Many of the behaviors that place individuals at risk for cancer are well recognized, and calls for behavioral change are not new. What is new is the growing body of evidence confirming the effectiveness of interventions to help people improve their health-related behaviors. Health care providers can boost quit rates among their patients who smoke by adhering to smoking cessation guidelines. Administrators can improve the use of screening tests among health plan members by having systems in place to remind physicians and patients of needed tests. Communities can enact policies to curb exposure to secondhand smoke, limit access to tobacco products by teenagers, and create safe places for physical activity. Each of these strategies works, but especially effective in bringing about behavioral change is the simultaneous action of several parties: health care providers, administrators, educators, and policy makers.

Although personal experience illustrates for most people the great difficulty of achieving sustained behavioral change, Americans have made substantial improvements in their health habits in the past few decades. There has been, for example, a steep decline in the number of Americans who smoke; there have been some improvements in diet; and screening for some cancers is widespread. Investment in the effective clinical and public health tools at hand can produce much greater improvements.

In this report, the National Cancer Policy Board reviews the evidence that cancer incidence rates can be dramatically reduced and outlines a national strategy to realize the promise of cancer prevention and early detection. The report examines

  • the extent to which the burden of cancer could be reduced through cancer prevention and early detection;

  • the effectiveness of cancer screening methods and interventions to alter smoking, eating, and exercise habits;1

  • approaches to enhancing the potential benefits of proven interventions;

  • a case study of screening for lung cancer, illustrating the problem of adopting new technology when the science is uncertain;

  • professional education and training needs;

  • federal and state programs that support cancer prevention and early detection; and


The Board recognized that a number of personal and health care behaviors are known to contribute to the burden of cancer but limited its review to tobacco use, obesity, physical activity, diet, alcohol use, and the use of screening tests. Examples of behaviors known to contribute to cancer risk but not considered in this review include exposure to sun and exposure to cancer-causing viruses through sexual activity (e.g., human papillomavirus) and blood contact such as through intravenous drug use (e.g., hepatitis B virus). Behaviors were selected based on their contribution to cancer and to other chronic illnesses such as cardiovascular disease and diabetes.

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