History of tobacco use among Kentucky women diagnosed with invasive cervical cancer: 1997-1998.

An association between cigarette smoking and cervical cancer has been demonstrated by numerous epidemiologic studies. However, just because there is an association does not mean that there is an etiologic connection between tobacco use and cervical cancer, although some studies do indicate such a relationship. There are numerous potential explanations, including smoking as a behavior being associated with other behaviors that place women at increased risk of HPV infection. In a state like Kentucky, where the prevalence of smoking is so very high, one would expect that the disease burden from cervical cancer would also be high. A review of available data on invasive cervical cancer cases from the Kentucky Cancer Registry shows that this is indeed the case, with the incidence rate of invasive cervical cancer in Kentucky being as much as 40% higher than the SEER rate during the 1991-1998 time period. An analysis of available tobacco use history data from the KCR on women diagnosed with invasive cervical cancer during 1997-1998 shows that 61% of them indicated a history of tobacco use.

Skin cancer prevention: the problem, responses, and lessons learned.

Skin cancer is one of the most common forms of cancer and has rapidly increased during the past three decades in the United States. More than 1 million new cases of skin cancer are estimated to be diagnosed in the United States each year. The National Skin Cancer Prevention Education Program (NSCPEP) was launched by the Centers for Disease Control and Prevention (CDC) in 1994 as a national effort to address the Healthy People 2000 objectives for skin cancer prevention. The NSCPEP is a comprehensive, multidimensional public health approach that includes (1) primary prevention interventions; (2) coalition and partnership development; (3) health communications and education; and (4) surveillance, research, and evaluation. In 1994, through support from the CDC, state health departments in Arizona, California, Georgia, Hawaii, and Massachusetts initiated primary prevention intervention projects to conduct and evaluate skin cancer prevention education. This article discusses the comprehensive, multidimensional public health approach highlighting examples from the state demonstration projects.

Evaluation of the Ultraviolet Index: media reactions and public response.

BACKGROUND: In response to the increasing rate of skin cancer, particularly melanoma in the United States, the Environmental Protection Agency, the National Weather Service, the Centers for Disease Control and Prevention, National Association of Physicians for the Environment, and the American Academy of Dermatology, developed the Ultraviolet Index (UVI) to inform the public of the strength of the sun's rays and advise on methods for sun protection. OBJECTIVE: Our purpose was to evaluate the extent to which television stations and newspapers reported the UVI and assess the public's response to it. METHODS: To evaluate the effect of this effort, we surveyed television weather forecasters at 185 stations and examined weather pages in 54 newspapers in 58 cities that received the UVI reports. We also conducted a population probability telephone survey of 700 white adults (18 years of age and older) in these 58 cities. RESULTS: Seventy-one percent of the 169 stations that provided survey data for both 1994 and 1995 broadcast the UVI; 61% of newspapers reported the UVI. Nearly 64% of the 700 respondents (n = 445) had heard of the UVI. Of these respondents, 38% (n = 170) stated that they or their family changed their sun protection practices as a result of the UVI. CONCLUSION: The majority of television weather forecasters and newspapers reported the UVI. Most of the public was aware of the UVI, causing some to change sun protection practices. Further evaluation is required to maximize the effect of the UVI on sun protection practices.

Full proceedings from the National Conference to Develop a National Skin Cancer Agenda. American Academy of Dermatology and Centers for Disease Control and Prevention, Washington, D.C., April 8-10, 1995.

National efforts to reduce skin cancer incidence and mortality require scientifically coordinated efforts. This report summarizes the first American Academy of Dermatology/Centers for Disease Control and Prevention national conference to develop a skin cancer agenda. Leading experts in dermatology, public health, medicine, health education, nursing, behavioral sciences, environmental health and epidemiology identified and prioritized skin cancer control issues in five key areas. Discussion centered around strategies for reducing UV exposure and increasing public and professional awareness of skin cancer. Panelists in five sessions developed consensus on several public and professional recommendations and a series of research strategies.

Secondary prevention of cancer.

In recent years prevention has become extremely important in the war against cancer. For many cancers, major risk factors are not amenable to change and, therefore, secondary prevention through screening and early detection is the major type of intervention. Furthermore, with the discovery of cancer genes and tumor markers, which make it easier than ever before to identify people with increased risk of developing certain types of cancers, the role of secondary prevention has assumed an even greater value. This paper reviews recent advances in secondary prevention of those cancers for which overall efficacy of screening to reduce mortality has been demonstrated but for which some residual controversies exist: breast, cervical, and colorectal cancers.

