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ACS study estimates number of cancer cases attributable to physical inactivity

By state, the proportion of cancer cases attributable to physical inactivity ranged from 2.3% in Utah to 3.7% in Kentucky.

A new report finds more than 46,000 cancer cases annually in the U.S. could be prevented if Americans met the 5 hours per week of moderate-intensity recommended physical activity guidelines

The latest data appearing in the journal Medicine & Science in Sports & Exercise show 3% of all cancer cases in U.S. adults aged 30 years and older during 2013 to 2016 were attributable to physical inactivity. The proportion was higher in women (average annual attributable cases 32,089) compared to men (14,277).

For both men and women, states with the highest proportion of cancers attributable to physical inactivity were in the South: Kentucky, West Virginia, Louisiana, Tennessee, and Mississippi. The lowest proportions were found in the Mountain region and northern states: Utah, Montana, Wyoming, Washington, and Wisconsin.

Led by Adair Minihan, MPH, at the American Cancer Society, this is the first study to estimate the number of cancer cases attributable to physical inactivity based on cancer sites (breast, endometrial, colon, stomach, kidney, esophageal adenocarcinoma, and urinary bladder) by state. Data show that 16.9% of stomach cancers, 11.9% of endometrial cancers, 11.0% of kidney cancers, 9.3% of colon cancers, 8.1% of esophageal cancers, 6.5% of female breast cancers, and 3.9% of urinary bladder cancers were associated with lack of exercise. By state, the proportion of cancer cases attributable to physical inactivity ranged from 2.3% in Utah to 3.7% in Kentucky.

While this data shows the importance of physical activity, there are many barriers to recreational physical activity, including a lack of time due to long working hours in low-wage jobs, the cost of gym memberships or personal equipment, lack of access to a safe environment in which to be active, and potential childcare costs involved with recreational physical activity. Unfortunately, these barriers are more likely to affect historically marginalized populations, including the Black population and individuals with a limited income, underscoring the importance of enhancing health equity.

“These findings underscore the need to encourage physical activity as a means of cancer prevention and implement individual- and community-level interventions that address the various behavioral and socioeconomic barriers to recreational physical activity,” write the authors. “Understanding and reducing the behavioral and socioeconomic barriers to physical activity is essential for optimizing intervention strategies targeting at risk groups across the country.”


Article: Minihan AK, Patel AV, Flanders WD, Sauer AG, Jemal A, Islami F. Proportion of Cancer Cases Attributable to Physical Inactivity by US State, 2013-2016.  Medicine & Science in Sports & Exercise. doi: 10.1249/MSS.0000000000002801.


  • ACS/ACS CAN statement on retirement of NIH director Francis Collins

    Dr. Collins is the longest serving presidentially appointed NIH director.

    Our CEO, Dr. Karen E. Knudsen, MBA, PhD, released the following statement today in response to the announcement that Francis Collins, MD, PhD, pictured above, will be stepping down by the end of the year as the director of the National Institutes of Health (NIH). He has held that position for more than 12 years. Read the NIH press release on Dr. Collins' retirement.


    “For more than a decade, Dr. Collins has provided exemplary leadership and stewardship as head of the NIH, the nation’s top medical research engine and the driving force behind numerous recent breakthroughs in cancer treatment and prevention through the National Cancer Institute.

    “During his tenure as director, Dr. Collins has overseen an increase in NIH funding from $29.5 billion to $43 billion, and has successfully shepherded the creation and implementation of numerous significant research initiatives. Among the most significant to cancer is the Cancer Moonshot, which has already funded more than 240 research projects and helped speed the development of improved and new uses for immunotherapies, boosted research efforts into childhood cancer, and worked to expand the use of early cancer detection strategies.

    “Additionally, Dr. Collins’ leadership helped ensure that years of NIH research into coronaviruses was quickly put to work developing safe and effective COVD-19 vaccines in partnership with industry. The critical science that led to an accelerated pathway to these vaccines is an essential component to curbing the pandemic and ensuring everyone, including cancer patients, can safely access necessary medical care and build a healthy future.

