Index*

A

Access to services, 152

distribution of cancer burden and, 8, 12–13, 22, 425, 433–434

obstacles to cancer screening participation, 225, 231–232, 243, 410, 436

recommendations for improving, 7, 8, 423–424, 425

Adenomatous polyps, 59, 175

Advertising of tobacco products, 4, 412

Agency for Healthcare Policy and Research, 99, 105

Agency for Healthcare Research and Quality, 10, 218, 334, 335

clinician training programs, 328

Evidence-Based Practice Centers, 384

guidelines development and dissemination, 384–387

Preventive Services Task Force, 10–11, 228, 275, 333–334, 387, 428– 430

Quality Interagency Coordination Task Force, 388

recommendations for, 10–11, 12, 428

research activities, 384–388

Task Force on Community Preventive Services, 334, 428, 429, 430

Translating Research into Practice, 387

weight-loss program evaluations, 139, 140t, 141t, 142, 143, 144

Aging of population, 10, 428

cancer risk, 22

implications for provider education and training, 296

See also Elderly patients

Alcohol consumption

alcohol types, 82–83

associated cancer risk, 82–83, 83t

breast cancer and, 84

cancer risk and, 86, 403

carcinogenic action, 83–84

colorectal cancer and, 84–85

health effects, 81–82

liver cancer and, 84

lung cancer and, 85

oropharyngeal/laryngeal/esophageal cancer risk, 83–84

potential effectiveness of cancer prevention, 1, 36, 400–401

predictive modeling of cancer reduction, 32–33

sociodemographic patterns, 85

tobacco use and, 47, 83

*  

Page numbers followed by t refer to tables. Page numbers followed by f refer to figures.



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Fulfilling the Potential of Cancer Prevention and Early Detection Index* A Access to services, 152 distribution of cancer burden and, 8, 12–13, 22, 425, 433–434 obstacles to cancer screening participation, 225, 231–232, 243, 410, 436 recommendations for improving, 7, 8, 423–424, 425 Adenomatous polyps, 59, 175 Advertising of tobacco products, 4, 412 Agency for Healthcare Policy and Research, 99, 105 Agency for Healthcare Research and Quality, 10, 218, 334, 335 clinician training programs, 328 Evidence-Based Practice Centers, 384 guidelines development and dissemination, 384–387 Preventive Services Task Force, 10–11, 228, 275, 333–334, 387, 428– 430 Quality Interagency Coordination Task Force, 388 recommendations for, 10–11, 12, 428 research activities, 384–388 Task Force on Community Preventive Services, 334, 428, 429, 430 Translating Research into Practice, 387 weight-loss program evaluations, 139, 140t, 141t, 142, 143, 144 Aging of population, 10, 428 cancer risk, 22 implications for provider education and training, 296 See also Elderly patients Alcohol consumption alcohol types, 82–83 associated cancer risk, 82–83, 83t breast cancer and, 84 cancer risk and, 86, 403 carcinogenic action, 83–84 colorectal cancer and, 84–85 health effects, 81–82 liver cancer and, 84 lung cancer and, 85 oropharyngeal/laryngeal/esophageal cancer risk, 83–84 potential effectiveness of cancer prevention, 1, 36, 400–401 predictive modeling of cancer reduction, 32–33 sociodemographic patterns, 85 tobacco use and, 47, 83 *   Page numbers followed by t refer to tables. Page numbers followed by f refer to figures.

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Fulfilling the Potential of Cancer Prevention and Early Detection Alliance, The, 422–423 Alpha-Tocopherol Beta Carotene Cancer Prevention Study Group, 79–80 American Academy of Family Physicians, 215 American Association for Cancer Education, 302f, 306 American Association of Health Plans, 329– 330 American Association of Medical Colleges, 301–303, 302f, 304–305 American Cancer Society, 13, 183, 306, 421 Cancer Prevention Studies, 43f, 45–46, 50, 52–53, 54 cancer reduction goals, 33, 34–35t clinician training programs, 328–329 research programs, 392, 399 screening guidelines, 228, 274–275 American College of Physicians, 215 American College of Radiology, 286–287, 288 American Gastroenterological Association, 183 American Legacy Foundation, 330, 394– 395 American Lung Association, 97, 317 American Society of Preventive Oncology, 302–303f American Urological Association, 215 Anti-Lung Cancer Action, 277, 283 Association of American Medical Colleges, 426 Association of Teachers of Preventive Medicine, 302f, 303, 305 B Barium enema, 179 Behavioral interventions conceptual models of change processes, 89–92 effectiveness, 2, 87, 153–155, 407 health care system implementation, 148– 153 to improve eating habits, 138–145 to improve physical activity, 111, 113– 120 to improve screening participation, 244– 250 incentive programs, 132 latency of effects, 39 predictive modeling, 32–33, 37, 38 public education campaigns, 11–12, 432 risk factor counseling, 345t service delivery strategies, 87–89 smoking cessation programs, 93–101 target behaviors, 2n, 17, 401 weight-loss programs, 127–129 Behavioral Risk Factor Surveillance System, 57 Benzene, 52 Beta-carotene, 69, 79–80 Bladder cancer, 44, 47–48, 54 fruit and vegetable consumption and, 68–69 Body mass index, 65–66 Breast biopsy, 197 Breast cancer alcohol consumption and, 84 carotenoid consumption and, 79 clinician education for early detection, 324–325 dietary fat intake and, 77 epidemiology, 25, 26 fruit and vegetable consumption and, 69 incidence, 19 obesity and, 62, 402 physical activity and, 58, 60, 402 potential effectiveness of preventive intervention, 1, 36, 37 quality of preventive services, 9 risk factors, 25–26 screening, 6, 7, 37, 158, 351–352, 403, 424 breast self-examination, 195–196 clinical breast examination, 186–187 cost-effectiveness, 198–199 DCIS detection, 186 effectiveness of early detection, 188– 194 genetic, 195, 197–198 insurance coverage, 6, 421 mammography, 403 Medicare coverage, 355 modalities, 186–187 for older women, 194 potential harms, 196–198 practice guidelines, 203–204f, 223 public awareness and understanding, 240–241, 242–243, 245, 246 strategies for improving, 244–250 subjective value judgments in, 199– 203 utilization, 225–226, 238–239 selenium intake and, 80

