bleeding; blood in the stool; cramping or abdominal pain; weakness and fatigue; or unintended weight loss should consult with their doctor.

    Screening can prevent colorectal cancer by finding and removing growth, called polyps, in the colon and rectum before they become cancer. It can also find colorectal cancer early, when it is small, hasn't spread, and may be easier to treat. When found early, before it has spread, the 5-year relative survival rate is 90%.

    Sources


  • ACS and ACS CAN mourn the loss of Chadwick Boseman, 43, from colon cancer

    ​Over the weekend, the world learned about the devastating loss of an icon who fought cancer so bravely. 

    ACS and ACS CAN extended messages of sympathy to actor Chadwick Boseman's family through social media. 

    ACS tweeted, "For more than a decade, we watched him transform himself into some of our greatest historical figures - Jackie Robinson, Thurgood Marshall, James Brown. He was also a superhero on screen and life. His transformational performance in Black Panther challenged Hollywood images and celebrated the Black community. And his dedication to sharing his craft with the world, all while battling this terrible disease, was a gift to us all. Our sincerest condolences are with his wife, his family, and all those who loved him."

    ACS CAN tweeted, "A heartbreaking loss of someone so young, especially for kids who got to see a superhero who looked like them for the first time. And a reminder that cancer doesn’t care if you are young or old, a celebrity or not…or if you’re a superhero."

    Rebecca Siegel, scientific director, Surveillance Research (pictured here), was quoted in an Aug. 29 article in USA Today on the how colorectal cancer disproportionately affects Black Americans. "The mortality difference is what’s striking," Rebecca said. "It’s also the elephant in the room of systemic racism that has been going on for decades and affects everyone in the Black community, regardless of their wealth status."

    In an article in The New York Times on the same day, she said: "The five-year survival rate for young people for early-stage disease is 94%." For people with late stages of the disease, the survival rate can be as low as 20%, she said, adding that early diagnosis is "the difference between life and death."

    Unfortunately, young people are less likely to receive an early diagnosis. Rebecca told the Times that the average time from symptoms to diagnosis for people under 50 is 271 days compared with 29 days for people 50 and older.

    “Young patients have symptoms, sometimes for years. For one thing, they’re much less likely to have health insurance than older people, and so they have less money. And they’re thinking, ‘I’m a 30-year-old, what could be wrong with me — it’s going to go away,’” Rebecca said.

    For information on colon cancer signs, risk factors, and prevention, visit cancer.org.


  • Dr. Len, our deputy chief medical officer, departs after 20 years with ACS

    ​For years, the media turned to our deputy chief medical officer for counsel on cancer issues

    J. Leonard Lichtenfeld, MD, better known as Dr. Len, leaves the Society on Sept. 1 after two decades of explaining cancer issues in easily understood terms to readers of his blog, members of the media, congressional committees, and ACS staff and volunteers.

    Most recently, he was the face of ACS during the COVID-19 pandemic. He and former ACS staffer David Sampson, strategic director, Medical & Science Communications, with whom he worked very closely, did podcasts, tweets, and numerous media interviews about the pandemic and its effect on cancer detection and treatment, and Dr. Len helped guide the decisions about event cancellations, and the closing of ACS offices, Hope Lodge facilities, and Discovery Shops.

    His guidance was always helpful, informative, and often comforting, perhaps because of his warm personality and folksy nature.

    “It has been an incredible journey and I mean that from the heart,” Dr. Len said. “I came to the Society as a medical editor in 2001, and in 2002 assumed responsibility for managing the newly created Cancer Control Science Department. Because I had a wide variety of experience – 19 years of practicing medicine, expertise in policy, legislative, and regulatory issues related to health care, as well as a lot of experience talking to the media – they created the job of deputy chief medical officer for me. I got to use all my skills. There are not many opportunities around that allow someone to do what I have been able to do. It was wonderful, and I will be forever grateful.”

    Dr. Len also served as interim chief medical officer from November 2018 to October 2019, taking over when Otis Brawley, MD, resigned to become the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University. 

    Dr. Len looks back with pride on his role in providing the public with cancer information based on evidence. “We were able to create policy and guidance and provide people with as unbiased information as we could. It made me so proud of the Society, and being honest and effective enhanced the American Cancer Society’s reputation,” he said. 

    Dr. Len was sensitive to not wanting to overpromise and tout promising therapies before they were scientifically proven. As a result, Dr. Len’s Blog, which he started writing in 2005, often provided the voice of scientific reason when it came to assessing the latest “cancer cure.” The head of a major cancer organization recently told Dr. Len that she has saved several of his blog posts and reads them regularly to keep her focused on her mission. Journalists, too, expressed appreciation for the information the blog provided.  

    During his time at the Society, Dr. Len has seen huge strides made in the treatment of cancer, as well as falling mortality rates. He cited two “game changers” - Gleevec and Herceptin - two drugs made possible, in part, by ACS-funded research. 

