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The majority of Americans are unaware of several major risk factors for cancer-most notably obesity, which will soon overtake smoking as the largest preventable cause of cancer in the U.S. High treatment costs are compromising care: one in four people who have had cancer or have an immediate family member who has had cancer are forgoing treatment or physician visits because of the expense. In addition, nearly three-quarters of Americans support greater federal investment in cancer research, even if it means higher taxes or adding to the deficit. These are a few of the many findings from the ASCO National Cancer Opinion Survey, a large, nationally representative survey conducted online by Harris Poll.

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"This research helps us understand what our fellow Americans know and believe about cancer and, therefore, where we need to focus as a nation in our efforts to conquer cancer," said ASCO President Bruce Johnson, MD, FASCO. "It is clear there are many important gaps we need to address-from educating the public about cancer prevention, to confronting high treatment costs, to investing in cancer research that is vital to improving patients' outcomes in the future."


The national study on Americans' attitudes about cancer, commissioned by ASCO, was scientifically conducted online by Harris Poll July 10-18, 2017, among 4,016 U.S. adults ages 18 and older. It is believed to accurately represent the broader population of the U.S. These data show that more than a third of Americans report having firsthand experience with cancer: 4 percent have or had cancer themselves, and 32 percent have an immediate family member who has or had cancer.


Key Cancer Risk Factors Unrecognized

While a majority of Americans correctly identify tobacco use (78%) and sun exposure (66%) as risk factors for cancer, far fewer are aware of other lifestyle factors that increase their cancer risk. Notably, less than a third of Americans (31%) realize that obesity is a risk factor for cancer, even though it is currently the second-leading preventable cause of the disease. In fact, a higher body mass index is associated with increased risk of a number of cancers, including colon, breast, high-grade prostate, and uterine cancers. According to a recent analysis by the NCI, if current rates of obesity continue to trend upward, by 2030 there could be about 500,000 additional cases of cancer in the U.S. than would otherwise be expected.


The research also found that less than one in three Americans (30%) recognize alcohol as a risk factor for cancer, despite the fact that alcohol consumption can raise the risk of certain cancers, including those of the mouth, liver, and breast.


At the same time, the majority of Americans are not taking some important preventive actions to reduce their cancer risk. Only 48 percent said they use sunblock or limit their exposure to the sun, 41 percent said they maintain a healthy weight, and 38 percent said they limit alcohol consumption in order to prevent cancer.


In addition, some misperceptions about cancer risk persist: 14 percent of Americans incorrectly identify cell phones as increasing the risk of cancer, and 8 percent incorrectly identify caffeine as a risk factor for cancer.


"Our lifestyles have a big impact on our risk of developing many common cancers," said ASCO Chief Medical Officer Richard Schilsky, MD, FACP, FASCO. "That so few Americans are aware that maintaining a healthy weight is associated with lower risk for many cancers should serve as a wake-up call. Unfortunately, obesity is a problem that cannot be solved overnight and will require broad societal engagement to address."


Concerns for a Loved One

Individuals who have an immediate family member who has or had cancer have the greatest concerns about being diagnosed with cancer. For example, among Americans whose family member has/had cancer, 63 percent said they are worried about experiencing pain and suffering if they personally are diagnosed with cancer. In contrast, among people with no experience with cancer, only 56 percent said they are concerned about pain and suffering if diagnosed.


Similarly, among Americans who have a family member who has/had cancer, 60 percent said they are worried about being a burden on family and friends if they personally are diagnosed, compared to 49 percent with no experience with cancer.


"As this survey shows, our perceptions of cancer are formed by our personal experiences with cancer," said Schilsky. "Seeing the effects of this disease firsthand can certainly raise caregivers' own fear and anxiety about what a diagnosis could mean for themselves."


Effects of High Costs on Treatment

Of serious concern, more than a quarter of Americans (27%) who indicated that either they or an immediate family member has/had cancer said they/their family member have taken specific actions to reduce treatment costs-any of which could have a negative impact on their cancer treatment. Nine percent said they have skipped doctor appointments, 8 percent said they have refused treatment, 8 percent said they have postponed filling or not filled prescriptions, 8 percent said they have skipped doses of prescribed medications, and 7 percent said they have cut pills in half.


"We should all be alarmed that Americans are potentially risking not only their health but also their lives due to high treatment costs," noted Schilsky. "No patient or family member should have to face an impossible choice-between their cancer treatment and food, shelter, clothing, and other necessary expenses. Adjusting the prescribed dose of a cancer medication either by skipping doses or cutting pills is dangerous, and many health care providers may be unaware that their patients are putting themselves at risk this way."


The study also reveals that a large majority of Americans believe the federal government should take action to lower prescription drug costs. For example, 92 percent of people said Medicare should be allowed to directly negotiate prescription drug prices with drug makers, 86 percent said the U.S. government should regulate the price of cancer drugs to lower their costs, and 80 percent said it should be legal for U.S. residents to buy cancer drugs from other countries.


More Robust Federal Investment

More than nine in 10 Americans (91%) believe the U.S. government should dedicate substantial funding to diagnose, prevent, and treat cancer. Nearly three in four Americans (73%) said the government should spend more to develop cancer treatments and cures, even if it means higher taxes or adding to the deficit. That's despite more varied views on other cancer-related priorities: just over half of Americans (54%) think the government should spend more to help Americans afford cancer screenings and care, and just under half (49%) believe more money should be spent on cancer prevention.


"Federal investment in cancer research plays a critical role in the search for new cures, and Americans clearly recognize this. This poll shows that people are not only expecting, but counting on Congress and the Administration to invest more in research that will deliver the next generation of cures to patients," emphasized Johnson. "More funding for cancer research would mean more innovation, more studies launched, more patients enrolled in clinical trials, more researchers entering the field, and faster progress toward new and improved treatments for patients."


On the whole, Americans are optimistic about the future of cancer treatment and expect there to be a steady pace of progress over the coming decades. Nearly four in five (79%) are optimistic the majority of cancers will be curable within the next 50 years, compared to 66 percent who think most cancers will be curable within the next 25 years, and 39 percent who believe most cancers will be curable within the next 10 years.