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Fulfilling the Potential of Cancer Prevention and Early Detection British male doctors study, 43f, 46, 47 Bronchoscopy, 285–286 Bupropion, 98–100 C Calcium, 76 Canadian Breast Cancer Screening Initiative, 187, 192–193 Cancer Intervention and Surveillance Modeling Network, 38–39 Carbohydrates, 77 weight-loss programs, 122, 123–124 Cardiovascular disease, 17 diet and, 66 obesity and, 61, 66 physical activity and, 58, 114 physical activity regimen to prevent, 111 Cardiovascular Health in Children, 143– 144 Carotenoids, 50, 69, 71, 79–80 Case finding, 156 Case management, 250 CATCH. See Child and Adolescent Trial for Cardiovascular Health Causes of cancer, 27–28, 31–32, 401–403 bladder cancer, 47–48 breast cancer, 58, 60, 62, 84, 402 cervical cancer, 51 colon cancer, 49–50, 59–60, 63 colorectal cancer, 58, 62, 72–73, 78–79, 84–85 endometrial cancer, 53, 62, 402 esophageal cancer, 64, 67, 402 kidney cancer, 48, 63, 74, 402 laryngeal cancer, 67 leukemia, 52 liver cancer, 52, 84 lung cancer, 45, 401 obesity, 61–64, 402 oropharyngeal cancer, 46–47, 67, 83–84 pancreatic cancer, 49, 74 prostate cancer, 53, 62, 73–74 red meat consumption, 72–74 stomach cancer, 50, 67–68 See also Lifestyle factors; Smoking-related cancer Centers for Disease Control and Prevention, 3, 10, 11, 256, 334, 435 budget, 381, 382t, 398–399 cancer screening programs, 7–8, 351– 352, 424 Center for Chronic Disease Prevention and Health Promotion, 418 clinician education programs, 324–326 data collection activities, 337–338 information dissemination activities, 336 Office of Smoking and Health, 418 recommendations for, 5, 7–8, 410–411, 418–419, 424 research activities, 381–384, 398–399 school diet and nutrition guidelines, 417 state programs, 338–340, 341, 418–419 Centers for Medicare and Medicaid Services, 9, 256, 388–390, 425 See also Medicaid; Medicare Cervical cancer, 350–351 clinician education for early detection, 324–325 epidemiology, 27 fruit and vegetable consumption and, 71–72 mortality, 27 potential effectiveness of preventive intervention, 1, 403 risk factors, 51, 421 screening, 6, 7, 158, 171, 218–220, 221f, 223, 253–255, 351, 403 smoking-related, 44, 51 Chemoprevention, 17 Child and Adolescent Trial for Cardiovascular Health (CATCH), 117, 137, 144 Church-based programs, 119, 147, 247f Clonidine, 98 Cochrane Collaboration, 190, 229, 395– 396, 397f Cognitive functioning medical attitudes and beliefs, 230–231, 241 models of behavior change, 89–92 Colonoscopy, 179–180, 181, 182, 183–185, 233, 234, 237 Colorectal cancer alcohol consumption and, 84–85 clinician education for early detection, 325–326 epidemiology, 26–27 folate intake and, 78–79 fruit and vegetable consumption and, 69–70 glucose metabolism and, 80–81 incidence, 19 obesity and, 62, 63, 402

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Fulfilling the Potential of Cancer Prevention and Early Detection physical activity and, 58, 59–60 potential effectiveness of preventive intervention, 1, 36, 37 public awareness and understanding, 235, 236 red meat consumption and, 72–73 risk factors, 27, 175 screening, 6, 7–8, 11, 223, 226, 359t, 403, 421, 424, 429 effectiveness, 175 fecal occult blood testing, 176–177, 181, 182–183, 233, 234, 235, 237, 238 future demand, 296 of Medicare beneficiaries, 296 participation, 233–238, 234f sigmoidoscopy, 178–179, 180, 181, 182–183, 233, 234, 235, 296 techniques, 175 selenium intake and, 80 smoking-related, 44, 49–50 whole-grain food consumption and, 75 Community Health Centers, 7, 342–344, 423, 424 Community-level interventions, 2, 87–88 clinical training for, 300 to improve eating habits, 144–145, 147 local administration of, 107 monitoring effectiveness of, 11, 430 obstacles to cancer screening participation, 226–227 physical fitness promotion, 118, 120 policy effects, 107 recommendations, 5–6, 418–421 research, 373, 383–384 smoking cessation, 105–108 smoking prevention, 110 weight-loss programs, 133 Computed tomography, 276 cancer screening, 11 helical, 260, 276–291, 292–293 Computerized Needs-Oriented Quality Measurement Evaluation System, 335, 387 Continuing medical education, 9, 319–322 Cost-benefit analysis, 170 Cost-effectiveness analysis, 170–171 Cost-utility analysis, 171 Costs cancer care, 20 as determinant of intervention outcomes, 102 insurance coverage for prevention efforts, 6–7, 421–423 lung cancer screening, 288, 290 obstacles to cancer screening participation, 225, 232 screening, 169–171, 181–182, 198–199, 213, 220, 222 smoking cessation programs, 105, 411 social costs of cancer, 20 state cancer control plans, 5 D Dairy product consumption, 75–77 DCIS. See Ductal carcinoma in situ Demographic patterns alcohol use, 85 cancer burden distribution, 20–22 cancer screening participation, 239–240, 257 diet-related cancer risk, 81 tobacco use, 54–57, 405 See also Elderly patients; Race/ethnicity; Socioeconomic status Dental schools, 316–317 Department of Defense, 13, 390–391 Department of Health and Human Services, 12–13, 352, 383–384, 433 evaluation of federal prevention services, 8, 10–11, 424–425, 428–430 recommendations for, 4, 8, 10–11, 414, 424–425, 428–430 research programs, 371–381 Department of Veterans Affairs, 338, 391– 392 Dexfenfluramine, 131 Diabetes, 17, 58, 66 Diagnostic testing, 156 Diet and nutrition, 86 cancer risk and, 402–403 fiber, 70, 75 fruits and vegetables, 66–72, 81 glucose metabolism, 80–81 interventions to improve eating habits, 133–134, 138–148 macronutrients, 77, 78t, 122–123 micronutrients, 77–80, 79t milk and dairy products, 75–77 potential effectiveness of cancer prevention, 1, 30, 36, 400–401 predictive modeling of cancer reduction, 33

