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Tobacco Atlas, Sixth Edition, now available in Spanish

Nearly 70 million smokers in Latin America are at risk of tobacco-related death and disease

Hundreds of thousands of Latin Americans continue to die every year from tobacco-related disease, according to the American Cancer Society and Vital Strategies, co-publishers of the Tobacco Atlas, Sixth Edition, now available in Spanish. 

While the proportion of the population who use tobacco has nearly halved across the region thanks to strong tobacco control policies in some countries, the region is seeing an increase in tobacco-related deaths, to more than 300,000 in 2016. Governments can reduce the associated health, economic, and social burden of tobacco use for generations to come by implementing proven life-saving policies as recommended by the World Health Organization (WHO).

“Every death from tobacco is preventable, and every government has the power to reduce the human and economic toll of the tobacco epidemic,” said Jeffrey Drope, PhD, co-editor and author of The Atlas and our scientific vice president of economic and health policy research. “Countries like Brazil and Uruguay have significantly reduced smoking rates, but prevalence is increasing in countries where governments have failed to act. These countries are often among the region’s most economically challenged. Increases in the health and financial burden of smoking will further harm their economies and opportunities for sustainable development. Policymakers need to resist the tobacco industry’s influence and implement strong policies to avoid this fate.”

According to the Tobacco Atlas, only two countries in the region - Argentina and Chile - have implemented tobacco taxes at levels recommended by the WHO, which are proven to be the single most effective way to reduce tobacco use. Tobacco industry tactics, including interfering in policymaking and aggressively promoting flavored tobacco products to hook youth, are impeding greater progress in reducing the burden of tobacco.

“From cultivation to disposal, tobacco causes health and environmental harm at every stage of its life cycle,” said Neil Schluger, MD, senior advisor for science at Vital Strategies and co-editor and author of The Tobacco Atlas. “It is linked to an ever-increasing list of diseases, burdening health systems and exacerbating poverty. It also harms non-smokers, especially women and children exposed to second-hand smoke, and tobacco workers who risk developing nicotine poisoning caused by skin contact with tobacco leaf. Regional leaders have enacted proven and new strategies to reduce tobacco use, like high taxes, large graphic warnings and bans on additives. We hope their efforts embolden other leaders to follow their example.”

Almost all countries in Latin America are signatories to the World Health Organisation’s Framework Convention on Tobacco Control, the global health treaty which requires them to enact proven measures to reduce tobacco use, but no country in the region has enacted all these measures at the highest level of achievement. Regional leaders and examples of best practices include:

  • Uruguay, which nearly halved smoking prevalence from 40% in 2006 to 21.6% in 2017, is a global leader in the adoption of large graphic warnings and limiting tobacco brand variants

  • Brazil, which has implemented progressively stronger tobacco control policies to more than halve smoking prevalence since 1980

  • Panama, which implemented a model policy to ban tobacco marketing

  • Colombia, which implemented and enforced comprehensive smokefree laws and

  • Argentina and Chile, which are the only countries in the region currently taxing tobacco at the highest level recommended by WHO. 

In Colombia, where cigarettes were comparatively cheap, tax increases introduced in 2016 led to a 15 percent reduction in the number of smokers.

In Mexico, a recent national health survey found a slight increase in smoking rates in spite of the government implementing a national quitline, cessation resources and large graphic warnings on tobacco packs. This suggests that Mexico needs to adopt a stronger and more comprehensive tobacco control policy.

Tobacco use is increasing in countries that have not adopted strong tobacco control policies, and the tobacco industry continues to aggressively target the region, especially its youth. Urgent action is needed in countries where youth smoking is increasing, like Suriname, where youth smoking increased from 13.5% in 1990 to 20.3% in 2015 and Guatemala, where youth smoking increased from 7.6% in 1990 to 11.2% in 2015.

About the Tobacco Atlas: Sixth Edition

The Tobacco Atlas compiles, validate,s and interprets global- and country-level data from multiple sources to present the best and most recent evidence, and build a holistic and accurate picture of the tobacco industry’s activities, tobacco use, and tobacco control across the globe. In print and online at - where policy makers, public health practitioners, advocates and journalists may interact with the data - The Tobacco Atlas graphically details the scale of the tobacco epidemic, progress that has been made in tobacco control, and the latest products and tactics being deployed by the tobacco industry to grow its profits and delay or derail tobacco control efforts. The Tobacco Atlas clearly explains the policy tools and other interventions that have been proven to help reduce the tobacco epidemic. In addition to addressing major developments across all topic areas, new for the Sixth Edition are chapters on regulating novel products, partnerships, tobacco industry tactics, and countering the industry. features a more graphic-rich interface and new functionality to enable users to hone in on the data points contained within the graphics.

