unhealthy diet, lowering physical inactivity, lowering exposure to UV radiation, limiting alcohol consumption, and preventing pathogenic infections. It is estimated that 40 percent of all cancer cases in the United States are attributable to preventable causes. The development and implementation of public education and policy initiatives designed to eliminate or reduce exposure to preventable causes have reduced cancer incidence, morbidity, and mortality in the United States. Unfortunately, while the prevalence of some risk factors like tobacco use is on the decline, the rise in prevalence of other risk factors such as obesity threatens to reverse the significant progress against cancer that has been made in the last five decades. Therefore, it is essential that all stakeholders work together to enhance the dissemination of our current knowledge to reduce cancer risk and implement evidence-based policies and programs that minimize the incidence, morbidity, and mortality of cancer attributable to preventable causes. Certain cancer risk factors are not always easy to avoid. These include carcinogens and pollutants encountered in the environment. Hormonal factors that result from normal physiology can also increase or decrease the risk of developing certain types of cancers. Furthermore, occupational or life stressors, such as chronic stress, lack of sleep, and night shift work, increase a person’s risk of developing certain types of cancers. As we learn more about environmental and occupational cancer risk factors and identify segments of the U.S. population who are exposed to these factors, new and equitable policies need to be developed and implemented to reduce cancer risk and improve the health of all populations. Screening for Early Detection Cancer screening means checking for the disease, or for abnormal cells that may become cancerous, in people who have no signs or symptoms of cancer. Cancer screening can help detect aberrations at the earliest possible stage during cancer development when they are successfully treatable, with a higher likelihood of being cured. The overarching goal of recommended screening is to reduce the burden of cancer at the population level. Cancer screening recommendations are developed for individuals who are at an average or higher-than-average risk of being diagnosed with cancer. Key considerations that determine who should receive screening and for which cancer include gender and age, as well as genetic, environmental, behavioral, and social influences. In the United States, the U.S. Preventive Services Task Force (USPSTF)—an independent, volunteer panel of national experts in disease prevention and evidence-based medicine— has recommendations for individuals who are at an average risk of being diagnosed with breast, cervical, colorectal, or prostate cancer. The USPSTF recommends that people who currently smoke or have a history of smoking, i.e., individuals who are at a high risk of being diagnosed with the disease, receive lung cancer screening. Despite the evidence that cancer screening saves lives, systemic and structural barriers disproportionately limit the access of medically underserved populations to routine cancer screening. Researchers are using evidence-based interventions—such as comprehensive public health campaigns and culturally tailored strategies—to reduce these barriers, but more work is needed to ensure that all eligible individuals have equitable access to routine cancer screening and follow-up testing if findings of the screening test are abnormal. Use of artificial intelligence (AI) to aid clinicians in cancer detection, and of liquid biopsy to detect multiple types of cancer from a single test, is an exciting new frontier that holds enormous potential for improving early detection of cancer. In recent years, FDA has approved several AI-assisted medical devices to aid clinicians in cancer diagnosis. However, a cautious approach to using AI in cancer care is warranted to avoid exacerbating inequities that can result from the fact that much of the data used to train current AI-driven models 1965 2021 Cigarette Smoking Rates Among U.S. Adults 42% 11.5% In May 2023, USPSTF issued a draft recommendation for breast cancer screening, lowering the age of eligible individuals from 50 to 40. Researchers estimate that the revised recommendation could save 19 percent more lives from breast cancer. Executive Summary AACR Cancer Progress Report 2023 5
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