Addressing The Cancer Burden
At A Glance
The Burden of Cancer
Cancer is the second leading cause of death in the United States, exceeded only by heart disease. In 2010, nearly 575,000 people died of cancer, and more than 1.45 million people had a diagnosis of cancer, according to the United States Cancer Statistics: 1999–2010 Incidence and Mortality Web-based Report.
The cost of cancer extends beyond the number of lives lost and new diagnoses each year. Cancer survivors, as well as their family members, friends, and caregivers, may face physical, emotional, social, and spiritual challenges as a result of their cancer diagnosis and treatment. The financial costs of cancer also are overwhelming. According to the National Institutes of Health, cancer cost the United States an estimated $263.8 billion in medical costs and lost productivity in 2010.
Racial and Ethnic Differences
Cancer can affect men and women of all ages, races, and ethnicities, but it does not affect all groups equally. For example, African Americans are more likely to die of cancer than people of any other race or ethnicity. In 2010, the age-adjusted death rate per 100,000 people for all types of cancer combined was 203 for African Americans, 171 for whites, 122 for American Indians/Alaska Natives, 119 for Hispanics, and 108 for Asians/Pacific Islanders.
Effective Cancer Prevention Measures
Opportunities exist to reduce cancer risk and prevent some cancers. Cancer risk can be reduced by avoiding tobacco, limiting alcohol use, limiting exposure to ultraviolet rays from the sun and tanning beds, eating a diet rich in fruits and vegetables, maintaining a healthy weight, being physically active, and seeking regular medical care. Research shows that screening for cervical and colorectal cancer at recommended intervals can prevent these diseases by finding lesions that can be treated before they become cancerous. Screening also can help find cervical, colorectal, and breast cancers at an early, treatable stage. Vaccines also can reduce cancer risk. The human papillomavirus (HPV) vaccine helps prevent some cervical, vaginal, and vulvar cancers. The hepatitis B vaccine can reduce liver cancer risk. Making cancer screening, information, and referral services available and accessible to all Americans can reduce cancer incidence and deaths.
CDC’s Leadership in Detecting, Preventing, and Controlling Cancer
CDC is a leader in cancer prevention and control in the United States. CDC's Division of Cancer Prevention and Control (DCPC) works with national organizations, state health agencies, tribes and tribal organizations, territorial health agencies, and other key groups to develop, implement, evaluate, and promote effective cancer prevention and control practices.
DCPC's comprehensive, collaborative approach to addressing the nation's cancer burden includes the following activities:
Monitoring. CDC helps states, U.S. territories, tribes, and tribal groups collect data on cancer incidence and deaths, risk factors, and the use of screening tests. Public health professionals use these data to identify and track cancer trends, strengthen cancer prevention and control activities, and prioritize resources.
Conducting research and evaluation. CDC conducts and supports research and surveillance that contribute to scientific knowledge related to cancer prevention and control and applies this knowledge to strengthen public health activities, programs, and policies at local, state, national, and international levels. This research integrates many areas of expertise, including behavioral science, economics, epidemiology, communications, health services, medicine, and statistics.
Building capacity through partnerships. CDC works with many partners to translate research into public health programs, practices, and services. CDC helps states, U.S. territories, tribes, and tribal groups apply scientific advances to develop strong cancer control programs for the people who most need them.
Educating. CDC develops educational campaigns and materials to inform health professionals, policy makers, the media, and the public about cancer prevention and control.
CDC's National Cancer Programs
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) helps low-income, uninsured, and underinsured women access lifesaving breast and cervical cancer screening and diagnostic services. The program provides services such as mammograms, Pap tests, clinical breast exams, and pelvic exams, as well as diagnostic follow-up for abnormal screening results and treatment referrals if cancer is diagnosed. It also supports essential public health activities—such as outreach, education, case management, quality assurance, and program evaluation—that are necessary to implement effective screening programs. Since it began in 1991, the NBCCEDP has provided more than 11 million breast and cervical cancer screening exams to more than 4 million women in all 50 states, the District of Columbia, 5 U.S. territories, and 11 tribes or tribal groups.
The National Comprehensive Cancer Control Program (NCCCP) brings together coalitions of key stakeholders in all 50 states, the District of Columbia, 7 U.S. territories, and 7 tribes or tribal groups to assess the burden of cancer, set priorities, and develop and implement comprehensive cancer control (CCC) plans. The NCCCP is working with CCC coalitions to develop and implement policy, system, and environmental changes that can promote primary prevention (e.g., through smoke-free policies), help doctors detect cancers when they are more treatable (e.g., through cervical and colorectal cancer screening), increase access to quality treatment, and address the needs of cancer survivors.
The National Program of Cancer Registries (NPCR) collects data on the number of cancer cases, as well as information on the type, extent, and location of cancers; stage at diagnosis; and the type of initial treatment. The NPCR supports central cancer registries in 45 states, the District of Columbia, Puerto Rico, and the U.S. Pacific Island jurisdictions. Data collected by these registries represent 96% of the U.S. population. Together, NPCR and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program collect data for the entire U.S. population. CDC collaborates with the SEER Program to publish these data annually in the United States Cancer Statistics: Incidence and Mortality Web-based Report. These data are used to assess the incidence of different cancers, guide prevention efforts, and address health disparities. The NPCR is working to enhance the use of cancer registry data by collecting additional data, expanding electronic reporting, and testing innovative public health applications of the data.