  • Third article in our Blueprint for Cancer Control focuses on survivorship

    Report outlines priorities to improve the lives of cancer survivors and caregivers

    Growing numbers of cancer survivors, provider shortages, rising health care costs, and socio-economic disparities in health outcomes have created an urgent need to provide coordinated, comprehensive, and personalized care for cancer survivors. 

    The report, appearing today in CA: A Cancer Journal for Clinicians, is the third article in our Blueprint for Cancer Control in the 21st Century. In it, the Society outlines a set of critical priorities for care delivery, research, education, and policy to equitably improve survivor outcomes and support caregivers.

    More than 1.7 million Americans are expected to be diagnosed with cancer in 2018, a number that continues to increase each year as a result of population growth and aging, despite declining incidence rates in men and stable rates in women.

    The rising cancer case burden as well as advances in early detection and treatment all contribute to an unprecedented and continuing rise in the number of Americans living with a history of cancer. The number of cancer survivors in the United States is projected to rise to 20.3 million in 2026 and to 26.1 million by 2040.

    The aging U.S. population also will result in increases in the number of older cancer survivors who are more likely to need complex care: 73 percent of survivors will be age 65 years or older by 2040, up from 62 percent in 2016.

    Efforts to respond to the growing need have the goal of minimizing the long-term impact of cancer by optimizing survivors' functioning, quality of life, ability to participate in work and life roles, and overall health, as well as better assisting family or friends supporting survivors as caregivers.  

    For the report, authors led by Catherine M. Alfano, PhD, ACS vice president of survivorship, reviewed research identifying and addressing the needs of cancer survivors and caregivers to create a set of critical priorities for care delivery, research, education, and policy to equitably improve survivor outcomes and support caregivers.  

    The report says efforts are needed to accelerate progress in three priority areas: 

    1. Implementing routine assessment of survivors' needs and functioning and caregivers' needs
    2. Facilitating personalized, tailored, information and referrals from diagnosis onward for both survivors and caregivers, shifting services from point of care (in clinical settings) to point of need outside of the clinic wherever possible
    3. Disseminating and supporting the implementation of new care methods and interventions.

    "Our investment in new, better cancer treatments has been a literal lifesaver, with more survivors than ever living years beyond their original diagnosis," said Dr. Alfano. "These survivors then must cope with new risks and ongoing symptoms, so failing to invest in efforts to address the long-term problems confronting survivors and their caregivers is unethical. Our aim with this report is to map out a comprehensive strategy that must be undertaken by multiple stakeholders to meet survivors' and caregivers' unique needs while minimizing the impact of provider shortages and controlling costs to healthcare systems, survivors, and families." 

    For more information about this chapter and our Blueprint for Cancer Control in the 21st Century, please see the resource list, below. Subsequent Blueprint chapters will focus on screening, treatment, and research, and will be released in the coming months.

    Blueprint resources for volunteers

  • Our 2017 Annual Report now available on

    Our 2017 Annual Report is now available electronically on This report highlights how we are attacking cancer from every angle, showcases our accomplishments and the diverse communities we serve and partner with to achieve our mission, and details revenue and spending in 2017. The report also demonstrates our comprehensive and important program of work. 

    The Annual Report is an opportunity for ACS to recognize the countless contributions of our volunteers, and community and corporate partners who join with us in our work to lead the fight against cancer. 

    Volunteers and staff are encouraged to take a moment to read the stories about our work in action, as well as review the audited and certified financial information in the Annual Report. It is a great way to appreciate the depth of public commitment we receive each year, as well as better understand the importance and scope of the work we accomplish. The report can be a vital communication tool tell the ACS story and engage both new audiences as well as longtime supporters.

  • Healthy diets linked to better outcomes in colorectal cancer patients

    Lower risk of death persisted even among those who improved diet after diagnosis.

    Colorectal cancer patients who followed healthy diets had a lower risk of death from colorectal cancer and all causes, even those who improved their diets after being diagnosed, according to a new American Cancer Society study.

