Cancer is the leading cause of death in Vermont. Cancer is any disease where uncontrolled growth and spread of abnormal cells occurs in the body. Cancer develops gradually as a result of many different factors related to lifestyle choices, environment and genetics. Anyone can develop cancer, including children; however, the risk of being diagnosed with cancer increases with age, and most cancers occur in adults who are older. Personal behaviors such as tobacco use, alcohol use, diet, physical inactivity, and overexposure to sunlight can increase the risk of developing certain cancers. Nearly two-thirds of cancer deaths in the U.S. can be linked to tobacco use, poor diet, obesity, and lack of exercise. When cancer is found and treated early, a person’s chance for survival is much better. Screening tests, including those available for breast, cervical, and colorectal and lung cancers, help to detect cancer at an early stage when treatment works best.

Cancer is very common. Roughly four out of 10 men and women in the U.S. will develop cancer in their lifetime. As Vermont and the nation’s population ages, the occurrence of new cancer cases is expected to increase. With treatment advances, people are living longer with a cancer diagnosis.

Cancer prevalence is the number of people alive today who have ever been diagnosed with cancer, excluding melanoma and other skin cancers. This includes individuals who are newly diagnosed, in active treatment, have completed active treatment, and those living with progressive symptoms of their disease. Approximately 35,000 adult Vermonters (7%) are living with a current or previous diagnosis of a non-skin cancer (Behavioral Risk Factor Surveillance System (BRFSS), 2015). There are no significant differences in the proportion of cancer survivors living in different counties in Vermont. Cancer prevalence among Vermonters has not changed significantly since 2010.

Cancer survivors face unique challenges to physical health and the maintenance of a healthy lifestyle. Survivors may also need ongoing monitoring for cancer recurrence and the development of new cancers. Cancer survivors are equally or more likely to present with other chronic conditions or risk factors such as tobacco use, obesity, poor nutrition, and lack of physical activity. These and other risk factors increase subsequent cancer risk, poor treatment outcomes and cause additional physical distress during cancer treatment and follow-up care.

Survivors need access to a variety of resources to manage the physical and psychological issues that may develop or persist following treatment. This includes the provision of regular follow-up care such as routine checkups and other cancer screenings to detect new or returning cancers early, identify side effects of cancer treatment, and reinforce preventive behaviors such as tobacco cessation, increased physical activity and improved nutrition.

This indicator is important because cancer is the leading cause of death in Vermont and many risk factors for developing cancer can be prevented or reduced. The Department of Health receives grant funds from the CDC to coordinate activities and partnerships that support strategies to reduce tobacco use, increase screening rates, and promote physical activity and healthy nutrition across the state. These Health Department activities are managed in the Division of Health Promotion and Chronic Disease Prevention, which houses other programs like the Tobacco Control Program, The Physical Activity and Nutrition Program, the Comprehensive Cancer Control Program, and the Ladies First Program – all of which promote strategies that play a role in lowering the risks for developing cancer. Other divisions such as the Environmental Health division manage the radon prevention program which provides free radon testing kits for use in homes across the state.

Vermont Department of Health Comprehensive Cancer Control (CCC) Program: The CCC program supports a strategic approach to preventing or minimizing the impact of cancer in communities through collaboration and implementation of Vermont’s Cancer Plan.

Vermont Cancer Registry: The Cancer Registry collects and analyzes data around cancer in Vermont to provide insights about cancer incidence, prevalence and mortality and to help examine trends over time.

Vermonters Taking Action Against Cancer (VTAAC): Vermont’s statewide cancer coalition; a growing network of groups and individuals that speaks with one voice about reducing the burden of cancer in Vermont. VTAAC works with the Department of Health to put the Vermont Cancer Plan into action by preventing overlap and directing resources to where they matter most in our state.

American Cancer Society: A national organization with the mission to free the world from cancer, working with the Department of Health to implement the Vermont Cancer Plan.

University of Vermont Cancer Center: An accredited Cancer Center that supports the implementation of the Vermont Cancer Plan and is dedicated to advancing the prevention, detection, treatment, and survivorship of cancer by providing state-of-the art cancer diagnosis and treatment, delivering compassionate cancer care, providing education to patients and the community, and advancing innovative research from the laboratory.