    “Before his tenure as NIH director, Dr. Collins worked for decades as a researcher, contributing to critical science, most notably for his leadership on the Human Genome project that is the direct result of the federal government's essential year-over-year investment in medical discovery.

    “We extend our gratitude to Dr. Collins for dedicating his career to the advancement of medical science in public service and look forward to working with the next director to continue the advancement of medical research, cancer breakthroughs, and the lifesaving work of the NIH.”


  • ACS and four Historically Black Colleges and Universities announce groundbreaking research program

    The American Cancer Society (ACS), along with four historically black medical schools including Charles Drew Medical School, Howard University, Meharry Medical College, and Morehouse School of Medicine, today announced a groundbreaking Diversity in Cancer Research (DICR) Program to help improve diversity, equity, and inclusion in the cancer research field. The inaugural initiatives of the overarching program include DICR Institutional Development Grants. The four HBCUs have received DICR grants in a pilot program for 2021-2022.

    The awards provided through the DICR program are unique in cancer research. They provide a large amount of salary support for the four colleges to select clinical faculty who need more dedicated time for their cancer research and scholarly activities. They also fund other student and postdoctoral programs and underpin the awards with career development funds and mentorship by established American Cancer Society Professors. The grants will build sustainability for both clinical and scientific cancer-focused careers, launching or sustaining the careers of 104 individuals by 2025.

    The impactful program will create a more inclusive research environment to address health disparities more effectively and could lead to targeted recruitment efforts focused on bringing people of color into clinical research protocols. Establishing a research community that is made up of a diverse group of people is vital to ensuring scientific excellence.  

    “The American Cancer Society is committed to launching the brightest minds into cancer research and to reducing health disparities,” said William Cance, our chief medical and scientific officer. “To accomplish this, we believe it is essential to invest in the minority workforce and their dedicated efforts to solve disparities and establish equity in cancer care.”

    “There are many reasons the Black community continues to experience disparities in cancer care outcomes. But one of the most critical factors behind the imbalance, and one of the most promising paths to closing the gap, is diversity in cancer care research. We must improve diversity and representation in our laboratories if we expect different outcomes in our hospitals,” said Wayne A. I. Frederick, MD, president of Howard University. “As a cancer surgeon and as the president of an HBCU, I believe the Diversity in Cancer Research Program will prove to be pivotal in altering the field of cancer care research and improving cancer care outcomes for Black Americans. I am deeply appreciative of the American Cancer Society’s efforts behind this initiative.”

    Data show that African Americans and Black people, Hispanics and Latinos, indigenous people, and native Hawaiians and other Pacific Islanders are underrepresented in grant funding. Fewer than 2% of applicants for the National Institute of Health principal grant program come from Black/African Americans, and fewer than 4% from Hispanic/Latino populations.  

    “We are incredibly excited about this new program with the American Cancer Society,” said James E.K. Hildreth, Ph., MD, president and CEO of Meharry Medical College. “There is a significant imbalance in the representation of minority populations in clinical research which has led to poorer outcomes for specific racial and ethnic minority groups. To eradicate the varying health disparities that affect these populations, we must prioritize diversifying clinical trials and those who conduct trials to ensure treatment is safe and effective. This is a fantastic step to ensuring minority populations receive effective treatment and provides great opportunities for our students and faculty to engage in cancer research.” 

    “The development of diverse, highly competitive, and independent research faculty has been a goal at CDU since its inception 55 years ago,” shared Dr. David M. Carlisle, president and CEO of Charles R. Drew University of Medicine and Science, located in South Los Angeles. “This generous grant from the American Cancer Society will directly support a range of programs towards that goal, including the Center to Eliminate Cancer Health Disparities as well as our Clinical Research and Career Development Program, which provides training and mentoring in health disparities and community-partnered participatory research to minority scholars and junior faculty at CDU. This funding will undeniably help CDU in forming a solid foundation in social justice for future cancer research leaders.”

