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Goal Area: Early Detection

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Goal: Increase early detection of cancers to reduce late-stage diagnosis. 

The goal of screening and early detection of cancer is to find cancer at its most treatable stage and often before a person has symptoms. Finding cancers earlier, in addition to reducing mortality, can improve quality of life for survivors by subjecting them to less aggressive treatments, thereby minimizing side effects and maintaining quality of life. 

Screening programs for breast, cervical, colorectal, lung, and prostate cancers have contributed to the notable decline in cancer mortality and improvement in survival rates over the past several decades, demonstrating the power of early detection in reducing the burden of cancer. One example of the success of early detection is reflected in national data available for breast cancer. Since 1976, following the American Cancer Society’s recommendation for annual mammograms to detect breast cancer, incidence for the disease has increased, in part due to the increase in screening. Deaths since that time, however, have consistently decreased as more cancers are found earlier and successfully treated. Breast cancers found at the localized stage now have a 100% five-year relative survival rate, whereas breast cancers found at a distant, or late stage, have just a 32.6% five-year relative survival rate.lx  

The objectives contained here for cervical, colorectal, and lung cancer follow screening guidelines issued by the United States Preventive Services Task Force (USPSTF), which grades a variety of health interventions using a letter scale. Early detection objectives align with evidence-based practices with USPSTF A and B grades for recommended services where there is high certainty the net benefit is substantial, or moderate certainty of moderate or substantial benefit, respectively.lxi Nevada’s cancer control partners have unified in following the American Society of Breast Surgeons’ 2019 screening mammography guidelines.lxii 

While prostate, skin, and oral cancer screenings have not received A or B grades from USPSTF, they are included here with a focus on reducing late-stage diagnosis and encouraging use of screening for those who, after discussion with their health care provider, may determine they are at higher risk for incidence of any of these cancer types.  

Breast, Cervical, Colorectal, and Lung Cancer Objective and Indicators

Objective: Increase the percentage of adults screened for breast, cervical,  colorectal, and lung cancers. 
Strategies: 
  • Educate Nevadans on the importance of early detection and evidence-based screening guidelines and encourage screening advocacy among peer and influencer groups. 
  • Develop and share evidence-based public messaging on cancer screenings. 
  • Recognize and promote cancer awareness months.  
  • Promote culturally tailored messaging about early detection, including a focus on “body part first” messaging and personal risk. 
  • Improve access to cancer screening for low-income, uninsured, geographically isolated, and other medically underserved populations through financial assistance, navigation to medical homes, mobile screening services, and health literacy education.  
  • Train providers on evidence-based interventions and trauma-informed approaches to improve screening rates.   
  • Support technology initiatives for provider access and sharing of screening data. 
  • Expand reimbursement and provider education for navigation and community health worker services. 
  • Support the expansion of telehealth and telemedicine for cancer screening referral and follow-up. 
  • Support workforce development efforts to increase the number of practicing screening providers in Nevada. 
  • Advocate for diversified funding and policies to support access to recommended cancer screenings for all eligible Nevadans. 
Indicators: 

Percentage of women aged 40+ in who received a mammogram in the last two years. 
Baseline: 62.7% 
Target: 66% 
U.S.: 70.2% 

Percentage of women aged 21-65 who have been screened for cervical cancer based on USPSTF guidelines. 
Baseline: 76% 
Target: 80% 
U.S.: 77.7% 

Percentage of people aged 45+ who have been screened for colorectal cancer based on USPSTF guidelines. 
Baseline: 60.9% 
Target: 64% 
U.S.: 66.9% 

Percentage of people aged 50-80 eligible for lung cancer screening who have been screened.  
Baseline: 7.4% 
Target: 15% 
U.S.: 9.9% 

Source: BRFSS

Prostate Cancer Objective and Indicator

Prostate Cancer 

Prostate cancer screening, often performed as a blood test to detect levels of prostate specific antigen or PSA, has a USPSTF C-grade recommendation for those with a prostate, aged 55 to 69 who are at increased risk such as due to race/ethnicity or family history. Screening should be done only after a discussion of the potential harms and benefits of screening. Several factors led to this recommendation, primarily overdiagnosis and overtreatment of low-risk prostate tumors that might never have become clinically significant yet could result in treatment that exposes patients to unnecessary risks, such as impotence and incontinence.lxiii  

Black men in Nevada have a 74% higher risk of being diagnosed with prostate cancer
and a 114% higher risk of dying from the disease.lxiv  

While prostate cancer screening does not earn an A or B grade, it is particularly important for Black men, who face a disproportionately higher incidence, earlier onset, more aggressive disease, and elevated mortality rates compared to other racial groups. In Nevada, Black men are more than 50% more likely to be diagnosed with prostate cancer than whites (184.1 vs. 107.6 per 100,000) and are more than twice as likely to die from the disease (47.8 vs. 21.9 per 100,000). Despite these risks, national data shows Black men are less likely to receive PSA screening and often encounter barriers such as mistrust of the healthcare system, poor physician-patient communication, limited knowledge about prostate cancer, and significant economic and geographic obstacles to care.  