    There are more than 1.4 million colorectal cancer (CRC) survivors in the United States. Previous studies have suggested a strong influence of diet quality in disease outcomes, and that some pre- and post-diagnosis dietary components are related to survival in men and women with CRC. But studies of dietary patterns to assess overall diet quality in relation to overall and CRC-specific mortality are inconsistent, making the development of evidence-based recommendations for CRC survivors difficult.

    To learn more, investigators led by Mark A. Guinter, PhD, MPH, American Cancer Society post-doctoral fellow, reviewed data from 2,801 men and women diagnosed with CRC in the American Cancer Society's large, prospective Cancer Prevention Study-II (CPS-II) Nutrition Cohort. They found those whose pre- and post-diagnosis diets were consistent with the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention had lower all-cause and CRC specific mortality.

    Pre-diagnosis diets that most closely aligned with ACS dietary recommendations were associated with a 22% lower risk of all-cause mortality compared to those on the other end of the spectrum. Significant inverse trends were observed for CRC specific mortality, as well. For the highest quartile of pre-diagnosis Western dietary pattern, which is characterized by high intakes of red meat and other animal products, there was a 30% higher risk of CRC death compared with the lowest quartile.

    Post-diagnosis dietary patterns were also significantly associated with the risk of death. The highest compared with the lowest ACS-score showed a 65% lower risk of CRC mortality, and a 38% lower risk of mortality from all causes.

    The study authors say additional diet patterns and scores that also were based on plant foods and low red and processed meat consumption corroborated their main findings. They conclude that the results suggest the importance of diet quality as a potentially modifiable tool to improve prognosis among men and women with CRC.

    "This study is this first to our knowledge that considered change in diet quality across the CRC continuum," said Guinter. "These results suggest that high diet quality after diagnosis, even if poor before, may be associated with a lower risk of death."

    Article: Associations of Pre- and Postdiagnosis Diet Quality With Risk of Mortality Among Men and Women With Colorectal Cancer. Guinter et al. J Clin Oncol 2018 DOI: 10.1200/JCO.18.00714


  • Otis Brawley honored by cancer caregivers

    Congratulations to Otis Brawley, MD, our chief medical and scientific officer, who was awarded the Association of Community Cancer Centers' Achievement Award at its 35th National Oncology Conference in Phoenix last week. 

    “He is an acknowledged global leader in the field of cancer prevention and control,” said Thomas A. Gallo, MS, MDA, ACCC president. In his role at ACS, “he is responsible for promoting the goals of cancer prevention, early detection, and quality treatment through research and education. He champions efforts to decrease smoking, improve diet, and provide the critical support cancer patients need,” Gallo added.

    In his acceptance remarks, Otis talked about mentors who “always taught us that you had to interpret the science strictly and you had to apply the science strictly.” 

    Since 1980, the Annual Achievement Award has been given to distinguished individuals or organizations who have reflected the values of community cancer care through their outstanding contributions.

    The Association of Community Cancer Centers (ACCC) is a community of more than 24,000 multidisciplinary practitioners and 2,100 cancer programs and practices nationwide.

    Founded in 1974, ACCC brings together healthcare professionals across all disciplines in oncology to promote quality cancer care. It is estimated that 65 percent of the nation's cancer patients are treated by a member of ACCC. 

  • Five individuals awarded our Medal of Honor

    The Medal of Honor, our highest recognition, is awarded to distinguished individuals who have made valuable contributions in the fight against cancer through basic research, clinical research, and cancer control.

    The evening of Oct. 18, during a black-tie celebration at the Ronald Reagan International Trade Center in the nation's capitol, five people who have made outstanding contributions in the fight against cancer were presented with the American Cancer Society Medal of Honor.

    They are:

    • The Honorable Joseph R. Biden Jr., for Cancer Control
    • Emmanuelle Charpentier, PhD, for Basic Research
    • Jennifer Doudna, PhD, for Basic Research
    • Charis Eng, MD, PhD, for Clinical Research
    • Michael J. Thun MD, MS, for Cancer Control Science

    "It's truly an honor to celebrate these individuals for their dedication and lifetime achievements that have significantly impacted the fight against cancer," Gary Reedy, our chief executive officer, said. 

    Originally called the American Cancer Society Award, the Medal of Honor was first presented in 1949 to Bowman C. Crowell, MD, who had recently retired as director of the American College of Surgeons in Chicago. He was honored for his efforts to improve the standards at cancer clinics. 