    ACS has committed to a $12 million investment to support the four HBCU medical schools with DICR institutional development grants to fund a four-year program that aims to increase the pool of minority cancer researchers by identifying talented students and faculty from HBCUs. This program will inform efforts to develop a national program to boost cancer research and career development at minority-serving institutions (MSIs). These grants are designed to build capacity and enhance the competitiveness of faculty at MSIs when applying for nationally competitive grant support and aid in faculty development and retention.

    “Here in Georgia, cancer health disparities exist by age, gender, race, income, education, and access to care, among other factors, with Georgia residents in rural communities experiencing worse cancer health outcomes than their urban counterparts,” said Valerie Montgomery Rice, MD, president and CEO at Morehouse School of Medicine. “The DICR program will be a much-needed and welcome contribution to our work at the Morehouse School of Medicine Cancer Health Equity Institute, forever changing the field of cancer research. The program will not only ensure diversity and inclusion in research, but address health disparities in diverse communities, and assist in our mission in leading the creation and advancement of health equity.” 


  • High burden of liver, stomach. and cervical cancers among the Hispanic/Latino population

    Lack of healthcare coverage limits progress against these potentially preventable cancers.

    A new report shows that although Hispanic men and women in the continental U.S. and Hawaii have 25% to 30% lower overall cancer incidence and mortality than non-Hispanic Whites, they continue to have a higher risk of potentially preventable, infection-related cancers, including approximately two-fold higher rates of liver and stomach cancers. Incidence of cervical cancer, which is almost completely preventable through screening and vaccination, is 32% higher in Hispanic women in the continental U.S. and Hawaii, and 78% higher in Puerto Rico compared to non-Hispanic White women.

    The report, appearing in CA: A Cancer Journal for Clinicians, is the most comprehensive review of contemporary cancer statistics for the U.S. Hispanic population, including Puerto Rico, and is published every three years. Also published today and available on cancer.org is Cancer Facts & Figures for Hispanic/Latino People 2021-2023 (pictured here).

    The study, led by Kimberly Miller, MPH, a scientist at the American Cancer Society, notes that much of the high burden of these cancers in this population could be reduced by increasing access to high-quality prevention, early detection, and treatment services. The Hispanic/Latino population has the highest percentage of people without health insurance of any major racial/ethnic group in the U.S. -- nearly triple that of non-Hispanic Whites (26% versus 9%, respectively, among ages 18-64 years during 2017-2018). In Puerto Rico, home to about 3 million Hispanic Americans, nearly one-half of individuals receive health insurance through Medicaid, which is substantially underfunded in the territory.

    Healthcare access challenges are also likely responsible, in part, for the narrowing gap in colorectal cancer (CRC) incidence between Hispanic people and non-Hispanic White people. CRC incidence rates in Hispanic people were 25% lower than those in non-Hispanic Whites in 1995 but only 9% lower in 2018. This likely reflects less CRC screening among Hispanic individuals, which can prevent CRC through the detection and removal of precancerous lesions. Fewer than half (49%) of Hispanic people ages 45 and older were up to date with CRC screening in 2018 compared to 58% of non-Hispanic Whites, with a lower percentage among those who were uninsured (19% versus 25%).

    The Hispanic/Latino population is the second-largest racial/ethnic group in the U.S., accounting for 19% (62.1 million) of the total population in 2020. The cancer burden in Hispanic people is expected to increase in part because population growth is now driven by births rather than immigration, and cancer rates among U.S.-born Hispanic people approach or surpass those of non-Hispanic Whites as a result of acculturation. However, cancer data are often only available for the Hispanic population in aggregate, masking these important differences by nativity, as well as those by Hispanic origin.