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Fulfilling the Potential of Cancer Prevention and Early Detection recommendations for cancer prevention strategies, 4, 409, 414, 417 recommended daily intake, 138 red meat consumption, 72–74, 81 research, 372, 436 role of health care providers, 149–150 sociodemographic patterns, 71–72, 81 training of health care providers in, 309–312 weight guidelines, 65–66 whole-grain foods, 74–75 See also Weight-loss programs Ductal carcinoma in situ (DCIS), 186 E Early Lung Cancer Action Project, 277, 287, 288 Education and training of health care providers administrators, 295 in clinical nutrition, 309–312 continuing education, 9, 319–322, 426 dental schools, 316–317 in exercise counseling, 312–313 goals, 295, 298–301 for graduate medical students, 311–313 nonphysician providers, 10, 428 nursing schools, 313–316 opportunities for improving, 330–331 for physical fitness promotion, 114 potential shortage of medical personnel, 10, 296, 297, 311, 428 private resources and programs, 328– 330 public resources and programs, 322–328 recommendations, 8–10, 425–428 in screening practices, 227–228 in smoking cessation, 307–309 types of providers in need of training, 295–298 undergraduate medical student training, 301–311 Educational attainment cancer screening participation and, 239, 253 diet-related cancer risk and, 81 smoking risk and, 57 Effectiveness of preventive interventions ancillary health benefits, 40 behavioral strategies, 2 characteristics of successful programs, 153–155, 407 clinical vs. public health interventions, 88–89 community-level interventions, 105, 107–108, 118, 120, 133, 144– 145 family-based interventions, 135–136 fruit and vegetable consumption, 66–72 goal-setting, 39 group interventions, 97 in health care settings, 151–152 to improve eating habits, 142–145 with minority populations, 108–109, 134–135, 147–148 pharmacological interventions, 98–99 physical fitness programs, 58, 59–61, 113, 114–115, 117, 118, 119– 120 physician involvement and, 96–97 potential, 1, 15, 28, 30, 400–401, 403 predictive models, 30–40 priority setting in clinical practice, 255– 257 program cost as factor in, 102 program impact, 88–89 prostate cancer, 208–211 recommendations for evaluation of, 9– 11, 427–430 recommendations for improving, 3–13, 410–432 research needs for improving, 13, 434 residential treatment programs, 97–98 school-based programs, 117, 119–120, 143–144 screening, 37, 161–167, 174–175, 403, 406–407 breast cancer, 188–196 improving participation, 236–238, 244–250, 254–255, 258 lung cancer, 261–264, 265–274, 277–282, 283–286, 292 measuring, 270 self-help interventions, 96 smoking cessation, 44–46, 47, 48, 49, 50, 51, 52–53, 93–101, 105, 107 smoking prevention campaigns, 109–111 systems of care as factor in, 9, 426–427 telephone counseling programs, 97, 114– 115 weight-loss programs, 124–129, 131, 132, 133, 134–138