    Candidates for the Medal of Honor are nominated nationwide. A special awards workgroup selects winners and shares recommendations with the American Cancer Society Board of Directors.

    More about our 2018 Medal of Honor awardees

    • Former Vice President Joe Biden headed President Obama's National Cancer Moonshot task force, which resulted in more than 80 new actions and collaborations from public and private sectors to speed progress in cancer prevention, diagnosis, treatment, and care, and worked with Congress to authorize an additional $1.8 billion for investment in cancer research. After the death of his son from brain cancer, Biden launched a nonprofit called the Biden Cancer Initiative.  As co-chair, he has led a highly skilled and well-regarded Board of Directors in bringing a sense of urgency to develop and drive implementation of solutions to accelerate progress in cancer prevention, detection, diagnosis, research, and care, and to reduce disparities in cancer outcomes.
    • Emmanuelle Charpentier, PhD, is a professor and researcher in microbiology, genetics, and biochemistry. Since 2015 she has been director of the Max Planck Institute for Infection Biology in Berlin, Germany. Charpentier is best known for her role in deciphering the molecular mechanisms of the bacterial CRISPR/Cas9 immune system and repurposing it into a tool for genome editing. This tool has revolutionized the speed and power of genetic-based cancer research models, and allowed new questions at the heart of certain cancers to be addressed. Dr. Charpentier is recognized as a leading expert in the fundamental mechanisms of regulation in infection and immunity in bacterial pathogens. As a result, this field of research is now developing rapidly with huge potential for further advancement of therapeutic tools to treat forms of cancer that have been resistant to treatment via other methods (e.g., tumor suppressor mutations).
    • Jennifer Doudna, PhD, is a biochemist, professor of chemistry in the Department of Chemistry and Chemical Engineering, and professor of biochemistry and molecular biology in the Department of Molecular and Cell Biology at the University of California, Berkeley. She has been an investigator with the Howard Hughes Medical Institute (HHMI) since 1997. She directs the Innovative Genomics Institute, a joint UC Berkeley-UC San Francisco center, and has been a leading figure in what is referred to as the "CRISPR revolution" for her fundamental work and leadership in developing CRISPR-mediated genome editing. This highly significant genome editing tool has been critical to cancer research and holds vast potential as a therapeutic tool to treat forms of cancer that have been resistant to treatment.
    • Charis Eng, MD, PhD, is the chair and founding director of the Genomic Medicine Institute of the Cleveland Clinic, founding director and attending clinical cancer geneticist of the institute's clinical component, the Center for Personalized Genetic Healthcare, and professor and vice chair of the Department of Genetics at Case Western Reserve University School of Medicine. She was honored with an American Cancer Society Clinical Research Professorship in 2009. More recently, she was elected to the National Academy of Medicine of the U.S. National Academies of Sciences for her achievements and leadership in genetics- and genomics-based research and personalized healthcare. As a leader in personalized care, she has translated genomic and cellular analysis to clinical practice. Her work has set a standard for the study of hereditary predisposition and its role in cancer. Early in her career, Dr. Eng published seminal work connecting different mutations in the RET gene to different manifestations of multiple endocrine neoplasia (type 2). Her famous discovery of the connection between mutations in the PTEN tumor suppressor gene and Cowden's Syndrome led to important contributions in the biochemical and cell biological activities of this critical tumor suppressor. This also led her to studies of many types of cancer including breast cancer, and to studies of hereditary predisposition. Dr. Eng's research demonstrated that mutations in PTEN coupled with mutations in SDHx (succinate dehydrogenase) increase the risk for development of breast cancer. She is now working to better understand how that might occur at a biochemical and cellular level. More recently, her laboratory has discovered another potential tumor suppressor gene, KLLN, which also seems to increase risk for development of breast cancer through perturbation of the cell cycle. 
    • Michael J. Thun, MD, MS, former vice president of epidemiology and surveillance research at the American Cancer Society, is a world-renowned cancer epidemiologist whose studies across broad areas of cancer control research, from chemoprevention to tobacco and obesity, have helped shape public health policies against cancer. Early in his career, as an epidemic intelligence health officer and staff scientist for Centers for Disease Control and Prevention, Dr. Thun studied occupational and environmental exposures and established himself as a national expert on the health hazards of cadmium and uranium in factory workers. During Dr. Thun's tenure at the American Cancer Society from 1989 to 2012, his research focused on a wide range of topics, including tobacco, excess body weight, alcohol consumption, aspirin, and nonsteroidal anti-inflammatory drugs. Findings from this research have informed public health policies and shaped national cancer prevention and control guidelines and recommendations. In a 1991 seminal paper in the New England Journal of Medicine, Dr. Thun reported that regular aspirin use at low doses may reduce the risk of fatal colon cancer. This work was a catalyst for clinical trials evaluating the efficacy of aspirin for the chemoprevention of gastrointestinal cancers. Together, these efforts led to the 2016 United States Preventive Services Task Force's recommendation for routine use of low-dose aspirin for the primary prevention of cardiovascular disease and colorectal cancer in certain adults aged 50 to 59 years.

