http://hints.cancer.gov

briefs

NUMBER 15

In this HINTS Brief, we discuss four behavioral pillars of cancer prevention.

Organizations Collaborate to

Focus on Prevention Messages

When it comes to cancer prevention, more

information does not necessarily mean

greater clarity. Despite a plethora of cancer

prevention information available from myriad

outlets, such information has not necessarily

increased public understanding. In recognition

of the need for clear, concise, and consistent

public messaging, the National Cancer

Institute (NCI) and the C-Change

organization—made up of leaders from

government, business, and nonprofit

sectors—have joined forces to unite the

cancer advocacy and research communities

around a core set of messages designed to

convey four behavioral pillars of cancer

prevention: improve your diet, increase

your activity, check your status, and

quit smoking.

C-Change has worked with the Ad Council, NCI, and other partners

to craft language that effectively communicates the importance of

healthy behaviors in preventing cancer.

In this HINTS Brief, we examine HINTS data related to four behavioral

pillars of cancer prevention and present information on the public’s

cancer-related knowledge and perceptions about nutrition, physical

activity, cancer screening, and smoking. These data underscore the

need for the cancer community to coordinate communications efforts.

Improve Your Diet 

• Experts recommend 4–13 servings of fruits and vegetables daily

depending on energy needs, with special emphasis on dark green and

orange vegetables and legumes.

Increase Your Activity 

• Experts recommend at least 60 minutes of physical activity every day

for children and adolescents and at least 150 minutes of moderateintensity aerobic activity or 75 minutes of vigorous activity for adults

each week.

Check Your Status 

• Breast cancer: For women between the ages of 50 and 69, there is

strong evidence that regular screening, including mammography,

lowers the risk of dying from breast cancer by 30%. For women in

their 40s, the risk can be reduced by about 17%. For women aged 70

or older,mammography may be helpful,although firm evidence is lacking.

– In November 2009, the U.S. Preventive Services Task Force

(USPSTF) modified its recommendations for mammography

screening for specific age groups. For women aged 50–74, USPSTF

recommended biennial screening mammography. The modified

recommendation was based on data suggesting biennial screening

mammography before age 50 resulted in more harm and

produced smaller benefits than for older women, and therefore

USPSTF recommended that this decision should be made by

individual patients and their physicians.

• Colorectal cancer: When performed every 1–2 years in people

between the ages of 50 and 80, the fecal occult blood test can

decrease the number of deaths attributed to colorectal cancer.

Experts have also found that regular sigmoidoscopy can reduce

colorectal cancer deaths. More research is needed to learn the best

timing between exams and to determine the effectiveness of

screening by colonoscopy.

• Cervical cancer: Regular use of the Pap test, followed by appropriate

and timely treatment, reduces deaths from cervical cancer. A vaccine

available to girls and young women aged 9–26 can help prevent

infection from the two types of human papillomavirus that cause the

majority of cervical cancers worldwide.

– In November 2009, the American College of Obstetricians and

Gynecologists released new guidelines recommending that women

delay their first Pap test until age 21 and be screened less often

than recommended in the past.

Quit Smoking

• Quitting smoking has significant and immediate health benefits for

men and women of all ages. Quitting smoking dramatically reduces

the risk of lung and other cancers, coronary heart disease, stroke,

and chronic lung disease.

The Four Behavioral Pillars

of Cancer Prevention

Quick Facts

• More than three-quarters (78%) of Americans think there

are so many cancer prevention recommendations that it is

hard to know which ones to follow.

• Diet, physical activity, and cancer screening recommendations

from national organizations often vary, highlighting the

need for coordinated communication efforts.

• Most experts agree that a healthy diet and an active

lifestyle have cancer prevention benefits, that abstaining

from smoking is the most important thing someone can

do to prevent cancer, and that age-appropriate screening

can detect many cancers at an early, treatable stage.
Public Knowledge about Nutrition, Physical Activity,

Cancer Screening, and Smoking Recommendations

References Used in This HINTS Brief

Cancer Trends Progress Report – 2009/2010 Update.April 2010. National Cancer

Institute, NIH, DHHS, Bethesda, MD. http://progressreport.cancer.gov.