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Fulfilling the Potential of Cancer Prevention and Early Detection whole-grain food consumption, 74–75 worksite programs, 100–101, 132, 142– 143 Elderly patients cancer screening participation, 232, 240, 241, 242 See also Aging of population Endometrial cancer, 53 fruit and vegetable consumption and, 71 obesity and, 62, 402 screening, 161–162 Environmental risk factors, 31–32 social cognitive theory, 91 tobacco smoke exposure, 53–54, 413f Esophageal cancer, 44, 46, 47 alcohol consumption and, 83–84 fruit and vegetable consumption and, 67 obesity and, 64, 402 Estrogen metabolism, 53, 60, 62, 84 Ethics issues in screening, 167–169 Evaluation of prevention services, 8, 9–11, 427–430 Exercise and physical activity, 86 behavior change interventions, 111, 113–120 breast cancer and, 60, 402 cancer risk reduction, 58–61, 58t, 402 colon cancer and, 59–60 community-level programs, 118 current patterns of, 405 health benefits, 58 health care provider role in promoting, 114, 150 lung cancer and, 60 obstacles to, 405–406 policy interventions to promote, 119 potential effectiveness in cancer prevention, 1, 30, 400–401 predictive modeling of cancer reduction, 33 programs in health care settings, 113– 115 programs to reach minority populations, 119–120 prostate cancer and, 60–61 recommendations for cancer prevention strategies , 4, 409, 414–415f, 416– 417 recommended daily levels, 111 research, 372, 381, 435–436 school-based programs, 116–117 terminology and measurement, 111–112 training of health care providers in, 312–313 transportation infrastructure and, 6, 119, 381, 416 weight-loss programs, 124–127, 136–137 worksite programs for promoting, 115, 116t F Family-level interventions smoking prevention, 110 weight loss, 135–136 Family planning, 7, 424 Fat, dietary, 72, 73, 76, 77 interventions to improve eating habits, 138–144, 145, 147 weight-loss programs, 122–124 Fecal occult blood testing, 176–177, 177t, 181, 182–183, 233, 234, 235, 237, 238 Federal government cancer prevention activities, 8, 332, 364, 425 clinical guideline development, 332–335 data collection activities, 336–338 direct delivery of services, 342–352 employee health benefits, 423 evaluation of prevention services, 8, 10– 11, 424–425, 428–430 indirect service delivery, 352–364 information dissemination activities, 335–336 research activities, 368, 398–399 role in improving access of underserved populations to medical services, 7, 423–424 smoking cessation strategies, 3–4, 410– 412 support for community-based programs, 5 See also specific agency; specific program Fenfluramine, 131 Fiber, dietary, 70, 75, 77 Fluorescent bronchoscopy, 285–286 Folate, 78–79, 85 FRAMES, 92 Fruit and vegetable consumption, 81 bladder cancer and, 68–69 breast cancer and, 69 cancer risk and, 66–67, 67t cervical cancer and, 71–72

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Fulfilling the Potential of Cancer Prevention and Early Detection colon cancer and, 69–70 cruciferous vegetables, 70 endometrial cancer and, 71 health benefits, 66 interventions to improve eating habits, 138–148 kidney cancer and, 72 liver cancer and, 72 lung cancer and, 69 oropharyngeal/esophageal/laryngeal cancer and, 67 ovarian cancer and, 70 pancreatic cancer and, 68 stomach cancer and, 67–68 thyroid cancer and, 71 G Gastroesophageal reflux, 64 General Motors, 383, 423 Genetic susceptibility breast cancer, 25–26 screening, 168–169, 195, 197–198 Gimme 5 program, 143 Glucose metabolism, 80–81 Go Girls! Program, 120 Group Health Cooperative, 102, 154f Group interventions, 97 H Health belief model, 89–90 Health Care Financing Administration. See Centers for Medicare and Medicaid Services Health care providers access of underserved populations, 7, 423–424 assessment systems, 150–151 in behavior risk reduction, 148–152 in delivery of screening services, 227– 230, 242, 409 in diet and nutrition management, 149– 150 in promoting physical fitness, 113, 114, 150 research on clinical practice, 374 in smoking cessation interventions, 94, 96–97, 149, 155 See also Education and training of health care providers Health maintenance organizations, 152– 153, 154f, 225, 243 quality of care, 379 Health Professional Follow-Up Study, 43f, 49 Health promotion, 28–29 Health Resources and Services Administration, 305 cancer prevention programs, 342–344 clinician training programs, 10, 326– 328, 428 Health risk appraisals, 151 Health-seeking behaviors, 89–90 cost of care and, 102 dental care, 316 medical attitudes and beliefs, 230–231, 241 See also Participation in cancer screening Healthy People 2010, 12–13, 97, 113, 149, 253, 298f, 332–333, 364, 413f, 430, 433 Helicobacter pylori, 50 Hormonal system, obesity and, 62 Human papilloma virus, 51 screening, 218–219 Hypertension, 66 I Immigrant populations, 243 Incentives for change, 132 Incidence of cancer, 19–20, 21t, 31 bladder cancer, 47–48 breast cancer, 25 cervical cancer, 27, 51 colorectal cancer, 26–27 endometrial cancer, 52–53 kidney cancer, 48 leukemia, 52 lung cancer, 25, 45 oropharyngeal cancer, 46 potential effectiveness of preventive intervention, 1, 30, 403 predictive modeling of prevention intervention outcomes, 31–40 prostate cancer, 26, 53 stomach cancer, 50 Indian Health Service, 349–351 Insulin, 63, 80–81 Insulin-like growth factor, 63 Insurance cancer burden distribution and, 12, 433