    Past recipients of the Society's Medal of Honor include:

    • Former U.S. President and First Lady George H.W. Bush and Barbara Bush
    • Former U.S Sen. Edward M. Kennedy of Massachusetts
    • George N. Papanicolau, MD, inventor of the Pap test
    • Robert C. Gallo, MD, recognized for his achievements in pioneering the field of human retrovirology
    • Judah Folkman, MD, a leading researcher in the field of antiangiogenesis
    • Former U.S. Surgeon General C. Everett Koop, MD
    • Advice columnists Ann Landers and Abigail Van Buren
    PHOTOS: Top photo, from left, CEO Gary Reedy; former vice president Joe Biden; Emmanuelle Charpentier, PhD; Charis Eng, MD, PhD; Jennifer Doudna, PhD; Michael J. Thun, MD, MS; and Board Chair Kevin Cullen, MD. In the smaller image, from left, Gary Reedy, Michael J. Thun, MD, MS, and Board Chair Kevin Cullen, MD.

  • Second article in our Blueprint for Cancer Control says tobacco control must be the highest priority in cancer control

    More than half of the 26 percent decline in cancer mortality rates in the U.S. since 1991 is due to reductions in tobacco smoking.

    On Oct. 10, the Society published our second in a series of articles in CA: A Cancer Journal for Clinicians that collectively will outline our vision for cancer control for the U.S. through 2035. Titled A Blueprint for the Primary Prevention of Cancer: Targeting Established, Modifiable Risk Factors, this second article in the series focuses on existing evidence about established, modifiable risk factors for cancer, the cancer burden in the United States due to each risk factor, and established primary prevention recommendations and interventions to reduce exposure to each risk factor. 

    The report was led by Susan M. Gapstur, PhD, MPH, our SVP of Behavioral and Epidemiology Research (pictured here). 

    "A comprehensive cancer control plan designed to support the implementation of evidence-based interventions, including cancer prevention interventions like those we described has enormous potential to substantially reduce the number of individuals diagnosed with and dying from cancer," said Susan. "It is the responsibility of government and industry as well as the public health, medical, and scientific communities to work together to invest in and implement a comprehensive cancer control plan at the national level and support and expand ongoing initiatives at the state and local levels. If we fail to do so, we will slow progress in our national efforts to reduce the burden of cancer." 

    In specific, the report focuses on several important modifiable risk factors:

    • Tobacco: More than half of the 26 percent decline in cancer mortality rates in the U.S. since 1991 is due to reductions in tobacco smoking. Despite this progress, tobacco smoking (active and second-hand smoke) remains the most common cause of cancers diagnosed (19.4 percent) and cancer death (29.6 percent). Moreover, the annual direct health care costs of tobacco in the U.S. are estimated to be $170 billion, and tobacco use results in $156 billion in lost productivity. There is considerable evidence that tobacco control can prevent more cancer deaths than any other primary prevention strategy. The demographic profile of today's smoker has changed over the last half century. Today, tobacco use is more prevalent among persons with lower educational attainment; lower income; within vulnerable populations, such as individuals with mental illness or addiction to other substances; within the Lesbian, Gay, Bisexual, Transgender (LGBT) community; and within certain racial or ethnic groups. Enhanced efforts to reach groups that are more likely to smoke are needed to further reduce the prevalence of tobacco use. 