Screening rates among Black men declined more sharply than among White men following the USPSTF’s shift away from recommending PSA testing and no recommendation for Black men specifically, such as for earlier screening or PSA monitoring, has been adopted. In Nevada, the rate of late-stage diagnosis of prostate cancer among Black men is similar to the state average and that of men of other races or ethnicities. As such, this plan seeks to reduce late-stage diagnosis of prostate cancer through a variety of strategies that, while not tailored to Black men, focus on the barriers to screening they encounter.  

 

 

Objective: Decrease the rate of late-stage prostate cancer diagnoses.  
Strategies: 
  • Educate Nevadans on prostate cancer risk and family history, early detection, and shared decision-making.  
  • Advocate for best practices in shared decision-making for screening. 
  • Recognize and promote Prostate Cancer Awareness Month in September. 
  • Strengthen collaboration with prostate cancer organizations. 
  • Develop a prostate cancer data report with an epidemiological review.   
  • Increase referrals for genetic counseling.  
  • Support policies for research and insurance coverage of screenings. 
Indicator: 

Percentage of late-stage prostate cancer diagnoses. 
Baseline: 21.7% 
Target: 20% 
Source: NCCR

Skin Cancer Objective and Indicator

Skin Cancer 

The USPSTF has ruled that there is insufficient evidence for skin cancer screenings in asymptomatic individuals, however not against screening for those who present with signs of skin cancer or who should be surveilled because of increased risk of skin cancer. The USPSTF also recommends sun safety and skin cancer prevention counseling for youth, adolescents, and young adults. As such, strategies provided in this plan to increase the early detection of melanoma focus on education on sun safety and the signs of skin cancer, risk factors, and access to skin cancer screening.  

Objective: Decrease the rate of late-stage melanoma diagnoses. 
Strategies: 
  • Educate Nevadans, including primary care providers, on the signs of skin cancer, including in skin of color, and the importance of regular skin checks and early detection. 
  • Recognize and promote Skin Cancer Awareness Month in May. 
  • Identify and train community influencers, such as hairdressers, barbers, and massage therapists, on the signs of skin cancer and how to discuss skin cancer screening with their clients. 
  • Recruit experts and champions, including individuals from communities of color, to participate in skin cancer early detection campaigns to support educational opportunities, and participate in other collaborative efforts.  
  • Support community skin check events, including skin checks at employee health fairs.  
  • Support policies and programs to expand the dermatology provider workforce in Nevada.
Indicator: 

Percentage of late-stage melanoma diagnoses. 
Baseline: 12.7% 
Target: 11.4%
Source: NCCR  

Oral and Oropharyngeal Cancers, also known as Head and Neck Cancers

Oral cancer and oropharyngeal cancer are two often overlooked cancers, despite increasing by about 1% per year since the mid-2000’s according to national statistics, largely driven by cancers occurring in the oropharynx. After decades of decline, mortality rates for these cancers have increased by 0.6% per year since 2009. In Nevada, incidence of cancers of the lip, oral cavity, and pharynx have remained steady over the past 15 years, however, similar to national rates, mortality has increased among both men and women in Nevada. The distribution of oral cavity cancers has shifted because of changing patterns in risk factors and because of an increase of about 2% per year in deaths from HPV-associated cancers of the base of the tongue, tonsils, and oropharynx.  

Oral cancers are more prevalent in an older adult population, yet are increasingly occurring in a younger population. Prevention of head and neck cancers through tobacco and alcohol cessation and HPV vaccination are addressed in the Prevention priority area of this plan. However, as incidence and mortality of these cancers continue to increase and as prevention efforts take some time to affect cancer burden, an emphasis must be placed on early detection of these cancers to prevent continued increased mortality. Screening for oral and oropharyngeal cancers is routine practice during recommended annual dental exams. Dental practitioners and specialists such as oral pathologists, oral surgeons, and ENTs, play an important role in the early detection of these, and other, cancers. 

