Forging an integrated agenda for primary cancer prevention during midlife.

The aging of the Baby Boomer population, the roughly 69 million adults who were born in the U.S. between 1946 and 1964, presents a number of important public health challenges. This cohort that now represents 26.4% of the total U.S. population is living longer than any cohort that came before it. Men aged 65 years are projected to live to age 83 years, and women aged 65 years are projected to live to 85 years, compared to about 46 years for men and 48 years for women in 1900.1,2 This trend toward increased longevity is expected to continue, with the number of adults aged ≥65 years increasing from 35 million, or 13% of the U.S. population, in 2010 to 72 million, or 20% of the population, in 2030.3 As many have pointed out, we are only now realizing the potential impact of this increase in longevity and remain ill-prepared to address it.4 The growing number of the aging population in the U.S. has major implications for cancer prevention and control. That the cumulative risk of developing cancer continues to expand until about age 70 years suggests that the number of middle- and older-aged people who are at risk for developing some type of cancer during their lifetimes will continue to increase as the population grows.2 Addressing modifiable risk factors for cancer in childhood through middle adulthood thus seems essential to improving the lives of this growing segment of the population. In fact, it has implications for the health of the nation as a whole.5 Realizing the need to set an agenda for cancer prevention in midlife, the Division of Cancer Prevention and Control at the CDC brought together in 2012 an expert panel of investigators from a range of disciplines and approaches to acquiring knowledge. The purpose was to discuss cancer risk in middle adulthood, with a shared aim of preventing cancer.6 This workshop was part of an innovative CDC-sponsored series entitled Cancer Prevention Across the Lifespan. The workshop on cancer prevention during midlife followed a 2011 CDC-sponsored workshop on preadolescent and adolescent exposures and risk for adult cancer.7 Taken together, the two workshops represent an innovative approach to cancer prevention, one that takes into account the intersections of age, cancer risk, and cancer prevention, with consideration for how they might vary by race/ethnicity, SES, and considerable comorbidities such as serious mental illness. Although taking such an integrated and holistic approach is admirable, it presents major challenges to advancing the expert panel’s agenda for cancer prevention during key periods of the life cycle. Not only would it require convening diverse groups of experts such as those who participated in the 2011 and 2012 CDC-sponsored workshops and expanding them to include scholars with newly identified areas of pertinent expertise, such as experts at the intersection of developmental biology and race, but its success also would depend on the ability to develop an infrastructure for fostering these kinds of collaborations. In order to inform such an approach, the argument is posited in this article for a means of capturing the complexity of age, cancer risk, and cancer prevention in the context of race/ethnicity, SES, and comorbidities, using findings from the 2012 CDC-sponsored expert panel on cancer prevention during midlife. In doing so, specific suggestions are offered for developing and sustaining such an approach.