Minimizing the burden of cancer in the United States: Goals for a high-performing health care system

CA Cancer J Clin. 2019 May;69(3):166-183. doi: 10.3322/caac.21556. Epub 2019 Feb 20.


Between 1991 and 2015, the cancer mortality rate declined dramatically in the United States, reflecting improvements in cancer prevention, screening, treatment, and survivorship care. However, cancer outcomes in the United States vary substantially between populations defined by race/ethnicity, socioeconomic status, health insurance coverage, and geographic area of residence. Many potentially preventable cancer deaths occur in individuals who did not receive effective cancer prevention, screening, treatment, or survivorship care. At the same time, cancer care spending is large and growing, straining national, state, health insurance plans, and family budgets. Indeed, one of the most pressing issues in American medicine is how to ensure that all populations, in every community, derive the benefit from scientific research that has already been completed. Addressing these questions from the perspective of health care delivery is necessary to accelerate the decline in cancer mortality that began in the early 1990s. This article, part of the Cancer Control Blueprint series, describes challenges with the provision of care across the cancer control continuum in the United States. It also identifies goals for a high-performing health system that could reduce disparities and the burden of cancer by promoting the adoption of healthy lifestyles; access to a regular source of primary care; timely access to evidence-based care; patient-centeredness, including effective patient-provider communication; enhanced coordination and communication between providers, including primary care and specialty care providers; and affordability for patients, payers, and society.

Keywords: access to care; burden of illness; cancer; health care; health insurance; spending; survivorship; value.

MeSH terms

  • Continuity of Patient Care / economics
  • Continuity of Patient Care / organization & administration*
  • Goals*
  • Health Equity / economics
  • Health Equity / organization & administration*
  • Health Services Accessibility / economics
  • Health Services Accessibility / organization & administration*
  • Humans
  • Insurance, Health / economics
  • Insurance, Health / organization & administration
  • Mass Screening / economics
  • Mass Screening / organization & administration
  • Neoplasms / economics*
  • Neoplasms / epidemiology
  • Neoplasms / prevention & control*
  • United States / epidemiology