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Fulfilling the Potential of Cancer Prevention and Early Detection coverage for prevention efforts, 6–7, 421–423 smoking cessation interventions, 101–102 trends, 225–226 obstacles to cancer screening participation, 225, 231–232, 237, 243–244 population coverage, 225 underserved populations, 7–8, 12, 423– 424 International Agency for Research on Cancer, 4, 32, 58, 62, 414 Internet programs cancer information programs, 335–336, 341 continuing medical education, 319–320 weight-loss programs, 130 Internet sales of controlled products, 3 Intravenous drug use, 17 J Joint Commission on the Accreditation of Healthcare Organizations, 10, 427 Jump Into Action Program, 117 K Kidney cancer, 44, 48 dairy product consumption and, 76 fruit and vegetable consumption and, 72 obesity and, 63, 402 red meat consumption and, 74 L Lactose, 76–77 Laryngeal cancer, 44, 46, 47 alcohol consumption and, 83–84 fruit and vegetable consumption and, 67 Legislative action cancer screening standards, 226 latency of effects, 39 smoking cessation strategies, 3–4 tobacco control efforts, 103–104f, 107– 108, 110–111, 411–412 Leukemia, 52–53 Lifestyle factors evidence for cancer association, 41–42, 42f, 43f health behavior trends, 2 maintenance of weight loss, 126 potential effectiveness of cancer prevention, 1, 403 significance of, 31–32, 41, 85–86 See also Behavioral interventions Lifetime probability of cancer onset, 19–20 cervical cancer, 27 lung cancer, 25 prostate cancer, 26 Live for Life program, 115 Liver cancer alcohol consumption and, 84 fruit and vegetable consumption and, 72 smoking-related, 44, 54 Lose Weight and Win Program, 119 Lung cancer, 44 alcohol consumption and, 85 carotenoid consumption and, 79–80 causes, 25 from environmental tobacco smoke exposure, 53–54 epidemiology, 25 fruit and vegetable consumption and, 69 incidence, 19, 289 lifetime probability, 25 mortality and morbidity, 25, 259 overdiagnosis, 274, 283 physical activity and, 60 potential effectiveness of preventive intervention, 1 prognosis, 25, 259 screening, 11, 158 bronchoscopy, 285–286 costs, 288, 290 effectiveness, 259, 292, 429 false-negatives, 273 future directions, 286–291, 296 guidelines, 274–276 informed consent, 289 potential for harm, 282, 284–285 radiography, 259, 261–274, 275 spiral computed tomography, 260, 276–291, 292–293 sputum cytology, 264, 265–271, 275, 285–286 technical development, 291–292 smoking-related, 45–46, 54, 401–402 sociodemographic patterns, 25 Lycopene, 71

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Fulfilling the Potential of Cancer Prevention and Early Detection M Mammography, 187–188, 196–197, 223, 403 Medicare coverage, 355 standards of care, 226 utilization, 225–226, 238–250, 357– 358t Mammography Quality Standards Act, 226 Managed care, 10, 101–102, 152–153, 225, 427 Medicaid enrollment, 360–361 Mass media antismoking campaigns, 105 coverage of medical research, 11, 431 physical fitness promotion, 120 Meat consumption, 72–74, 81 Medicaid, 8, 101, 232, 343, 359–361, 364, 425 pharmacotherapy coverage, 362–363t preventive services, 225, 226 Medicare, 8, 101, 153, 364, 425 enrollment, 354 preventive services, 225, 226, 237, 296– 297, 355–358 quality of care, 354, 389 smoking cessation program coverage, 358–359 spending, 354 MESH headings, 368–369 Methionine, 85 Migrant Health Centers, 7, 342–344, 423, 424 Migrant populations, 31 Minnesota Heart Health Program, 118, 133, 145 Mortality and morbidity alcohol consumption effects, 81–82 bladder cancer, 47 breast cancer, 25 screening effectiveness, 187, 189– 194, 403 cervical cancer, 27, 51, 403 colorectal cancer, 27, 233, 403 distribution by cancer type, 19, 19f, 20f, 21t, 29 distribution by cause, 18t distribution by sex, 18t effects of screening, 161–167, 256–257, 261–264, 265–272, 403 esophageal cancer, 46 kidney cancer, 48 laryngeal cancer, 46 lung cancer, 25, 259, 261–264, 265– 272, 401 need for screening, 157–158 obesity and, 61, 66 oropharyngeal cancer, 46–47 pancreatic cancer, 49 physical activity related to, 58 potential effectiveness of preventive intervention, 1, 400–401, 403 predictive modeling of prevention intervention outcomes, 31–40 prostate cancer, 26, 53, 207 screening effectiveness, 208–209, 213–214 treatment outcomes, 209–211 smoking cessation effects, 44–46, 47, 48, 401–402, 404 smoking-related, 28, 42 sociodemographic distribution, 12–13, 20–22, 23t, 24t, 433 stomach cancer, 50 trends, 18–20, 19f, 20f Motivational interviewing, 92 N National Cancer Institute, 13, 46, 286–287, 334, 364 breast cancer screening guidelines, 200, 203 budget, 371, 398 Cancer Education Survey, 306 cancer reduction goals, 33, 34–35t clinician education programs, 322–324 Community Intervention Trial for Smoking Cessation, 105 data collection activities, 336–337, 379– 380 Division of Cancer Control and Population Sciences, 375, 376f health disparities research, 13, 433–434 information dissemination activities, 335–336, 430, 432 predictive modeling of cancer reduction, 33, 38–39 Prostate, Lung, Colorectal, and Ovarian trial, 178 research activities, 371–380, 398 state programs, 340 National Cancer Policy Board, 15–16 National Committee for Quality Assurance, 10, 153, 427