    • Obesity and overweight: In the U.S., approximately, 7.8 percent of cancer cases in 2014 were attributed to excess body fatness, second only to cigarette smoking. Its contribution was higher among women (10.9 percent of cases) than among men (4.8 percent of cases). Among women, 60.3 percent of uterine cancer and, among men and women combined, more than 30 percent of gallbladder, liver, and kidney/renal cancers as well as esophageal adenocarcinoma were attributed to excess body fatness. Despite clear evidence that excess body fatness contributes substantially to cancer risk, the full impact of the obesity epidemic on the cancer burden, including the long-term effect of obesity that begins in childhood, is yet to be completely understood. 

    • Alcohol: Alcohol is the third most-important major modifiable contributor to cancer, associated with 6.4 percent of cancers in women and 4.8 percent of cancers in men in 2014. However, for some cancers, the attributable fraction exceeds 10 percent; among men and women combined, an estimated 40.9 percent of oral cavity/pharynx cancers, 23.2 percent of larynx cancers, 21.6 percent of liver cancers, 21 percent of esophageal cancers, and 12.8 percent of colorectal cancers were attributed to alcohol consumption. Notably, among women, alcohol intake accounted for 16.4 percent of all cases, or 39,060 breast cancers in 2014. 

    • Diet: The combination of low calcium, fiber, and fruit and vegetable intake and high red and processed meat intake is estimated to cause 4.2 percent of cancers among men and women combined. However, there was considerable variation across specific dietary factors and types of cancer. For example, 5.4 percent of colorectal cancers are associated with high red meat consumption causes, 8.2 percent with high processed meat consumption, and 10.3 percent and 4.9 percent for low dietary fiber and calcium consumption, respectively. Low fruit and vegetable consumption was attributed to 17.6 percent and 17.4 percent of oral cavity/pharynx and larynx cancers, respectively. A lack of clear evidence about the role of early life dietary exposures as well as many other dietary hypotheses means the percentage of cancers attributable to diet may continue to rise beyond current estimates once more is known. 
    • Physical inactivity: It is estimated that 2.9 percent of all cancer cases in the U.S. in 2014 were attributable to low physical activity, with the contribution greater among women (4.4 percent) than among men (1.5 percent). The cancer with the highest percentage related to low physical activity was uterine cancer (26.7 percent), followed by colorectal cancer (6.3 percent among men and women combined). As additional cancer types are determined to be causally associated with low amounts of physical activity, the total number of cancer cases attributed to low physical activity will continue to rise. 

    For more information about this chapter and our Blueprint for Cancer Control in the 21st Century, please see the resource list, below. Subsequent Blueprint chapters will focus on screening, treatment, survivorship, and research and will be released in the coming months.

    Blueprint resources:

  • Society names Bill Phelps, PhD, as SVP of Extramural Research

    Bill will oversee all Extramural Research and training programs, working with each program director and all business units to advance our research efforts.

    The Society has named Bill Phelps, PhD, as our new senior vice president of Extramural Research, effective immediately. He replaces Bill Chambers, PhD, who retired in June. 

    Bill has been with the Society for 14 years, first serving as director of our preclinical and translational research program, and then as vice president of Extramural Research for the last two and a half years. He has been instrumental in developing many initiatives that support the Extramural Research department, including its operations, communications, fundraising, liaison efforts, and strategic planning. He has managed our peer review committees focused on cell biology, infectious disease, molecular genetics, and cancer drug discovery.

    Before joining the Society in 2004, Bill worked in antiviral and anticancer research with the pharmaceutical industry for 13 years. He also spent two and a half years as vice president of research and development with a small startup biotech company. 

    Additionally, he held an appointment as adjunct professor of genetics and microbiology at Duke University Medical Center from 1996-2004. Bill is a graduate of Rhodes College (BS in Biology), Virginia Tech (MS in Botany), and the University of Minnesota (PhD in Microbiology). He was also a postdoctoral fellow at the National Cancer Institute.

  • Report outlines cancer risk among Hispanics/Latinos in the U.S.

    Newly available data for Puerto Rico highlight a concerning burden of colorectal and prostate cancers, and a higher occurrence of infection‐related cancers, especially given ongoing health care infrastructure challenges that have been exacerbated by the recent hurricane.

    The cancer burden in Puerto Rico, a U.S. territory with a 99% Hispanic population, is substantially different from that of Hispanics in the continental U.S., according to Cancer Statistics for Hispanics/Latinos, 2018. The report, published every three years, says that men in Puerto Rico have higher prostate and colorectal cancer rates than non-Hispanic whites (NHWs) in the continental U.S, in contrast to U.S. Hispanics as a whole, who have lower rates for these cancers. The report appears today in CA: A Cancer Journal for Clinicians.