Although the lateral borders of the tongue, floor of the mouth and soft palate are the high-risk locations, oral cancers of the gingivae (gums) and buccal mucosa (inner cheek) are increasing in incidence. Although approximately 90% of oral cancers are squamous cell carcinomas, both patients and healthcare providers should be aware that there are other cancers and malignancies that occur in the oral cavity, including salivary gland cancers, lymphomas, leukemias, mucosal melanomas, and odontogenic cancers in the maxilla and mandible. Metastatic cancers ranging from breast to colon to lung may also be seen in the oral cavity and jawbones and may be the first presenting sign of an unknown primary cancer in another organ.    

Dentists can play significant roles in detecting oral cancers early by performing comprehensive extra-oral and intra-oral examination. This involves feeling the head and neck for lymph nodes and masses and closely examining every specific area of the oral cavity methodically using a mouth mirror, tongue depressor and gauze. Every patient should visit their dentist twice a year and ask for their oral cancer screenings if they do not receive one. In addition, patients should regularly examine as much of their mouth as possible and bring any white patches, red patches, lumps, bumps, swellings or non-healing sores to the attention of their dentist. If the dentist does not have a diagnosis or the issue persists or worsens, patients should locate and make an appointment with a clinical oral pathologist or oral medicine specialist. These dental specialists are experts in oral diseases, tumors, and cancers and will evaluate the lesion and perform a surgical biopsy as needed. Most oral pathologists can be found in academic health centers and dental schools.  

The vast majority of oropharyngeal cancers are associated with the human papillomavirus. Therefore, HPV vaccination at an early age will greatly help with prevention for future generations. Oropharyngeal cancers are harder to visually detect than oral cancers. A mass may be visible on one side of the back of the mouth with redness, ulceration and asymmetry as compared to the other side. In some instances there may not be such a visible mass, but a patient may report difficulty swallowing, feel like “something is stuck” in their throat or have voice changes. There may be a swelling or enlarged lymph node on the lateral neck as the first indication of an oropharyngeal cancer. If a patient has these findings, they should be evaluated by an ENT doctor who will examine the oropharynx/throat through endoscopy and perform a biopsy as needed to determine the definitive diagnosis and management plan.  

Key Facts: 

  • About 4% of cancers diagnosed in the U.S. are head and neck cancers.lxv  
  • In 2025, there were an estimated 72,680 cases of head and neck cancer diagnosed and an estimated 16,680 deaths.lxvi 
  • The 5 major types of head and neck cancer include: 
    • Laryngeal and hypopharyngeal cancer 
    • Nasal cavity and paranasal sinus cancer 
    • Nasopharyngeal cancer 
    • Oral and oropharyngeal cancer 
    • Salivary gland cancer.  
  • In Nevada, as with the U.S. as a whole, head and neck cancer is more common in men than in women, with an incidence ratio approximately equal to 3:1 and is most commonly diagnosed among those ages 50 and older.lxvii  
  • Of the cases of head and neck cancer diagnosed in the United States, it is estimated that nearly 70% will be attributed to HPV infection.lxviii 

 

References

lx SEER Cancer Stat Facts, Breast Cancer. Accessed May 12, 2025, https://seer.cancer.gov/statfacts/html/breast.html  

lxi U.S. Preventive Services Task Force. "Grade definitions." July 2012, https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/grade-definitions. 

lxii American Society of Breast Surgeons. "Position Statement on Screening Mammography." 2019, https://www.breastsurgeons.org/docs/statements/asbrs-ppr-screening-mammography.pdf. 

lxiii Broderick, Jason M. "PSA screening in prostate cancer: The controversy continues." Urology Times, 2020, https://www.cancer.org/research/acs-research-highlights/prostate-cancer-research-highlights/screening---early-detection-prostate-cancer-studies/five-years-after-guidelines-recommend-against-prostate-cancer-screening.html. 

lxv National Cancer Institute, Head and Neck Cancers. Accessed May 13, 2025. https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet  

lxvi American Cancer Society Cancer Statistics Center. "Oral Cavity and Pharynx and Larynx." Accessed 13 May 2025, https://cancerstatisticscenter.cancer.org/types/oral-cavity-and-pharynx and https://cancerstatisticscenter.cancer.org/types/larynx. 

lxvii USCS Data Visualizations: Oral Cavity and Pharynx, rate of new cancers 2017-2021. Accessed 13 May 2025, https://gis.cdc.gov/Cancer/USCS/#/Demographics/. 

lxviii Centers for Disease Control and Prevention. "Head and Neck Cancers Basics." Accessed 13 May 2025, https://www.cdc.gov/head-neck-cancer/about/index.html#cdc_disease_basics_testing_screening-statistics.