Despite significant progress in the early detection, treatment, and survivorship of cancer in recent decades, cancer disparities continue to plague segments of the US population. Many of these cancer disparities, especially those among historically marginalized racial and ethnic groups and those with lower socioeconomic resources, are caused and perpetuated by social and structural barriers to health. These social and structural barriers, which operate beyond the framework of cancer control, also systematically increase vulnerability to and decrease adaptive capacity for the deleterious effects of anthropogenic climate change. The established and emerging overlap between climate vulnerability and cancer risk presents complex challenges to cancer control, specifically among populations who suffer compounding hazards and intersectional vulnerabilities. By embracing these intersections, we may be able to conceptualize promising new research frameworks and programmatic opportunities that decrease vulnerability to a wide range of climate and health threats to advance health equity.

Research on heat and its risks has focused on heat waves as an increasing emergency under climate change, but this emphasis has obscured the chronic—not just acute and episodic—exposure of billions of people globally to increasingly dangerous levels of heat. In many regions, predominantly in the global tropics, heat index exceeds a level of extreme caution according to the US National Weather Service (90°F, 32.2 °C) for more than an entire season and in some cases for much of the year. We propose chronic heat as an alternative framing for heat-related hazards in these regions and demonstrate how its risks differ and are incompletely captured by current heat–health research practices. Chronic heat poses unique risks compared to acute heat because the intersection of enduring societal- and individual-level factors leads to substantially divergent cumulative exposures over seasonal timeframes and associated health outcomes, quality-of-life impacts, and tradeoffs. These multiple interacting factors are difficult to tease out and attribute with traditional heat–health research practices, and therefore understanding of the impacts of chronic heat has remained poor. Further, managing chronic heat requires use of social services, programs, and partners not previously engaged in the context of heat, going beyond heat response as emergency management. Our chronic heat framework identifies a shift needed in heat research and practice to understand and address chronic and cumulative heat exposures increasingly experienced worldwide under intensifying climate change.

Structural inequity and environmental injustice in the US have patterned cancer disparities, particularly along racial and socioeconomic lines, while reducing the ability of affected communities to avoid these negative health outcomes.^1-3 The relationship between environmental injustice and elevated risk of cancer incidence and mortality is well established,^1,2 as are relationships between social risk factors and cancer,³ but cancer control studies in socially at-risk communities also affected by environmental injustice are less frequent. In this study, we use a novel environmental injustice index to characterize the prevalence of cancer screening across geographic clusters of social risk factors, environmental burden, and compounded social-environmental injustice in 6 densely-populated urban areas.

Background: Annual mammography screening declined year-on-year during the COVID-19 pandemic through 2021. This study examined changes in 2022 compared with 2018 in the national prevalence of self-reported up-to-date mammography. Methods: Using 2018 to 2022 data from the Center for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, we assess relative changes defined as annual prevalence ratios (aPR) in the SR receipt of past-year and up-to-date (UTD) breast cancer screening (biannual mammography in women of ages 50–74 years) during the third year of the COVID-19 pandemic overall and by sociodemographic characteristics. Results: UTD breast cancer screening declined for the first time since 2018 [2018 compared with 2022, from 78.7%–76.6%; aPR, 0.97; 95% confidence interval (CI), 0.96–0.98] despite a small increase in past-year breast cancer screening from 2020 to 2022 (57.9%–59.6%; aPR, 1.03; 95% CI, 1.01–1.05). This translated to 747,791 fewer women reporting UTD with recommended breast cancer screening in 2022 versus 2018. UTD breast cancer screening declines between 2018 and 2022 were largest for American Indian/Alaska Native women (74.8%–62.2%; aPR, 0.83; 95% CI, 0.74–0.93), women with less formal educational attainment (< high school: 73.1%–65.5%; aPR, 0.9; 95% CI, 0.85–0.95), and women without a usual source of care (48%–42.9%; aPR, 0.85; 95% CI, 0.78–0.92). Conclusions: Previously noted pandemic-related declines in past-year breast cancer screening now reflect in women reporting being UTD, with the largest declines in American Indian/Alaska Native women and those with lower socioeconomic status. Impact: Future studies should monitor screening prevalence in relation to breast cancer diagnostic stage overall and by sociodemographic groups.

The American Inflation Reduction Act (IRA) of 2022 contains climate-related provisions that may have noteworthy implications for cancer control and prevention. This commentary assesses the potential co-benefits of the IRA for cancer control efforts, specifically policies and programs to reduce carcinogen exposure via air quality monitoring and air pollution reduction. Allocations through the IRA for air quality improvement, paired with its environmental justice provisions, hold promise for advancing cancer prevention by targeting resources to communities most susceptible to environmental hazards. Moreover, climate resilience measures dictated by the IRA are crucial for oncology professionals grappling with the dual challenges of climate change and cancer care. Climate-driven extreme weather events can exacerbate carcinogen exposure and disrupt access to cancer care, underscoring the need for resilient health-care infrastructure. The IRA’s provisions for clean energy incentives and infrastructure upgrades offer oncology care institutions opportunities to mitigate emissions and bolster resilience against climate-related disruptions, ultimately improving cancer outcomes. Climate-related initiatives funded by the IRA present a unique and timely avenue to advance equitable cancer control efforts. This commentary underscores the critical intersection between climate resilience policy and oncology care, highlighting the potential to promote a healthier and more resilient future for all.