    Cancer continues to be the leading cause of death among Hispanic people, followed by heart disease, reflecting the younger age of the population and the lower proportion of deaths due to heart disease among Hispanic women. An estimated 46,500 cancer deaths will occur among Hispanic individuals in the continental U.S. and Hawaii in 2021, for whom the most common causes of cancer death are lung cancer (13%), CRC (11%) and liver cancer (11%) among men, and breast cancer (14%), lung cancer (10%), and CRC (9%) among women. Breast cancer is also the leading cause of cancer death in women in Puerto Rico, and prostate cancer leads in men, reflecting the low-smoking prevalence in the territory.

    Variations in cancer risk between Hispanic people and non-Hispanic White people, as well as within the Hispanic community, are primarily driven by differences in exposure to cancer-causing infectious agents and behavioral risk factors. For example, the prevalence of cigarette smoking in 2019 was 16% among non-Hispanic Whites compared to 9% among Hispanic people residing in the continental U.S. However, within the Hispanic population, smoking prevalence ranged from 6% among Central/South American people to 17% among Puerto Rican people who reside stateside. Counterbalancing generally low smoking rates, Hispanic people have among the highest prevalence of excess body weight, the second-most important modifiable cancer risk factor, especially among those who are U.S.-born.

    “Addressing this critical gap for Hispanic individuals in obtaining access to high quality cancer prevention, early detection and treatment is going to be essential for mitigating the predicted growth in the cancer burden,” said Kimberly. “In addition, more research is needed to assess not only the impact of the COVID-19 pandemic on the utilization of cancer care, but also the impact on cancer incidence and mortality trends as COVID-19 has disproportionately affected minority populations in the U.S.”

    Article: Miller KD, Ortiz AP, Pinheiro PS, Bandi P, Minihan A, Fuchs HE, Tyson DM, Tortolero-Luna G, Fedewa SA, Jemal AM, Siegel RL. Cancer Statistics for the US Hispanic/Latino Population, 2021. CA: A Cancer Journal for Clinicians. doi: 10.3322/caac.21695.


  • Dr. Ellie Daniels moves from interim to permanent SVP, Extramural Discovery Science

    Elvan “Ellie” Daniels, MD, MPH, has moved into the SVP, Extramural Discovery Science role permanently. She had been serving as interim lead since April 1, and as a member of the Office of Cancer Research and Implementation (OCRI) leadership team since mid-January.

    "Ellie’s leadership these last five months has been outstanding, and her list of accomplishments in this short period of time is impressive. She has a broad vision for expanding and diversifying our extramural research programs, along with detailed operational experience in all areas," said our Chief Medical and Scientific Officer Bill Cance, MD. "I have the utmost confidence that she is the right person for the job. She is passionate about cultivating a diverse research community and addressing health disparities which is so critical to our success," he added.

    Under Dr. Daniels leadership this year we have launched three innovative programs to broaden our impact and extend the reach of our mission work: Diversity in Cancer Research – Internships, Institutional Development Grants to each of the four Historically Black Colleges and Universities medical schools, and Cancer Health Equity Research Centers at Minority Serving Institutions.

    Dr. Daniels joined ACS in 2012. As senior scientific director for clinical and cancer control research, she oversaw research program development, pre-application management, peer review, and grant management in the areas of cancer prevention, screening and early detection, access to care, cancer treatment, palliative care, and survivorship. Research reviewed in her program included psychosocial and behavioral research, implementation and dissemination science, community-based participatory and practice-based research, clinical trials, and health equity research.

    Dr. Daniels is a family physician who previously served as an associate professor at Morehouse School of Medicine and directed the school’s Southeast Regional Clinician Network, a practice-based research network.


  • Mental health distress continued past lockdown

    ​Long-term impact needs monitoring, especially among those with pre-existing conditions.

    A new ACS report finds that many men and women in the U.S. continued to experience psychological distress, depression, and anxiety half a year into the COVID-19 pandemic. 

    Data show that during the pandemic, almost half (42%) of participants in the study reported at least mild psychological distress, and 10% of participants reported moderate-to-severe psychological distress. Individuals with pre-existing health conditions, such as cancer, were more likely to report depressive symptoms during the pandemic.