Melanoma awareness and self-examination practices: results of a United States survey.

BACKGROUND: Skin cancers are common and there has been a dramatic increase in their incidence, particularly melanoma. However, little is known about awareness of melanoma and early detection practices in the general U.S. population. OBJECTIVE: In 1995, the American Academy of Dermatology increased their efforts to promote awareness of melanoma. This study was conducted to document current knowledge of melanoma and self-examination practices. METHODS: In February 1995, a telephone survey was conducted in a nationally representative sample of 1001 persons at least 18 years of age (3% margin of error) that included questions on knowledge, attitudes, and practices regarding early detection of melanoma. RESULTS: Almost 42% of those surveyed were unaware of melanoma, and only 26% of those who were aware could identify its specific signs. Most recognized at least one common risk factor for melanoma (e.g., sun exposure, fair skin). However, many did not distinguish melanoma from other skin cancers in terms of risk factors, signs of early disease, and body site distribution. The lowest measures of melanoma knowledge and attitudes were found among those who are male, nonwhite, and parents, and those with the lowest level of education and income. More than half (54%) did not conduct a self-examination. This practice was most frequently reported by women, white persons, and the elderly, as well as those with a greater knowledge of melanoma. CONCLUSION: Our research documents deficiencies in knowledge and practices related to early detection of melanoma in the general U.S. population and supports the need for public education about melanoma.

The National Breast and Cervical Cancer Early Detection Program: a comprehensive public health response to two major health issues for women.

The passage of the Breast and Cervical Cancer Mortality Prevention Act established a nationwide, comprehensive public health program to increase access to breast and cervical cancer screening services for women who are medically underserved. This act created the first opportunity for state health agencies to build a public health infrastructure for cancer control at the state and community levels. The Congress appropriated $30 million in fiscal year 1991 for the first year of this program. In the summer of 1991, the Centers for Disease Control and Prevention (CDC) used a competitive application process to fund the first eight states to establish early detection programs. Since then, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has become a nationwide program with a budget of $100 million. Thirty-five states and nine American Indian Tribes are supported to implement comprehensive screening programs. Fifteen states, three territories, and the District of Columbia receive planning and infrastructure grants as part of the Capacity Building Program. The NBCCEDP surveillance data through January 31, 1995 shows that 556,003 screening tests have been provided to women who are medically underserved. The success of NBCCEDP has contributed to the growing pressure on state health agencies to focus more attention and resources on chronic disease prevention and control.

State legislation related to breast cancer: 1980-1994.

Increased screening mammography usage is important for reducing breast cancer mortality in the United States. This article summarizes state breast cancer screening legislation enacted between 1980-1994. Forty-three laws were identified and analyzed based on five categories: screening/education programs; third-party reimbursement for screening; third-party reimbursement for reconstruction/prosthesis; mammography facility accreditation; and alternative therapy information. Third-party reimbursement mandates were subdivided into Medicaid/public assistance; state employee health benefits; Medicare supplement insurance; age/frequency provisions; and screening based on risk factors besides age. The larger context of breast cancer screening needs for the present and future are discussed.

Trends and differentials in mortality from cancers of the oral cavity and pharynx in the United States, 1973-1987.

BACKGROUND: This analysis consisted of an examination of trends and differentials in mortality from cancers of the oral cavity and pharynx in the United States for a recent 15-year period. METHODS: The authors have used national cause-of-death data for the United States and intercensal population estimates to examine mortality from oral and pharyngeal cancers between 1973 and 1987 and to study differentials according to gender, race, and region of residence. RESULTS: The overall mortality rate from these cancers decreased by 19% during the 15-year period, with most of the decline occurring after 1979. Mortality was much higher for men than for women and for blacks than for whites throughout the interval. Despite the overall decline, mortality rates increased among blacks, especially among black men. Mortality was highest in the South Atlantic, New England, and Mid-Atlantic states and lowest in the Mountain states. CONCLUSIONS: The disparity between male and female mortality from oral and pharyngeal cancer stems mainly from differences in the likelihood of developing these cancers, whereas the differences between blacks and whites appears to arise more from differences in survival than in incidence. Different age patterns of mortality for blacks and whites exist, in which mortality among whites, but not among blacks, rises continuously with age. An unexplained finding was that mortality rates were reported to have fallen in recent years, whereas incidence and survival rates have reportedly remained almost unchanged. This apparent inconsistency may have resulted from declines in the incidence of oral and pharyngeal cancers that have been masked by improved detection.