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Fulfilling the Potential of Cancer Prevention and Early Detection National Council of State Boards of Nursing, 314 National Dialogue on Cancer, 421 National Family Planning Program, 352 National Governors Association, 341 National Health and Nutrition Examination Survey, 64–65 National Health Interview Survey, 57, 336– 337 National Heart, Lung, and Blood Institute, 121, 123, 124–125 National Human Genome Research Institute, 380–381 National Institute of Nursing Research, 380 National Institute on Aging, 380 National Institute on Drug Abuse, 380 National Institutes of Health, 13, 174, 433 breast cancer screening guidelines, 200– 201 prostate cancer screening guidelines, 215–216 research activities, 371–381 National Library of Medicine, 368 National Lung Screening Study, 286 National Polyp Study, 175 National Technical Assistance Office, 330 National Weight Control Registry, 125 New York Academy of Medicine, 310 Next Step Trial, 142–143 Nicotine replacement therapy, 98–100 North Karelia project, 145 Nortriptyline, 98 Number-needed-to-screen, 167 Number-needed-to-treat, 167 Nurses, 296 cancer prevention activities, 313–314 smoking cessation training, 315–316 training, 313, 314–316, 328–329 Nurses’ Health Study, 43f, 49, 78–79 O Obesity, 30, 86 associated cancer risk, 61–62, 61t, 402 breast cancer and, 62, 402 colon cancer and, 63, 402 endometrial cancer and, 62, 402 esophageal cancer and, 64, 402 health risks, 61 kidney cancer and, 63, 402 pharmacological treatments, 130–131 prostate cancer and, 62 recommendations for cancer prevention strategies, 4, 414–415f, 416–417 research, 372, 436 trends, 37, 64–65, 64f, 405 weight guidelines, 65–66 See also Weight-loss programs Occupational disease, 31–32, 57 Office of Disease Prevention and Health Promotion, 4 Office of Family Planning, 352 Office of Management and Budget, 361– 364 Oral cancer, 44, 46–47, 54 alcohol consumption and, 83–84 dentist role in prevention, 316–317 fruit and vegetable consumption and, 67 smokeless tobacco use and, 54 Orlistat, 131 Oslo Youth Study, 117 Osteoporosis, 17 Outcomes measurement, 165–167, 379– 380, 391–392 Ovarian cancer dairy product consumption and, 76–77 fruit and vegetable consumption and, 70 screening, 171, 174 P Pacific Business Group on Health, 422 Pancreatic cancer, 44, 49, 54 fruit and vegetable consumption and, 68 red meat consumption and, 74 Pap smears, 218, 219, 226, 253, 350–351, 353t Participation in cancer screening, 224 breast cancer, 225–226, 238–250 clinician factors, 227–230 colorectal cancer testing, 233–238, 234f community factors, 226–227 health care system characteristics and, 225–227, 410 insurance coverage and, 225–226, 231– 232 patient factors, 230–233 prostate cancer, 251–252 strategies for improving, 229–230, 252, 254–255, 258, 409–410 breast cancer, 244–250 colorectal cancer, 236–238 Partnering with Employers for Prevention, 383

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Fulfilling the Potential of Cancer Prevention and Early Detection Partnership for Prevention, 256, 423 Patient role in medical decision-making, 12, 172–173, 299, 431 colorectal screening, 182–183 participation in cancer screening, 230– 233 prostate cancer screening, 215 Pawtucket Heart Health Program, 118, 133 Pharmacological interventions Medicaid coverage, 362–363t obesity, 130–131 for smoking cessation, 6, 98–99, 421 Pharyngeal cancer, 44, 46–47, 54 alcohol consumption and, 83–84 fruit and vegetable consumption and, 67 Physical activity. See Exercise and physical activity Physician-Based Assessment and Counseling, 114 Physicians. See Health care providers Planet Health, 137–138 Population attributable risk, 36 Predictive modeling of cancer reduction, 31–40 Prevention Curriculum Assistance Program, 303 Preventive Services Task Force. See Agency for Healthcare Research and Quality, Preventive Services Task Force Primary prevention, 27–28, 29 Project LEAN, 145 PROJECT WALK, 120 Prostaglandins, 59–60 Prostate biopsy, 211–212 Prostate cancer dairy product consumption and, 76 epidemiology, 26 lifetime probability of, 26 mortality, 26 obesity, 62 overdiagnosis, 207 potential effectiveness of preventive intervention, 36 red meat consumption and, 73–74 screening, 37, 158, 173 antigen testing, 11, 205–208, 211, 213, 214, 251, 252 cost-effectiveness, 213, 214 decision to implement, 213–217 digital rectal exam, 205, 213 effectiveness of early detection, 208– 211, 429 insurance coverage, 226 potential harms of, 211–213 practice guidelines, 215–217, 216– 217f, 223, 252 schedule, 206 utilization, 251–252 selenium intake and, 80 smoking-related, 44, 53 surgical complications, 212–213 treatment outcomes, 209–211, 214 vitamin E and, 80 Prostate, Lung, Colorectal, and Ovarian study, 286 Protein, dietary, 77 Public awareness and understanding antismoking campaigns, 105, 110–111 breast cancer screening, 240–241, 242– 243 cancer risk, 288, 289 cancer screening participation and, 230, 245, 246 colorectal cancer, 235, 236 delivery of behavioral interventions, 88 federal government initiatives, 335–336 lung cancer screening, 287–288 of medical research, 12, 431–432 NCI research activities, 376–378 physical fitness programs, 118 prostate cancer, 251, 252 recommendations for educational interventions, 11–12, 430–432 Public Health Service Act. See Title X (Public Health Service Act) PubMed database, 368–369 Q Quality assurance, 151 in cancer screening, 226 in delivery of preventive services, 9–10, 427–428 Medicare mechanisms, 354 research activities, 379, 389 R Race/ethnicity alcohol consumption patterns, 85 breast cancer risk, 26 cancer burden distribution, 12–13, 22, 23t, 24t, 349–350

