Prevention and Early Detection of Cancer in the United States

Cancer is a major public health problem in the United States. Many types of cancer may be prevented by adopting a healthy lifestyle and avoiding mutagens and carcinogens, such as tobacco. Primary cancer prevention refers to the prevention of cancer through health promotion and risk reduction. This includes avoiding carcinogens, using cancer vaccines or chemoprevention agents, and considering prophylactic surgeries in individuals at high risk for developing cancer, such as those with genetic predispositions (Mahon, 2010a; Meyskens & Tully, 2005).

Cancer screening and early detection are forms of secondary cancer prevention aimed at identifying cancer early, when it is most treatable (Champion & Rawl, 2005; Mahon, 2010a, 2010b; Smith, Tully, & Padberg, 2005). These measures target people who are asymptomatic. Guidelines for screening people of average risk are available from a number of organizations (Smith, Cokkinides, Brooks, Saslow, & Brawley, 2010).

Tertiary cancer prevention refers to the prevention and early detection of second primary cancers in individuals who have been diagnosed with cancer. This includes using specific tests to detect cancer and recurrences early (Mahon, 2010b). In cancer care, examples of tertiary prevention include monitoring for early signs of recurrence using tumor markers, detecting second primary malignancies early in long-term survivors, and using chemoprevention agents.

Individualized cancer risk assessment is critical to all levels of cancer prevention. Recommendations for cancer prevention and screening, as well as tertiary prevention in cancer survivors, are based on an individualized cancer risk assessment (Mahon, 2010a).

It Is the Position of ONS That

Cancer Prevention and Education Services

• Oncology nurses develop, implement, and evaluate evidence-based measures to ensure that individuals and families have access to education about cancer prevention and appropriate cancer screening.
• Advanced practice oncology nurses obtain, document, and interpret cancer risk assessments; recommend appropriate cancer early-detection and prevention strategies to individuals and families; and arrange or provide comprehensive cancer screening services based on an individual’s level of risk.
• Cancer survivors receive age-appropriate cancer screening for new cancers as well as screening and prompt follow-up for long-term complications related to cancer treatment.
• Programs that focus on early detection of specific cancers (e.g., breast, prostate) also contain content on prevention and detection of other common cancers.
• Cultural differences that impact successful promotion of primary, secondary, and tertiary prevention are integrated into practice.
• Individuals are assessed for eligibility for chemoprevention trials based on personal level of risk, informed about the trials, and offered participation in the trials if eligible.
• Individuals are fully informed of their options for managing their personal risk for developing cancer and understand the limitations, benefits, and risks of each strategy.

Public Education

• Oncology nurses are well suited to provide education to the general public about prevention measures and general population screening guidelines for early detection of cancer.
• Oncology nurses are well suited to provide the necessary information and education to facilitate client decision making about participation in cancer prevention and control clinical trials.
• Oncology nurses strive to provide comprehensive cancer prevention education and early-detection services in a manner consistent with the cultural background and healthcare beliefs of individuals and families. Educational materials are targeted to the appropriate level of literacy and are culturally sensitive.
• Oncology nurses are involved in the development of educational resources that have a focus on wellness, including the prevention and early detection of cancer in at-risk populations.
• Education programs are developed and provided on the primary prevention of cancer (e.g., smoking cessation programs, nutritional counseling, cancer vaccines, avoidance of exposure to ultraviolet light) beginning in childhood and throughout life to encourage people to adopt healthy lifestyles (Mahon, 2010b ).

Professional Education

• Oncology nurses, at generalist and advanced practice levels, must have educational preparation in behavioral, biologic, genetic, educational, and economic principles of cancer prevention and early detection (Mahon, 2009).
• Continuing education and specialized educational programs must be developed and provided to practicing nurses to facilitate integration of cancer prevention and early detection in clinical practice.
• Oncology specialty certification examinations and nursing licensure examinations include evaluation of knowledge related to cancer prevention and detection practices in the general population.

Research

• Oncology nurses conduct research to further assess the efficacy of cancer prevention and early-detection programs, psychological impact of cancer prevention and detection strategies, and promotion of participation in prevention and early-detection activities.

Health Policy

• The development and evaluation of cancer prevention and detection health policy are based on cancer control research and use a multidisciplinary approach that includes the public.
• Payers provide coverage for cancer risk assessment counseling, cancer predisposition genetic testing, smoking cessation aids or programs, cancer vaccines, and early-detection and screening services based on individual risk.
• Payers provide coverage for clinical trials evaluating cancer prevention and detection strategies and chemoprevention.

References

Champion, V.L., & Rawl, S.M. (2005). Secondary prevention of cancer. Seminars in Oncology Nursing, 21, 252–259.

Mahon, S.M. (2009). Cancer genomics: Advocating for competent care for families. Journal of Clinical Oncology Nursing, 13, 373–376.

Mahon, S.M. (2010a). Cancer epidemiology and prevention. In J. Eggert (Ed.), Cancer Basics (pp. 35–54). Pittsburgh, PA: Oncology Nursing Society.

Mahon, S.M. (2010b). Common risk prediction models and cancer risk communication. In K.A. Calzone, A. Masny, & J. Jenkins (Eds.), Genetics and Genomics in Oncology Practice (pp. 79–102). Pittsburgh, PA: Oncology Nursing Society.

Meyskens, F.L., & Tully, P. (2005). Principles of cancer prevention. Seminars in Oncology Nursing,21, 229–235.

Smith, J.J., Tully, P., & Padberg, R.M. (2005). Chemoprevention: A primary cancer prevention strategy. Seminars in Oncology Nursing, 21, 243–251.

Smith, R.A., Cokkinides, V., Brooks, D., Saslow, D., & Brawley, O.W. (2010). Cancer screening in the United States, 2010: A review of current American Cancer Society guidelines and issues in cancer screening. CA: A Cancer Journal for Clinicians 60(2), 99–119.

Approved by the ONS Board of Directors, 4/01; revised 8/02, 10/04, 3/05, 3/07, 10/10.