another substantive approach for advancing health equity (786). Thus, additional federal investment for these programs would improve equity in cancer screening, follow-up care, and advance the goals of the Cancer Moonshot, as underscored by Senator Robert P. Casey, Jr., p. 160. HPV infections can lead to six types of cancer, including nearly every case of cervical cancer (see Prevent and Eliminate Infection from Cancer-causing Pathogens, p. 48) (787). There are effective, evidence-based strategies that can prevent HPVattributed cancers, such as guideline-concordant HPV vaccination, cervical cancer screenings, and timely follow-up care (see Sidebar 15, p. 49). Although HPV vaccination coverage increased among adolescents 13 to 17 years old in 2021 (215), there is still progress to be made to reach the Healthy People 2030 full vaccination goal of 80 percent in adolescents (217). Eliminating HPV-attributed cancers will only be achieved by coordinated strategies among all stakeholders to build confidence in vaccination and improve screening and treatment for HPV-related lesions. Leveraging Policy to Reduce Tobacco-related Illness Decades of public health awareness campaigns and effective tobacco control policies have resulted in historically low smoking rates among adults in the United States. In 2021, 18.7 percent of U.S. adults regularly used any tobacco product (32), and 11.5 percent of adults regularly smoked cigarettes. Despite the progress made against tobacco use among adults, tobacco product use during adolescence is still cause for great concern as this greatly increases the risk of nicotine dependence later in life. Results from the most recent National Youth Tobacco Survey indicate that 16.5 percent of high school and 4.5 percent of middle school students currently use any tobacco product (788). E-cigarettes remain the top choice for youth under the age of 18, with 14.1 percent of high school students reporting e-cigarette use and 3.3 percent of middle school students reporting e-cigarette use. Additional tobacco control policies across all levels of government remain important to continue reducing tobacco-related cancers as smoking remains the number one preventable cause of cancer (see Figure 24, p. 162). In September 2022, FDA Commissioner Robert Califf, M.D., MACC requested an independent, operational evaluation of the FDA Center for Tobacco Products (CTP) to ensure the Center is prepared to address the impending challenges associated with youth tobacco use, tobacco-attributed disease, and death. The report from the Reagan-Udall Foundation for the Food and Drug Administration provided 15 recommendations, across multiple areas, to strengthen CTP’s response towards the rapidly changing tobacco product landscape (790). In alignment with report recommendations, FDA and NIH awarded funding for a new Center for Rapid Surveillance of Tobacco, which will enhance CTP’s and the research community’s ability to understand, track, and assess changes in tobacco use and the product marketplace (791). Further policies that could reduce tobacco-related illness include expanding flavor prohibitions to all tobacco products beyond e-cigarettes; increasing restrictions on tobacco product advertising and promotions; and increasing funding for awareness and cessation programs within FDA, NCI, and CDC’s Office on Smoking and Health. Accelerating Progress Against Pediatric Cancer Cancer is the leading disease-related cause of death in children in the U.S. Each year, more than 15,000 children and adolescents under 19 years of age are diagnosed with cancer (792). Due to advances in treatments, about 80 percent of children survive their diagnoses. The overall cancer death rate for children under 14 years of age has declined an average of 1.5 percent per year between 2015 and 2019 (325). Nonetheless, cancer diagnosis continues to be devastating news for affected children and their families. Chronic conditions resulting from pediatric cancer treatments can continue The sale of e-cigarettes increased from 15.5 million units in January 2020 to 22.7 million units by December 2022 . continued on page 162 FDA Center for Tobacco Products collects tobacco user fees from manufacturers of 6 traditional tobacco products: cigarettes, cigars, snuff, roll-your-own tobacco, chewing tobacco, and pipe tobacco. These fees, totaling close to $710 million annually, fund all FDA tobacco regulatory activities. Although FDA is authorized to regulate e-cigarettes, the agency is not allowed to collect user fees from e-cigarette manufacturers. Funds from other regulatory efforts are used, contributing to delays in regulation and enforcement. AACR Cancer Progress Report 2023 159 Advancing the Future of Cancer Research and Patient Care Through the Adoption of Evidence-Based Policies
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