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Fulfilling the Potential of Cancer Prevention and Early Detection cancer prevention research, 374–375, 382 cancer screening participation, 239–240, 241, 243, 246, 253, 254, 257, 350 cervical cancer risk, 51 colorectal cancer risk, 26–27 colorectal cancer screening, 234 diet-related cancer risk, 81 dietary patterns, 81 health attitudes and beliefs, 230–231, 241 kidney cancer risk, 48 leukemia risk, 52 lung cancer risk, 25 obesity patterns, 65, 405 oropharyngeal cancer risk, 46 pancreatic cancer risk, 49 physical fitness interventions, 117, 118 programs to improve eating habits, 146, 147 prostate cancer risk, 26 smoking cessation, 57, 108–109 stomach cancer risk, 50 tobacco use patterns, 55–56, 405 weight-loss interventions, 134–135 Rehabilitation, 28 Research, 13 cancer control, 366, 382–383 cancer screening, 372–373, 382, 389, 436–437 community-based interventions, 373, 383–384 current state, 365 determinants of effectiveness, 13, 434 diet and nutrition, 372, 436 on effectiveness of screening, 164–167 health services, 366 informational resources, 370–371 interdisciplinary, 366–367 model programs, 396–398 needs, 367t, 434–437 obesity, 372, 436 organizational sponsors, 13, 367–368 See also specific organization outcomes measures, 165–167 physical activity, 372, 381, 435–436 private sponsors of, 392–398, 395t provider practices, 374 on public awareness and understanding, 376–378 public understanding of, 12, 431–432 publishing trends, 368–369 quality of care, 379 recommendations for, 13, 434 special populations, 378–379, 382, 388 spending, 398–399 tobacco, 371–372, 435 translational, 365, 366–367, 396–398 Residential treatment smoking cessation programs, 97–98 Rice, 74–75 Robert Wood Johnson Foundation, 393–394 S School-based programs to improve eating habits, 143–144, 417 physical fitness, 116–117, 119–120, 416–417 for weight loss, 137–138 Screening, 17 absolute benefit, 157–158, 166–167 accuracy, 158 breast cancer. See Breast cancer, screening Centers for Disease Control and Prevention programs, 7–8, 351– 352, 424 cervical cancer, 6, 7, 158, 171, 218–220, 221f, 223, 253–255, 403, 421 clinician compliance with guidelines, 229 colorectal cancer. See Colorectal cancer, screening costs, 169–171, 181–182, 198–199, 220, 222 decision to implement, 171–174, 182– 183 effectiveness of early detection, 161–167, 208–211, 222, 259 evaluation of effectiveness, 11, 429 false-positive/false-negative results, 168– 169 genetic risk, 168–169, 195, 197–198 human papilloma virus, 218–219 insurance coverage, 6, 421, 422–423 lung cancer. See Lung cancer, screening medical decision-making, 12 Medicare coverage, 355–358, 356t ovarian cancer, 171, 174 overdiagnosis, 158, 207, 274 overuse, 257–258 participation in. See Participation in cancer screening

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Fulfilling the Potential of Cancer Prevention and Early Detection patient records, 229 potential effectiveness, 1, 37, 257, 401, 406 potential for harm, 167–169, 180–181, 211–213, 219, 222 practice guidelines, 174–175, 183–185, 203–204f, 216–217f, 221t, 222– 223, 346t predictive value, 159–161, 160t prevalence of disease and need for, 157– 158 principles of effectiveness, 157, 409 priority setting in clinical practice, 255– 257 prostate cancer. See Prostate cancer, screening public health challenges, 224 public understanding, 11–12, 431 rationale, 28, 156 regulatory standards, 226 reliability, 158, 161 research, 372–373, 382, 389, 436–437 sensitivity, 159, 160 skin cancer, 174 specificity, 159 terminology, 156–157 test performance evaluation, 159f utilization, 225–226, 353t, 406–407 Seattle 5 a Day Worksite Program, 143 Secondary prevention, 28, 29 Selenium, 80 Self-efficacy beliefs, 90 Self-help programs, for smoking cessation, 96 Settings for interventions behavioral interventions, 87–89 church-based programs, 119, 147, 247f health care settings, 113–115, 140–141, 148–153 implications for provider education and training, 295–296, 300 nurse employment patterns, 314 screening tests, 247 See also Community-level interventions; School-based programs; Worksite intervention Sexual behavior, 17, 51 Sexually transmitted disease, 27 Sibutramine, 131 Sigmoidoscopy, 178–179, 180, 181, 182– 183, 233, 234, 235, 237, 296 Skills-training, 92, 93f weight-loss programs, 127 Skin cancer, 80 screening, 174 Smoking cessation, 2, 275–276 cancer risk reduction, 45–46, 47, 48, 49, 50, 51, 52–53, 401–402 characteristics of successful programs, 93–96, 154f community-level interventions, 105–108 cost-effectiveness of, 105 dentist role in, 316–317 education and training of health care providers for, 307–309 effectiveness of behavioral interventions, 94, 95t, 96–101 federal programs, 8, 425 future demand for services, 297 group interventions, 97 health benefits, 44–45 health care providers involved in, 297 insurance coverage for, 6, 101–102, 421, 423 lay treatment counselors, 317–319 legislative action to encourage, 3–4, 410–412 Medicaid programs, 361 Medicare coverage, 358–359 NCI research, 371–372 nurse training for, 315–316 obstacles to service delivery, 155 pharmacological interventions, 98–99 potential public health benefits, 28 private research initiatives, 393–395, 396 program costs, 102, 411 programs for underserved populations, 108–109 research needs, 435 residential treatment programs, 97–98 role of health care providers, 8, 94, 96– 97, 149, 425 self-help programs, 96 sociodemographic patterns, 57 stepped treatment, 297–298 telephone counseling programs, 97 trends, 404–405 weight gain and, 45 worksite interventions, 100–101 See also Smoking-related cancer; Tobacco use Smoking-related cancer alcohol consumption and, 47, 83 bladder cancer, 47–48