    He remembers well the first reports of Imatinib (Gleevec) being used successfully to treat chronic myeloid leukemia (CML). “I had experience with that disease as a practitioner. Back then it was almost universally fatal. I had a young man whose CML became acute, and he committed suicide because he knew what the outcome would be. That was a devastating phone call,” he said. Today, thanks to tyrosine kinase inhibitors, of which Gleevec is just one, the current 5-year relative survival rate for adults is 69% for CML, up from 22% in the mid-70s.  

    Dr. Len said he also remembers being at an ASCO (American Society of Clinical Oncology) meeting when thousands of oncologists stood up and cheered upon hearing reports of Herceptin's success treating HER2-positive breast cancer. 

    Immunotherapies and targeted drugs also are saving lives from lung cancer and melanoma. “The decline in melanoma deaths year over year has been incredible,” he said, “and reports are coming out right now saying we are making incredible gains in reducing mortality in lung cancer.” This 2019 blog talks about more and more people surviving melanoma, once a sure killer, and this blog talked about how we could achieve similar success with lung cancer. 

    “I am still very concerned about overpromising and under delivering, but I come to this point in my career more optimistic than ever about cancer treatments,” he said, although he was quick to note that COVID-19 “could put a significant dent in our progress.” He said “the research enterprise has been disrupted, some clinical trials have been halted, people are afraid to get screened. We will pay a societal price for what we have seen happening as a result of COVID.” 

    Dr. Len wants his colleagues to know that “this is an incredible organization that does incredible things every day – affecting policy in Washington, creating guidelines, and helping cancer patients and their families. There are so many terrific people in this organization who are so committed. No question, what has kept me here is the recognition of all the efforts and commitment that so many people have to this organization: Staff, volunteers, and donors. To be part of that as a team member was incredibly special on a personal level.” 

    He added: “We are going through difficult times and difficult times require difficult decisions, not only here, but throughout the world. My departure is a consequence of that. Having said that, I am grateful for the experience I have had, and the people I have worked with and had the opportunity to touch. I am moving forward with optimism and we’ll see what the future holds.”

    Good luck, Dr. Len, with the new endeavors you choose to pursue.


  • Good news on black/white disparity in lung cancer incidence

    ​It has been reversed or eliminated among young adults, reflecting healthy change in smoking behavior among Black Americans

    A trend of higher lung cancer incidence rates in young Black people versus young white people in the U.S. has flipped, with the Black/white gap disappearing in men and reversing in women. The changing trends coincide with steeper declines in smoking in Black Americans, according to a new study published August 20 in JNCI Cancer Spectrum.

    The study also provides damning evidence of the harm of of R.J. Reynold’s tobacco advertisement campaign targeting African Americans in the 1990s, and underscores the importance of targeted tobacco prevention interventions. 

    Lung cancer is the leading cause of cancer death in the U.S., with about 80% of the total 154,000 deaths recorded each year caused by cigarette smoking. Historically, lung cancer incidence rates have been higher in non-Hispanic Black people than non-Hispanic white people among men of all ages and among younger women, likely reflecting historically higher smoking rates in Black adults.

    For the new study, ACS investigators led by Ahmedin Jemal DVM, PhD, pictured here, examined smoking prevalence data and national lung cancer incidence rates for Black and white people by sex among contemporary young birth cohorts, to investigate whether incidence patterns are consistent with race- and sex-specific smoking patterns.

    They found incidence decreased in both Black and white men born since about 1947 and in women born since about 1957, with the declines steeper in Black people than white people. Those steeper declines led to the Black/white gap disappearing in men born in 1967 to 1972, and reversing in women born since about 1967. Similarly, historically higher smoking rates in Black people versus white people disappeared in men and reversed in women born since about 1965.

    There was one notable exception. The authors identified increasing lung cancer incidence rates in Black men born around 1977-1982, which indeed led to higher lung cancer incidence rates in Black than white men born during this period. “This increase likely reflects the steep rise in initiation of smoking among Black adolescents in 1990s, which coincided with the R.J. Reynold’s tobacco advertisement campaign targeting African Americans,” write the authors. “Between 1991 and 1997, the prevalence of current cigarette use among Black high school students doubled from 14.1% to 28.2%.”

    The authors say that their findings have significant public health implications. “Our study reflects the success of national, state, and local anti-tobacco public health policies and activities in the Black community despite the tobacco companies’ targeted and deceptive marketing strategies,” Ahmedin said. “At the same time, the increase in lung cancer incidence among Black men born around 1982 reflects the lack of strong public health policies to prevent the rise in smoking initiation in 1990s.”

    “While these patterns herald progress in reducing racial disparities in lung cancer occurrence and the success of tobacco control in the Black community, the increasing lung cancer incidence rates in Black men born circa 1977-1982 is concerning and underscores the need for targeted tobacco prevention interventions,” the authors conclude.


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