According to the National Cancer Institute (NCI), a cancer survivor is
anyone living with, through, or beyond a cancer diagnosis. While we
use the term “cancer survivor” here in this report, it is important to
note that not all people with a cancer diagnosis identify with it.
As a result of advances in cancer research more people are
surviving longer and leading fuller lives after their initial cancer
diagnosis. In fact, the number of cancer survivors living today in the
United States is estimated to have risen to more than 13. 7 million,
which is approximately 4 percent of our nation’s population ( 2).
This is a growing population; in fact, it is estimated that the number
of cancer survivors in the United States will reach 18 million by
2022 ( 2). This expansion can be attributed to numerous factors
including earlier cancer detection, which increases the chance
for curative treatment; more effective and less toxic treatments,
particularly for advanced and metastatic disease; and the aging
and growing population.
Also increasing is long-term survivorship. However, survivorship
rates vary considerably depending on cancer type, patient age at
diagnosis, and other characteristics. In the United States in 2012,
an estimated 64 percent of survivors were diagnosed with cancer
five or more years ago, and 15 percent were diagnosed 20 or more
years ago ( 2). Among children diagnosed with cancer, the chances
of long-term survival are even greater: three out of every four
American children receiving a cancer diagnosis are alive 10 or more
years later (95).
There are at least three distinct phases associated with cancer
survival, each accompanied by its own unique set of challenges.
These phases include the time from diagnosis to the end of initial
treatment, the transition from treatment to extended survival, and
long-term survival. Here, we focus on the issues facing long-term
cancer survivors, which vary depending on the age of the survivor.
While some cancer survivors experience few, if any, health-related
challenges, many suffer serious and persistent adverse outcomes.
Some of these effects may start during cancer treatment and
continue long term, but others can appear months or even years
later. These long-term and late effects may be emotional and/or
physical. For example, cancer survivors are at increased risk for
anxiety and depression as well as damage to the heart, lungs, and
kidneys, cognitive impairment, and infertility.
Further, many survivors live in fear that their cancer will return at
some point. In fact, cancer survivors are at risk for recurrence of
the original cancer and for the development of a new, biologically
distinct, second cancer, with risk dependent on the original type of
cancer, stage of disease at diagnosis, and treatments received.
The almost 60,000 pediatric cancer survivors (aged from 0 to 14
years) estimated to be living in the United States often face an
increased risk of serious negative long-term and late effects as a
result of treatments received while their bodies are still developing
( 2). Adolescents (ages 15 to 19 years) and young adults (ages 20
to 39 years) also have to confront a distinctive set of concerns,
including adapting to long-term cancer survivorship while beginning
careers and thinking about families of their own.
It is clear that a person diagnosed with cancer may be faced with
critical problems that diminish their quality of life for many years.
Thus, a new focus for cancer research is to help the increasing
number of cancer survivors achieve a higher quality of life by
avoiding or diminishing the potential long-term and late effects
of successful treatments. By gaining a better understanding of
these issues confronting cancer survivors, the cancer research
and advocacy community can continue to play an integral role
in meeting the needs of survivors, their loved ones, and future
Americans navigating the cancer journey.
CT screening for early detection of lung cancer, are most
Prevention and Detection of Tumor Recurrence
clinically effective when targeted at those at highest risk of
developing the disease for which they are being screened
(94). Targeting those most at risk also has the benefit of
decreasing the complications and cost of unnecessary health
care interventions for those at low risk of disease. Research
to develop new, accurate, and reliable ways to discern an
individual’s cancer risk is vital to ensure that the public has
confidence in current screening guidelines and any future
changes to these guidelines.
As for prevention and early detection of primary tumors,
our increasing knowledge of the risk factors for cancer
occurrence and progression is enabling us to identify those
cancer survivors with the highest risk for tumor recurrence
(see sidebar on Cancer Survivorship). This is allowing us to
direct risk-reducing medical interventions to only those who
will benefit, reducing health care costs associated with treating
those who will not benefit and may even be harmed.
Currently, there are few established ways to identify cancer
survivors at high risk for disease recurrence. One group known
to be at high risk is women who have successfully completed
treatment for invasive breast cancer. A subset of patients
in this group has breast cancer powered by the hormone
estrogen. For these women, drugs that block the effects or