Identifying people with risk factors for developing cancer is extremely important. For example, it is important that primary care providers screen patients for tobacco use, alcohol consumption, overweight and obesity, and sun exposure practices to make sure people with those risk factors for cancer know it and can get information about how to make behavior changes. Providers and their patients should also discuss any family cancer history to determine whether genetic testing should be considered.

For breast, cervical, colorectal, and lung cancers, following appropriate screening recommendations is critical. Screening can result in detection of a cancer at an earlier stage when responses to treatment are more favorable and survival rates are higher.

Evidence based strategies include promoting healthy behaviors and following screening guidelines such as getting a mammogram or being screened for colorectal cancer. Several programs housed within the Department of Health’s Division of Health Promotion and Chronic Disease Prevention support activities that promote those strategies.

Cancer can be perceived as a chronic condition and recommendations are emerging for long-term survivorship care. It is difficult to measure the outcomes of strategies specifically addressing the health needs of cancer survivors due to variations in cancer type, treatment and individual socioeconomic characteristics. However, some of the basic tenants of health care delivery and support that are known to improve physical health for the general population also apply to cancer survivors.

After treatment ends, cancer survivors should receive regular follow-up care. This includes routine checkups and other cancer screenings specific to their needs. This can help to detect new or returning cancers early and identify side effects of cancer treatment. Provision of a survivorship care plan including a written post-treatment summary outlining the proposed follow-up plan can help ensure cancer survivors receive the best long-term regular care possible.

Survivors can also improve their treatment outcomes and lower their risk of developing a new or secondary cancer by living a healthy lifestyle. Examples of healthy behaviors include:

• Avoiding tobacco
• Limiting alcohol use
• Avoiding too much exposure to ultraviolet rays from the sun and tanning beds
• Eating a diet rich in fruits and vegetables
• Keeping a healthy weight
• Being physically active

The Health Department’s 3-4-50 initiative is a simple framework to help us grasp the reality of the impact of health behaviors on chronic disease. The initiative promotes the concept that 3 health behaviors (lack of physical activity, poor diet and tobacco use) contribute to 4 chronic diseases (cancer, cardiovascular disease, lung disease and diabetes) that claim the lives of more than 50 percent of Vermonters. Connecting individuals with programs that promote improved healthy lifestyle behaviors is an important strategy that supports health maintenance and improvements for cancer survivors.

The Vermont Department of Health is funded by the CDC to work on cancer prevention, screening, and control through Comprehensive Cancer Control, Breast and Cervical Cancer Screening, and Cancer Registry grants. The Department is also funded to address obesity prevention activities through a grant called State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity, and Associated Risk Factors and Promote School Health. Our strategy is to work with providers, hospitals, clinics, schools and community partners to create healthy environments, promote best practices, and support Vermonters to make healthy choices that will prevent or help control cancer risk factors.

The Vermont Cancer Plan, published by the Vermont Department of Health Comprehensive Cancer Control Program (VT CCC) and the statewide cancer coalition Vermonters Taking Action Against Cancer (VTAAC), provides a strategic roadmap to reduce the burden of cancer in Vermont.

By focusing on the health and well-being of all Vermonters through quality health systems, promoting physical activity, nutrition, and tobacco prevention and cessation interventions – the most effective ways to lower your risk of developing cancer – we can help to address the behaviors and risk factors that contribute to cancer disease and ensure better quality of life for those who are living with those conditions that increase risk.

Vermont tracks risk behaviors and chronic disease using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS). Since 1990, Vermont, along with the 49 other states, Washington D.C. and U.S. territories, has participated in the BRFSS with the Centers for Disease Control and Prevention (http://www.cdc.gov/brfss). The CDC provides the Vermont Department of Health with funding each year to carry out the survey. Several thousand Vermonters are randomly and anonymously selected and called annually, on both landlines and cell phones. An adult (18 or older) is asked a uniform set of questions. The results are weighted to represent the adult population of the state.

Note that beginning in 2011 the CDC implemented changes to the BRFSS weighting methodology in order to more accurately represent the adult population. While this makes calculations more representative of the population, the changes in methodology also limit the ability to compare results from 2011 forward with those from previous years. The Vermont Department of Health recommends that comparisons between BRFSS data from 2011 forward and earlier years be made with caution. Statistical differences may be due to methodological changes, rather than changes in opinion or behavior.