    The study led by Corinne Leach, senior principal scientist, American Cancer Society, used data from our Cancer Prevention Study-3 (CPS-3) cohort from two waves, 2018 and July- September 2020, to characterize levels of psychological distress among U.S. men and women during the COVID-19 pandemic. The results appear in the journal, Lancet Regional Health-Americas.

    The study also identified factors associated with increased depression and anxiety during the pandemic, including sociodemographic characteristics, stressors, and comorbid conditions associated with increased risk for poor COVID-19 outcomes. A secondary focus examined the association of these factors with longitudinal change in psychological distress. Financial stressors, such as loss of employment and reduced compensation, or work/life balance stressors, such as caregiving responsibilities, were also examined. According to the data, individuals with these types of life stressors more likely had an escalation of psychological distress during the pandemic.

    The report suggests that adults are continuing to experience psychological distress beyond the initial lockdown period. The results of this and prior studies support the importance of regular mental health assessment and subsequent mental health support among those with a history of mental health issues and those who may be isolating to keep themselves safe from COVID-19 or other infections.

    Results also highlight the importance of investigating the continued and long-term impact of the COVID-19 pandemic on mental health as social distancing, a factor previously associated with depression and anxiety, continues to be promoted over a year into the pandemic and as the world slowly opens again, potentially triggering different types of anxiety as people adjust to a new normal.

    Several learning opportunities for how to improve population mental health during and after pandemics, natural disasters, or other life-altering events have been created by the COVID-19 pandemic and regular mental health assessment by healthcare professionals is needed to better provide support for those at risk of developing, or those already experiencing, anxiety and depression,” said the authors. “These data from the American Cancer Society's Cancer Prevention Study-3 (CPS-3) cohort in particular will help clinicians identify populations vulnerable to persistent mental health and other long-term issues to provide earlier clinical support.”


    Article: Leach CR, Rees-Punia E, Newton CC, Chantaprasopsuk S, Patel AV, Westmaas JL. Stressors and Other Pandemic-Related Predictors of Prospective Changes in Psychological Distress. Lancet Regional Health-Americas. doi: 10.1016/j.lana.2021.100069.

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  • Seeking: African American/Black caregivers for paid focus groups

    ACS is hosting online conversations this month and next to help us  better support cancer caregivers.

    The American Cancer Society wants to better understand how we can support people who provide care for a loved one with cancer, and we are hosting a series of confidential, paid online focus group conversations to learn more. 

    We’re looking to connect with African American or Black adults ages 18 and older who are currently providing care or have provided care in the past to someone with cancer. 

    Through these conversations, we are looking to understand:

    • Participants’ experiences caring for someone with cancer
    • Their unmet needs as a caregiver
    • Opinions on how we can best meet caregiver needs

    Here are the details:

    • Location: Zoom
    • Time commitment: 90 minutes or less
    • Reward: $50 payable by check
    • Confidential: No names will be used in our reporting and the information will not be shared with the person the participants cared for.

    Here are the dates: 

    • August
      1. Monday, August 30: 2 – 3:30 p.m. EST
      2. Tuesday, August 31: 5:30 – 7 p.m. EST
    • September
      1. Thursday, September 2: 10 a.m. – 12:30 p.m. EST
      2. Tuesday, September 7: 5:30 – 7 p.m. EST
      3. Tuesday, September 14: 2 – 3:30 p.m. EST
      4. Tuesday, September 21: 5:30 – 7 p.m. EST

    Here’s how to participate: Email Asher Beckwitt, PhD, at asher@asherconsult.com.

    Learn more - and share!

    Read this recruitment flyer and feel free to share it.


  • Sept. 9: ACS National Consortium to hold second Issue Hub

    Learn steps health care systems can take to better prepare for future disruptions.

    Register now for our Sept. 9 webcast to hear leading clinicians and researchers discuss vulnerabilities within our nation’s public health and healthcare systems that contributed to the decrease in cancer screening and care during the pandemic, as well as the further exacerbation of inequities. 

