Cancer is the #2 killer of Americans overall, and the #1 killer for Asian American, Indigenous, and Latino women. Adopting a healthy lifestyle can help prevent it, and people should be screened for some cancers.
The US Preventative Services Task Force is "an independent, volunteer panel of national experts in prevention and evidence-based medicine." The USPSTF issues broad recommendations that apply only to people who have no signs or symptoms of the specific disease or condition. They recommend screenings for these cancers (in alphabetical order):
- Breast cancer* - women age 50-74 (see more below)
- Cervical cancer - women age 21-65
- Colorectal cancer* - men and women age 45-75 (see more below)
- Lung cancer - for smokers who have a "20 pack-year smoking history and currently smoke or have quit within the past 15 years"
In light of symptoms, family history, and other individual circumstances, doctors may recommend additional testing.
For most cancers, Blacks have the highest death rate and shortest survival of any racial and ethnic group in the US, though the Black-White disparity has, thankfully, narrowed somewhat in the last 30 years. For specific cancers, there are a range of other disparities by race, ethnic group, and/or country of origin; some are tied to differences in screening rates. Needless to say, screenings are important to assure detection and treatment as early as possible.
Two screening recommendations have gotten a lot of attention, and the USPSTF reports an “Update in Progress” for both of them.
- Colon cancer. Until recently, the USPSTF recommended that all adults be screened starting at age 50. Yet when Chadwick Boseman died in August, 2020, I (and many others) learned that Black people are often diagnosed with colorectal cancer at a younger age than Whites; his cancer was diagnosed at age 39. This had apparently been known for a long time! An article published in 2005 recommended that Blacks be screened beginning at age 45, and in 2017 (twelve years later!), the US Multisociety Task Force on Colorectal Cancer formalized that recommendation. In 2018, the American Cancer Society recommended that all adults be screening beginning at age 45, and in May of 2021 the USPSTF finally adopted this as the "draft" standard! This may continue to evolve.
- Breast cancer. The USPSTF clearly recommends mammography for women aged 50-74, but say that the decision for women 40-49 "should be an individual one" based on comparing possible harms and benefits. To my eye, some related documents get too nuanced, including very subtle changes in wording (opportunity for vs. regular vs. annual mammograms). Many women get a mammogram every 1-2 years beginning at age 40. The USPSTF current standard is already 5 years old, and the multi-year process of developing an update is underway.
- Wellness and exercise. According to the American Cancer Society, approximately 42% of US cancer cases and 45% of cancer deaths "could potentially be prevented with the adoption of healthier lifestyles." So the standard recommendations for wellness programs and exercise, as discussed in my previous article on Heart Health, certainly apply here.
- Look at the data. As previously, one key recommendation is to see where you stand. Find out whether your employees and their adult family members are up to date on screenings (obviously requiring some assumptions about required frequency), and see how your experience compares with available benchmarks. In this area in particular, be sure to "de-average", both in benchmarking, and in choosing areas that you might be able to impact. Consider creating a dashboard of these metrics for senior leadership—perhaps by business, job family, geography, and/or another relevant dimension, in addition to race/ethnic group and gender.
- Campaign. Employers of all size should consider a campaign encouraging people to get screened with their current doctors, especially if your screening rates are well below benchmarks. In addition, if you have some Employers of all size should encourage people to get screened with their current doctors, especially if your screening rates are well below benchmarks. If you have some very large work settings, you could also consider doing onsite screenings.
Employers should encourage healthy lifestyles, and staying current with all required screenings, in all the ways that work for your organization. This will help all employees and families, especially those groups whose cancer rates are currently highest.
Note: Figures in this article are drawn from a number of sources, including the American Cancer Society's outstanding Cancer Facts & Figures.
Is your firm addressing cancer, including gaps? Why or why not? And how? Please share in the comments, or message me directly.
In our next article, we'll consider the compound impact of these and other disparities, and identify some principles for tackling them holistically.
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3 年This is right on Ray! We are learning about some subtle and some not so subtle disparities, by simply asking the question, "Has anybody ever even looked at this?"
Such an important post! I often think that I caught my tumor early because of my privilege: I have good health insurance, *my doctor took me seriously*, I was able to schedule scans and tests quickly, I have a research background and access to information that led me to the right doctor, and I live just a few miles from one of the best cancer centers in the country. What would have happened if even one of those things wasn't accessible to me? How do we make this the norm and not the option only for the privileged? I would add that normalizing conversations about our health can also help others be more proactive, but even that is limited to just our networks, which are less likely to include people who are not privileged in their health. Thank you for bringing up this very salient topic and opening up dialogue about it.