Many people start the new year with resolutions to lead healthier lives. But healthy choices are not necessarily easy choices, and powerful social and economic forces are often stacked in opposition to what we need to be healthy—more so for some of us than others.
As a cancer epidemiologist, I’ve studied the link between rates of cancer in the general population and possible causes and risk factors. My findings can help people learn to lower their cancer risk, and I’m grateful to be able to pass that information along. But I want to be clear that good health and lower cancer risk are not solely dependent on personal choices. Our culture and environment matter too. And if rates of cancer incidence remain unchanged, the number of new cancer patients in the next few decades could overwhelm an already stressed healthcare system.
In 2021, using sophisticated statistical methods and U.S. cancer registry and census data, I co-authored an article with fellow cancer researchers predicting the total number of cancer incident cases will increase by almost 50% as a result of the growth and aging of the US population—from 1.5 million to nearly 2.3 million cases. This means more people will need costly diagnostic and treatment services, and more people will be living with the physical and psychological aftermath of a cancer diagnosis.
Our country’s ability to meet the needs of current patients, especially cancer patients, is challenged and about to get worse. Like climate change, the future of cancer is predictable and modifiable. Just as communities in coastal areas adapt to heavy storms and rising sea levels, we can build resilience to this predictable increase in cancer cases through improvements in cancer care. But we also need to mitigate the looming crisis in new cancer cases, much as reduced greenhouse gases slow global warming. We need to slow down the increase in cancer cases by reducing cancer risk and promoting good health for all.
Over the last two decades, cancer death rates have fallen in the U.S., and more people survive cancer than in the past. I worry this progress has made us complacent about cancer risk. Over time, the proportion of adults who smoke plummeted, from 52% for men and 34% for women in 1965 to 13% for men and 10% for women in 2021. But the resulting decreases in lung cancer have been offset by increases in other types of cancer. In recent years, overall cancer incidence rates remained flat for men and showed a slight increase for women. Progress in cancer prevention has stalled. We’re not doing enough to curb disturbing increases in many cancers, including breast cancer and childhood cancer. And disparities persist in cancer incidence rates across different population subgroups and geographic areas, even after adjusting for differences in age. Differences in cancer incidence rates by time, place, and population point to missed opportunities to identify and address what’s driving these differences.
Cancer can occur at any age, and cancer is not inevitable with age. Today, common strategies to prevent cancer focus on health services such as vaccines, smoking cessation, and cancer screening. Although evidence-based strategies in the clinical setting are valuable, they exclude many factors that contribute to cancer risk across a person’s lifespan. Cancer risk results from conditions outside the clinic, in the places where people live, work and play. We have a growing body of research on multiple risk factors besides smoking for different types of cancer, but limited research on effective policy and community-based strategies to address these risk factors.
Last year, President Joe Biden launched his Cancer Moonshot 2.0, an ambitious initiative to reduce the cancer death rate by 50% over the next 25 years and “end cancer as we know it today.” The initiative’s goals focus on improvements in diagnostics and therapeutics, among other strategies. The target drop in the cancer death rate is more likely to be achieved if complemented by enhanced efforts to reduce cancer risk and promote health as people age. An obvious strategy to reduce cancer deaths is to reduce the number of new cancer cases. The Biden administration has also proposed new rules for Affordable Care Act marketplace insurers in 2025 to ensure “network adequacy,” meaning an adequate number of doctors, hospitals and other providers in their covered networks.
In addition to investments in improved cancer care, we need investments to counter the structural drivers of cancer inequities and help more people live longer, healthier, cancer-free lives. More research is needed on community-based intervention strategies to reduce exposure to known or suspected carcinogens and other causes of cancer. Promising policies and practices can be studied to understand what works, for whom, in what setting, and why.
I’d welcome better answers to the persistent question that nags every cancer epidemiologist: “So what can be done about it?” And, ultimately, I’d love for our prediction of a massive increase in cancer cases to be proven wrong.