    Panelists will also explore and showcase concrete action steps that can be taken to build resilience in our public health and health care systems. These tangible solutions will not only prepare us for any ongoing or future disruptions to the delivery of cancer screening, diagnostics, and care, but will also aid in appropriately addressing persistent disparities. 

    This Issue Hub #2 is free and open to all, and will run from 1 to 2:30 p.m. EST.

    Discussion objectives include:

    • Understand where there are weaknesses and/or vulnerabilities in the U.S. health care system that worsened outcomes in cancer screening and care during the COVID-19 pandemic.
    • Identify steps for strengthening our health care systems to be better prepared and equipped to address future disruptions (e.g. pandemics, natural disasters, etc.).
    • Learn how some systems have successfully navigated cancer screening and care during the pandemic and improved outcomes.

    The American Cancer Society (ACS) National Consortium is developing bold but sensible recommendations toward the safe and equitable recovery of cancer screening and care during the COVID-19 pandemic.

    On June 1, the consortium welcomed over 300 attendees to participate on our inaugural Issue Hub titled “Accelerating What We Know Works in Cancer Screening and Care.”  Read more about that here. A recording of the June Issue Hub is available here.

    A third Issue Hub will be scheduled later this year.

    About the ACS National Consortium

    ACS and ACS CAN have organized mission priorities and program work to effectively respond to consequences from the COVID-19 pandemic on cancer screening and care. The National Consortium, which focuses on accelerating, strengthening, and mobilizing, is one component of this initiative. It is an issue-focused, time-bound partnership that is dedicated to the acceleration of a national response to the COVID-19 pandemic in relation to its detrimental impact on our collective progress in cancer screening and care across the U.S. Our overall return to screening effort is supported by Genentech, Pfizer, Merck, and the National Football League.


  • Breast cancer screening rates drop in low-income communities

    8% decline from July 2019-2020 reverses an 18% improvement between July 2018-2019.

    A new study finds breast cancer screening rates (BCSR) declined among women aged 50 to 74 years at 32 community health centers that serve lower-income populations during the COVID-19 pandemic in the U.S.

    The report, appearing in the journal, CANCER, suggests that breast cancer screening rates within community clinics in low-income communities declined by 8% from July 2019-2020, reversing an 18% improvement between July 2018-2019.

    This is one of the first studies to examine BCSRs among lower-income populations during the pandemic. Investigators led by Stacey Fedewa, PhD, scientific director, Surveillance & Research (pictured here), examined BCSRs among 32 community health centers that provide healthcare services to communities of color and lower income populations and received grant funding from ACS to improve their BCSRs.

    “This study is important because these populations have long-standing barriers to accessing care, lower breast screening rates, higher breast cancer mortality rates, and are especially vulnerable to healthcare disruptions,” said Dr. Fedewa.

    Findings show that if 2018 to 2019 BCSR trends continued through 2020, 63.3% of women would have been screened for breast cancer in 2020 compared to the 49.6% of women that did get screened. This data translates to potentially 47,517 fewer mammograms and 242 missed breast cancer diagnoses.

    It is not yet known how negative outcomes will be distributed, and if breast cancer mortality disparities will widen. It is also not known how breast cancer screening services fared in community health centers nationwide as the clinics included in this study were part of an ACS grant-funded by the National Football League to improve breast cancer screening rates. Authors note that it’s possible that interventions established before and continued through 2020 may have mitigated the pandemic’s effects on breast cancer screening services.

    “Declining breast cancer screening rates in clinics serving communities with lower-incomes that already have barriers to accessing healthcare and have higher breast cancer mortality rates means there is a need for additional policies to support and resources to identify women in need of screening,” said the authors. “These actions will be critical as communities and clinics return to screening with hopes of reaching pre-pandemic breast cancer screening rates in the communities they serve.”


    Article: Fedewa SA, Cotter MM, Wehling K, Wysocki K, Killewald R, Makaroff L. Changes in breast cancer screening rates among 32 community health centers during the COVID-19 pandemic.  CANCER, 2021. doi: 10.1002/cncr.0038.


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