Screening for Breast Cancer. November 2009. U.S. Preventive Services Task Force

Agency for Healthcare Research and Quality, Rockville, MD.

http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm.

First Cervical Cancer Screening Delayed Until Age 21, Less Frequent Pap Tests

Recommended. November 2009. The American College of Obstetricians and

Gynecologists,Washington, D.C.

http://www.acog.org/from_home/publications/press_releases/nr11-20-09.cfm.

For More Information on Cancer

• Call the NCI Cancer Information Service at 1-800-4-CANCER

• Visit http://cancer.gov

• Order NCI publications at https://cissecure.nci.nih.gov/ncipubs/

May 2010

The National Cancer Institute (NCI) fielded the first Health Information National Trends Survey (HINTS) in 2002 and 2003, surveying

6,369 Americans. Subsequent surveys followed in 2005 (5,586 Americans surveyed) and 2008 (7,674 Americans surveyed). HINTS was

created to monitor changes in the rapidly evolving field of health communication.The survey data can be used to understand how

adults 18 years and older use different communication channels to obtain health information for themselves and their loved ones, and

to create more effective health communication strategies across populations.

HINTS Briefs provide a snapshot of noteworthy, data-driven research findings.They introduce population-level estimates for specific

questions in the survey and summarize significant research findings that are a result of analyzing how certain demographic

characteristics influence specific outcomes. Many Briefs summarize research findings from recent peer-reviewed journal articles using

HINTS data.

Changes in cancer prevention recommendations inevitably lead to C-Change is encouraging cancer organizations, as well as other

public frustration and confusion about who should be screened, how organizations, to emphasize the four behavioral pillars in their

often they should be screened, and what screening modalities should organizations’ communications efforts. Evidence-based, audience-tested

be used; how much exercise is recommended for good health; and messages and resources are available at http://www.c-changeprojects.org/

which aspects of diet are associated with cancer prevention or cancer CommunicationsPlan/CancerMessages.asp.

risk. Coordinated communications efforts, can help ensure that the

public receives clear, consistent messages regarding cancer prevention.

About HINTS

http://hints.cancer.gov

Diet Cancer Screening

Nutrition guidelines regarding the recommended number of fruits and Different reputable, nationally recognized organizations have created a variety

vegetables per day vary across organizations. Such lack of consistency is of cancer screening guidelines and continue to update those guidelines as

reflected in the public’s knowledge and understanding of nutrition better evidence becomes available. Although current HINTS data pre-date

recommendations. In 2005, most Americans (82%) agreed that “there are so recently revised cancer screening recommendations, the data offer insight

many recommendations about nutrition that it’s hard to know which ones into Americans’ knowledge about screening recommendations as they

to follow.” HINTS 2005 found that most Americans (89%) underestimated existed at the time of data collection. HINTS 2003 found that most

the recommended number of fruit and vegetable servings per day for adults. respondents (73%) knew that the recommended frequency for mammography

screening was every 1–2 years, and approximately 54% knew that the

Physical Activity recommended age at which to begin colon cancer screening was age 50.

HINTS 2005, meanwhile, revealed that the majority of Americans (79%) were In HINTS 2007, more than half of the U.S. population (60%) correctly

unaware of a change in recommendations for yearly Pap tests. identified that at least 150 minutes of physical activity is recommended per

week, which reflects current government recommendations. However, Smoking there is a lack of knowledge regarding the effect of physical activity on

cancer prevention. Although studies have found an association between Although most Americans have gotten the message that smoking causes lung

physical activity and reduced risk of colon and breast cancers, more than cancer, approximately 10% of Americans—an estimated 11 million people—

68% of respondents to HINTS 2007 said that they didn’t know which types believe that there is little or no relationship between smoking and cancer,

of cancer risk were associated with physical activity. according to HINTS 2003.An additional 5%—an estimated 5 million

people—had “no opinion,” indicating that even the most definitive

recommendations warrant repeating.

How Can This Inform Your Work?