    Also available is the companion publication, Cancer Facts & Figures for Hispanics/Latinos 2018-2020, now on

    Here are highlights:

    • Prostate cancer is the leading cause of cancer death among men in Puerto Rico, accounting for nearly 1 in 6 deaths during 2011-2015, whereas lung cancer accounts for the largest percentage of cancer deaths among other U.S. Hispanic men. Further, Puerto Rico was the only state or territory included in the analysis where lung cancer was not the leading cause of cancer death among men overall. This reflects not only high prostate cancer mortality in the territory (26.7 per 100,000 in Puerto Rico versus 18. 2 in NHWs and 16.2 in other U.S. Hispanics during 2011-2015), but also exceptionally low lung cancer death rates among men in Puerto Rico (19.8 versus 56.3 in NHWs and 26.5 in other U.S. Hispanics). 
    • Mortality rates for colorectal cancer in men in Puerto Rico during 2011-2015 were 17% higher than those in NHWs and 35% higher than those of other U.S. Hispanics combined.

    These differences highlight the wide variation in cancer risk within the U.S. Hispanic population, for whom population-based health data are often only available in aggregate. Hispanics/Latinos represent the largest racial/ethnic minority group in the U.S., accounting for 17.8% (57.5 million) of the continental U.S. population in 2016, including more than one-third of the population in some southern and western states (e.g., California, New Mexico, Texas). An additional three million Hispanic Americans reside in Puerto Rico. The U.S. Hispanic population is one of the most diverse and rapidly growing groups in the U.S. and is expected to nearly double in size by 2060. 

    Although overall cancer incidence and mortality rates in Hispanics in the continental U.S. and Hawaii are 25% to 30% lower, respectively, than in non-Hispanic whites, rates among some U.S.-born Hispanics approach those in non-Hispanic whites. Given that the rapid growth of Hispanic population in the U.S. is now driven by birth rather than immigration, the authors of the report anticipate a burgeoning cancer burden among Hispanics.   

    Currently, however, the cancer profile in U.S. Hispanics reflects that in Latin America, as one-third of this population is foreign-born and maintains much of the cancer risk of their country of origin. As a group, Hispanics are less likely than NHWs to be diagnosed with the four most common cancers (prostate, breast, lung and bronchus, and colorectal), but have a higher risk of infection-related cancers (stomach, liver, and cervix), which, with the exception of liver cancer, are more frequent in Latin American countries. For example, stomach cancer mortality rates among continental U.S. Hispanics are twice those in NHWs.

    • Cancer is the leading cause of death among Hispanics, followed by heart disease.
    • In 2018, an estimated 42,700 Hispanic men and women in the U.S. will die from cancer. This does not include cancer deaths in Puerto Rico due to data limitations. 
    • Among Hispanic men, lung (16%), liver (12%), and colorectal (11%) cancers cause the most cancer deaths, whereas among women, these are breast (16%), lung (13%), and colorectal (9%) cancers. 
    • Lung cancer accounts for 14% of cancer deaths among Hispanics compared to 25% in the overall population because of the historical and continuing low smoking rates in Hispanics. In contrast, liver cancer accounts for 12% of cancer deaths in Hispanic men versus 6% in men overall.

    Variations in cancer risk between Hispanics and NHWs, 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 2017 was 17% among NHWs compared to 10% among Hispanics residing in the continental U.S., similar to the rate among island Puerto Ricans; however, within the Hispanic population smoking prevalence ranged from 6% among Dominicans and Central/South Americans to 17% among Puerto Ricans who reside stateside. Counterbalancing generally low smoking rates, continental Hispanics and those in Puerto Rico have among the highest prevalence of the second-most important cancer risk factor – excess body weight—as well as type 2 diabetes, which increases risk independent of body weight.

    "Efforts to further progress in cancer control in Hispanics in the U.S., including Puerto Rico, must consider the substantial differences in cancer risk within this heterogeneous population," write the authors. "Effective strategies for decreasing cancer rates among Hispanics include the use of culturally appropriate lay health advisors and patient navigators; targeted, community-based intervention programs to increase screening and vaccination rates and encourage healthy lifestyle behaviors; and further funding for Puerto Rico–specific and subgroup-specific cancer research and surveillance."

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