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Fulfilling the Potential of Cancer Prevention and Early Detection colon cancer, 49–50 environmental tobacco smoke, 53–54, 413f kidney cancer, 48 latency of intervention strategies, 39 leukemia, 52–53 lung cancer, 45–46, 401 mortality, 28, 42, 401, 404 oropharyngeal cancer, 46–47 pancreatic cancer, 49 potential effectiveness of preventive intervention, 1, 30, 36, 400–401 prostate cancer, 53 stomach cancer, 50 trends, 25, 42, 86, 291 types of diseases, 44, 44t See also Lung cancer; Smoking cessation; Tobacco use Social cognitive theory, 91 Society of Thoracic Radiology, 288 Socioeconomic status cancer burden distribution, 12, 22 cancer screening participation and, 226– 227, 230, 232, 239, 242, 243, 257 diet-related cancer risk and, 71–72, 81 interventions to improve eating habits, 147–148 lung cancer risk, 25 tobacco use, 55–57 Spiral computed tomography, 260, 276– 291, 292–293 Sputum cytology, 264, 265–271, 275, 285– 286 Stanford Five-City Study, 118, 133 Stanford Three-City Community Study, 145 Starch, dietary, 77 State government cancer control plans, 5, 418–421 cancer prevention activities, 338–341 community-based programs, 5–6 mandated insurance coverage, 421 Medicaid programs, 359–361 monitoring of preventive services, 9 nurse licensure, 314 physical education requirements, 417 smoking cessation programs, 3–4, 101, 102, 317–319, 411 tobacco control efforts, 103–104f, 107– 108, 110–111, 407–408, 410– 412 Stomach cancer, 44, 50 fruit and vegetable consumption and, 67–68 whole-grain food consumption and, 75 Substance abuse as cancer risk factor, 17. See also Alcohol consumption Substance Abuse Prevention and Treatment Block Grant awards, 3 Sun exposure, 17 Surveillance, 156–157 government programs, 336–338 Surveillance, Epidemiology, and End Results Program, 32 Swedish Two-County Trial, 189, 194 Synar amendment, 3 Systems of health care behavior risk reduction in, 148–153 cancer screening, 225–227, 409 delivery of behavioral interventions, 87, 88–89 determinants of screening participation, 225–227 effective delivery of prevention services, 9, 426–427 public health infrastructure, 418 public health mission, 419f T Taxation, 3, 39, 111, 410, 412 Telephone counseling to improve eating habits, 145 in promoting physical fitness, 114–115 screening reminders, 245–246, 248–249 for smoking cessation, 97 weight-loss programs, 129–130 Tertiary prevention, 28 Testicular cancer screening, 161–162 Theory of Planned Behavior, 90 Theory of Reasoned Action, 90–91 Thyroid cancer, 71 Title X (Public Health Service Act), 7, 352, 423, 424 Tobacco use characteristics of effective interventions, 407–408, 408f geographic variation, 358 legislative efforts to control, 103–104f, 107–108, 110–111 NCI research, 371–372, 375–376

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Fulfilling the Potential of Cancer Prevention and Early Detection objectives of programs to reduce, 413f pipes and cigars, 54 prevention of, 109–111 private research initiatives, 393–395, 396 recommendations for regulation of, 3–4, 410–412 research needs, 435 smokeless tobacco, 54 sociodemographic patterns, 54–57, 405 trends, 403–405 vendor licensing, 3 Tomatoes, 71 Transdisciplinary Tobacco Use Research Centers, 396 Translational Research Centers in Behavioral Science, 398 Transportation Equity Act for the 21st Century, 6 Transportation infrastructure, 6, 119, 381, 416 Transtheoretical model of change, 91–92 Treatwell study, 142 Trevose program, 129 U Underserved populations cancer burden, 12–13, 22, 433 cancer prevention research, 374–375 cancer screening, 257 clinician skills for service delivery to, 299 health disparities research, 378–379, 382, 388 physical fitness programs, 119–120 programs to improve eating habits, 146– 148 recommendations for improving access to services, 7–8, 423–424 smoking cessation programs, 108–109 weight-loss programs to reach, 134–135 University of Alabama, 310 University of Arizona, 310 University of California, 310 University of Colorado, 310 University of Nevada, 310 University of North Carolina, 310 University of Texas, 311 V Value expectancy theory, 89–91 Vegetables. See Fruit and vegetable consumption Veterans Health Administration, 344–349 Vitamin A, 79 Vitamin C, 50 Vitamin D, 76 Vitamin E, 80 W Weight-loss programs, 409 behavioral programs, 127–129 commercial, 129 community-based, 133 dietary restriction, 120–125, 136 environmental approaches, 133–134 goals, 120 maintenance of weight loss, 125–127 mediated approaches, 129–130 pharmacological treatments, 130–131 physical activity interventions, 124–127, 136–137 to reach underserved populations, 134– 135 worksite, 131–132 for young people, 135–138 Weight Watchers program, 129 Wheat, whole-grain, 74–75 Whole-grain foods, 74–75 Women’s health cancer risk, 22, 25 oropharyngeal cancer risk, 46 screening programs, 7 underserved populations, 7 Working Well, 142 Worksite intervention CDC programs, 383–384 fitness programs, 4 to improve eating habits, 133–134, 142– 143 insurance coverage for prevention efforts, 6–7, 422–423 promoting physical fitness, 115, 116t screening, 247f smoking cessation programs, 100–101 state support for, 5 weight-loss programs, 131–132

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Fulfilling the Potential of Cancer Prevention and Early Detection Y Young people access to tobacco, 3, 4 physical fitness, 4, 116–117, 119–120, 136–137, 405–406, 414, 416– 417 programs to improve eating habits, 4, 143–144, 414, 417 smoking prevention campaigns, 109–111 tobacco use patterns, 54–55, 56t, 404– 405 weight-loss interventions, 135–138