The updated guidelines include recommendations for community action to accompany the four major recommendations for individual choices to reduce cancer risk, saying a supportive social and physical environment is indispensable if all Americans are to have genuine opportunities to choose and maintain healthy behaviors.

The American Cancer Society publishes its Guidelines on Nutrition and Physical Activity for Cancer Prevention to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. The guidelines, published about every five years, are developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and reflect the most current scientific evidence related to dietary and activity patterns and cancer risk. They were last updated in 2006.

The guidelines include four major recommendations, each of which includes several supporting recommendations.

Achieve and Maintain a Healthy Weight Throughout Life

• Be as lean as possible throughout life without being underweight.
• Avoid excess weight gain at all ages. For those who are currently overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.
• Engage in regular physical activity and limit consumption of high-calorie foods and beverages as key strategies for maintaining a healthy weight.

Adopt a Physically Active Lifestyle

• Adults should engage in at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week, or an equivalent combination, preferably spread throughout the week.
• Children and adolescents should engage in at least 1 hour of moderate or vigorous intensity activity each day, with vigorous intensity activity occurring at least 3 days each week.
• Limit sedentary behavior such as sitting, lying down and watching television, and other forms of screen-based entertainment.
• Doing some physical activity above usual activities, no matter what one’s level of activity, can have many health benefits.

Consume a Healthy Diet, with an Emphasis on Plant Foods

• Choose foods and beverages in amounts that help achieve and maintain a healthy weight.
• Limit consumption of processed meat and red meat.
• Eat at least 2.5 cups of vegetables and fruits each day.
• Choose whole grains instead of refined grain products.

If You Drink Alcoholic Beverages, Limit Consumption

• Drink no more than 1 drink per day for women or 2 per day for men.

The authors of the report say the tobacco control experience showed that policy and environmental changes at national, state and local levels are critical to achieving changes in individual behavior. They say similar purposeful changes in public policy and in the community environment are required to help individuals maintain a healthy body weight and remain physically active throughout life. In that vein, the Guidelines also include recommendations for community action:

Public, Private, and Community Organizations Should Work Collaboratively at National, State, and Local Levels to Implement Policy and Environmental Changes That:

• Increase access to affordable, healthy foods in communities, worksites, and schools, and decrease access to and marketing of foods and beverages of low nutritional value, particularly to youth.
• Provide safe, enjoyable, and accessible environments for physical activity in schools and worksites, and for transportation and recreation in communities.

“Our guidelines have always stressed what people can do themselves to lower their risk of cancer, and that’s important,” said Colleen Doyle, MS, RD, director of nutrition and physical activity, and co-author of the report. “But we must also take public action to make those behaviors easier for all Americans. We can’t just tell people to eat more fruits and vegetables and get more exercise when there are so many forces working against them being able to do that easily, and on a regular basis.

“We’ve got to work together to ensure that worksites and schools have healthy food options; that our neighborhoods are designed so that our children can safely ride their bikes or walk to school; that people have the information they need to help them make healthier food choices, whether at the grocery store or when eating out.

“The environments in which we live, work, learn and play have a tremendous impact on our ability to make and sustain healthy lifestyle choices. So if we’re not working to change those environments so that the healthier choice is the easier choice, we’re missing the boat.”

The report also reviews the evidence on diet and physical activity factors that affect risks for select cancers, as well as a section on common questions about diet, physical activity and cancer; from coffee and dietary supplements to garlic, fiber, and irradiated foods.

The full report can be viewed at: http://onlinelibrary.wiley.com/doi/10.3322/caac.20140/full

[Photo by Marc Smith]

The report, Cancer Statistics 2012, published online ahead of print in CA: A Cancer Journal for Clinicians says over the past 10 years of available data (1999-2008), cancer death rates have declined in men and women of every racial/ethnic group with the exception of American Indians/Alaska Natives, among whom rates have remained stable. The reduction in overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of more than a million total deaths from cancer during that time period.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute and Centers for Disease Control and Prevention, as reported by the North American Association of Central Cancer Registries, and mortality data from the National Center for Health Statistics. Cancer Facts & Figures 2012, the report’s accompanying consumer publication, includes a Special Section each year, which in 2012 focuses on cancers with increasing incidence rates.

