Cancer Prevention Starts with You
While heart health gets all the headlines this month, February is also National Cancer Prevention Month.
According the American Association for Cancer Research, “The federal government estimates that 2 million Americans were diagnosed with cancer (other than non-melanoma skin cancer) during 2024, and that more than 600,000 died from their disease. Research shows that more than 40% of these cases and nearly half of the deaths can be attributed to preventable causes—smoking, excess body weight, physical inactivity, and excessive exposure to the sun, among others.”
And that is among the general population. A recent report issued by the New York City Health Department found that chronic diseases, such as cancer, and premature death “disproportionately affect communities of color and New Yorkers with low incomes.” When it comes to cancer in the city, Black women tend to have higher rates of mortality from breast cancer and are diagnosed at later stages, despite widespread availability of screenings. The death rates of Black men from screenable cancers are about 50 percent higher than white, Latino, or Asian men. Barriers to treatment are other key factors.
“Research shows that more than 40% of [cancer] cases and nearly half of the deaths can be attributed to preventable causes.”
The report, part of the health department’s HealthyNYC initiative to increase New Yorkers’ life expectancy, also demonstrates that the city understands the “dire and preventable” inequities faced by these groups in fighting chronic illnesses and wants to address them. One of the goals of HealthyNYC is to reduce “deaths due to screenable cancers by 20% by 2030.” Promoting awareness of the problem, along with the importance of screenings, and a coordinated effort to desegregate the health care system and improve outcomes are ways city health officials hope to boost survival rates among all demographics.
The data we have collected from our own patients, predominantly families who live in shelters or public housing, are reflective of the statistics in the city’s report. Food deserts and the high cost of healthy food lead to poor eating, stress takes a huge toll, and time is extremely limited for healthcare and screenings, even when the hurdles to access healthcare are overcome. By tracking disease rates and initiating a Social Determinants of Health study a few years ago that we plan to undertake again this year, we have seen similar disease trajectories and struggles in trying to achieve healthier lifestyles when so many aspects of daily survival require attention.
We devised our successful bi-annual Women’s Wellness Days of Self-care over a decade ago to combine screenings for breast and cervical cancer and mobile mammograms with spa treatments, massages, and giveaways of pampering personal-care items, lingerie and clothing. This is on top of education and empowerment sessions for preteens to prepare them for puberty, women’s classes on stress management and preparing for menopause, and books and pamphlets on women’s health topics and preteen self-esteem. HPV vaccines are also offered as part of the event.
Linda You, the director of clinical services at The Floating Hospital pointed to these vaccinations as key in the prevention of cervical and some head, neck and penile cancers. While the HPV vaccine’s contribution to cancer prevention seems like a clear positive, the low acceptance rate in our clinics reflects a national ambivalence toward it. “I think people associate it with sexual activity, and parents don’t want to talk about it. It’s also not required for school,” she noted. Although our providers “make sure people are aware of it … there is a lot of fall off for teenage vaccines in general.” Even adults, who are now also eligible for it, aren’t receiving it in great numbers. One study put the figure at around 16% of the population aged 27 to 45, which is the recommended range for adults.
In addition to the wellness events, we perform pap smears in our clinics and hope to offer on-site mammograms in the future as well. “We started doing some of these things in order to target women who generally don’t think about things like pap smears,” she said. “It’s important to do this screening so that we can assess changes and get them resolved quickly.” As a primary care provider, we offer screenings and referrals for mammograms as part of our focus on preventative medicine. She emphasized that anyone finding something new or unusual in a self exam should see a medical provider quickly and prioritize any follow-up appointments.
Current U.S. Preventative Services Task Force guidelines for all women, aged 40 to 75, with average risk of breast cancer are to receive a mammogram at least every two years. Recommendations for screenings of cervical cancer begin much earlier, at age 21, and should be repeated every three years. From age 30, women should also receive a high-risk HPV test, which should be repeated every five years.
Colorectal cancer is another type that can be caught early and treated successfully with screening. The USPSTF noted that “Black adults have the highest incidence of and mortality from colorectal cancer compared with other races/ethnicities,” based on data collected from 2013 to 2017. “The causes for these health disparities are complex; recent evidence points to inequities in the access to and utilization and quality of colorectal cancer screening and treatment as the primary driver for this health disparity rather than genetic differences.”
“Having a regular physical to discuss comprehensive preventative care and address all your issues at once is important.”
According to the USPSTF’s guidelines, colon cancer testing should begin at age 45 and stop around 75 depending on the patients and their histories. There are several testing options and they can be used individually or in combination. Some are yearly and others, such as a colonoscopy, can be prescribed every five years up to every 10 years, for patients at low to average risk.
“Make sure to have your screenings done at the appropriate age,” Linda said. “Having a regular physical to discuss comprehensive preventative care and address all your issues at once is important.”