Other highlights include:

• A total of 1,638,910 new cancer cases and 577,190 deaths from cancer are projected to occur in the United States in 2012.
• The most rapid declines in death rates occurred among African American and Hispanic men (2.4% and 2.3% per year, respectively).
• Death rates continue to decline for all four major cancer sites (lung, colorectum, breast, and prostate), with lung cancer accounting for almost 40% of the total decline in men and breast cancer accounting for 34% of the total decline in women.
• About 1,024,400 cancer deaths (732,900 in men and 291,500 in women) were averted from 1991/1992 through 2008 as a result of 18 years of consistent declines in cancer death rates.
• Cancer incidence and death rates vary considerably among racial and ethnic groups. For all cancer sites combined, African American men have a 15% higher incidence rate and a 33% higher death rate than white men, whereas African American women have a 6% lower incidence rate but a 16% higher death rate than white women.
• Compared with whites, African American men and women have poorer survival once cancer is diagnosed. The 5-year relative survival is lower in African Americans than in whites for every stage of diagnosis for nearly every type of cancer.
• Cancer incidence and death rates are lower in other racial and ethnic groups than in whites and African Americans for all cancer sites combined and for the four most common cancer sites. However, incidence and death rates for cancers related to infectious agents, such as those of the uterine cervix, stomach, and liver, are generally higher in minority populations than in whites.
• Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket.

The Special Section, which is also published as a standalone article in CA, finds that despite declines in incidence rates for the most common cancers, the incidence of several cancers has increased in the past decade, including cancers of the pancreas, liver, thyroid, and kidney and melanoma of the skin, as well as esophageal adenocarcinoma and certain subsites of oropharyngeal cancer associated with human papillomavirus (HPV) infection. Researchers led by Edgar P. Simard, PhD MPH, examined trends in incidence rates from 1999 through 2008 for those seven cancers to detail changes by race, sex, and age.

They found rates for HPV-related oropharyngeal cancer, esophageal adenocarcinoma, and melanoma increased only in whites, except for esophageal adenocarcinoma, which also increased in Hispanic men. Liver cancer rates increased in white, black, and Hispanic men and in black women only. In contrast, incidence rates for thyroid and kidney cancers increased in all racial/ethnic groups except American Indian/Alaska Native men.

Increases in incidence rates by age were steepest for liver and HPV-related oropharyngeal cancers among those ages 55 to 64 years and for melanoma in those aged 65 years and older. Notably, for HPV-related oropharyngeal cancer in men and thyroid cancer in women, incidence rates were higher in those ages 55 to 64 years than in those aged 65 years and older. Rates increased for both local and advanced stage diseases for most cancer sites.

The reasons for these increasing trends are not entirely known. Part of the increase (for esophageal adenocarcinoma and cancers of the pancreas, liver, and kidney) may be linked to the increasing prevalence of obesity as well as increases in early detection practices for some cancers. The special section says these rising trends will exacerbate the growing cancer burden associated with population expansion and aging and that additional research is needed to determine their underlying cause.

These annual reports have become critical tools for scientists, public health experts, and policymakers in assessing the current burden of cancer to help prioritize efforts to fight the disease. The estimates are some of the most widely quoted cancer statistics in the world. The Society’s leading team of epidemiologic researchers compiles and analyzes incidence and mortality data to estimate the number of new cancer cases and deaths for the current year nationwide and in individual states.

The expected numbers of new cancer cases and cancer deaths should be interpreted with caution because these estimates are based on statistical models and may vary considerably from year to year. Not all changes in cancer trends can be captured by modeling techniques and sometimes the model may be too sensitive to recent trends, resulting in over- or under-estimates. For these reasons, the estimates should not be compared from year-to-year to determine trends; age-standardized cancer incidence and death rates are the best way to monitor changes in cancer occurrence and death. Despite these limitations, the American Cancer Society’s estimates of the number of new cancer cases and deaths in the current year provide reasonably accurate estimates of the burden of new cancer cases and deaths in the United States. Such estimates will assist in continuing efforts to reduce the public health burden of cancer.

Cancer Statistics 2012 can be viewed at cacancerjournal.com, while Cancer Facts & Figures 2012 is available at cancer.org/statistics.