The Colorectal Cancer Control Program (CRCCP) is working to increase colorectal cancer screening rates among U.S. adults aged 50 years or older to 80% by 2014. The CRCCP supports 25 states and 4 tribal groups to provide screening and diagnostic follow-up care for low-income, uninsured populations; data collection and tracking; public education and outreach; case management; education for health care providers; and evaluation activities to measure clinical outcomes, costs, and effectiveness of the CRCCP. Grantees must use recommended, evidence-based screening tests and strategies (e.g., patient and provider reminder systems) to increase screening rates.
Additional Initiatives to Address Cancer
In addition to national cancer control programs that focus on breast, cervical, and colorectal cancers, CDC supports education awareness, and research activities that are designed to address cancer survivorship and reduce the burden of prostate, gynecologic, ovarian, and HPV-associated cancers.
Prostate cancer. CDC conducts research and develops materials to help people make informed decisions about prostate cancer screening. Current research focuses on how patients with prostate cancer make treatment decisions and how a patient's partner influences these decisions. This research also looks at the screening behaviors of primary care physicians and the patterns of follow-up care for American Indian men who have elevated prostate-specific antigen levels.
Gynecologic cancers. CDC provides information and educational materials for women and health care providers to raise awareness about the leading gynecologic cancers: cervical, ovarian, uterine, vaginal, and vulvar. These materials are part of the public health campaign Inside Knowledge: Get the Facts About Gynecologic Cancer. CDC also works with other organizations to add to the growing knowledge on ovarian cancer through projects designed to identify the factors related to early detection, treatment, and survivorship. Current research is examining awareness and adherence to screening guidelines by general practitioners, clinical practice in the follow-up of ovarian masses, availability of gynecologic oncologists for ovarian cancer care, and ovarian cancer treatment patterns and outcomes.Cancer survivorship. Because of advances in detecting and treating cancer, more people are living longer after diagnosis. However, survivors often face a range of health challenges. CDC worked with its partners to develop A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies to find ways to meet the needs of cancer survivors and their family members, caregivers, and health care providers. Guided by this report, CDC works with national, state, local, territorial, and tribal groups to conduct and support programs and research that promote the well-being of cancer survivors from diagnosis through the years after treatment.
To help ensure that people are healthy at every stage of life, CDC is committed to the following activities:
Increasing the emphasis on primary prevention by integrating tobacco prevention and control into all state cancer control activities and providing routine referrals to quitlines as part of all cancer screening programs.
Leveraging opportunities provided by health reform legislation to expand the reach of early detection activities by
Supporting activities that will help CDC and key stakeholders understand the potential impacts of this legislation.
Using CDC's existing infrastructure in state health departments to expand the delivery of evidence-based clinical preventive services.
Exploring new roles for public health as barriers to screening are reduced.
Focusing on population-based approaches related to quality assurance, policy and system change, and effective communication strategies in order to increase the use of recommended breast, cervical, and colorectal screening.
Increasing the use of cancer registry data by state and local health officials to meet policy priorities and ensure screening and treatment quality. These data also can be used to guide future prevention efforts, monitor changes in disease patterns, and tailor early detection and primary prevention strategies to communities with the greatest needs.
Defining and supporting evaluation and applied research activities to reduce disparities in cancer rates among different population groups.
Expanding CDC's public health strategies to address cancer survivorship in underserved populations and improve end-of-life support for cancer patients and their families, friends, and caregivers.
Kentucky Cancer Registry: Using Data for Colorectal Cancer Control
In Kentucky, acute care hospitals and their associated outpatient facilities are required to report all diagnosed cases of cancer to the Kentucky Cancer Registry. In 2001, the data indicated that colorectal cancer incidence and deaths were increasing in the state and that colorectal cancer was the second most common cause of cancer death among men and women combined in Kentucky. The data also indicated that only about one-third of Kentuckians were receiving screening tests as recommended by national guidelines.
Screening tests for colorectal cancer, including colonoscopy and sigmoidoscopy, can detect precancerous polyps and early-stage colorectal cancer when it is more treatable. To help reduce colorectal cancer rates in Kentucky, registry staff collaborated with representatives from comprehensive cancer control (CCC) programs at the state and regional level, including the Kentucky Cancer Consortium and Kentucky Cancer Program. Registry data can be used to support the need to implement interventions proven to prevent and control cancer.
Since 2001, state officials in Kentucky have been working together to use the data provided by the Kentucky Cancer Registry to reduce the state's burden of colorectal cancer. In 1999, only 34.7% of eligible Kentuckians were screened by colonoscopy or sigmoidoscopy. In 2008, the percentage had nearly doubled, to 63.7%. Colorectal cancer incidence among men and women combined was 68.5 per 100,000 people in 2001, but had declined to 57.1 in 2006. Death rates in 2001 were 22.4 per 100,000, but declined to 18.9 in 2006.
Registry data helped to guide the decision of state officials to focus on colorectal cancer, which has resulted in fewer diagnoses of colorectal cancer among Kentuckians and fewer deaths. This success should encourage public health officials to use registry data to address other types of cancer. Registry staff continue to use the data collected each year to highlight the need for effective interventions to reduce cancer rates in the state and to monitor progress toward meeting this goal.
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Delaware Cancer Consortium: Using Strategic Planning and Sustained Partnerships
In 2009, the CDC-funded Delaware Cancer Consortium (DCC) received the 2009 Exemplary State Comprehensive Cancer Control Implementation Award for its cancer prevention initiatives. The DCC has achieved major milestones in cancer prevention by implementing a strategic 4-year plan and partnering with the American Cancer Society, hospitals and medical practices throughout Delaware, and state policy makers.
Delaware now leads the nation in the percentage of people who have received a colonoscopy or sigmoidoscopy in the last 5 years. Screening rates for colorectal cancer in Delaware are more than 12 points higher than national rates. In addition, the state ranks 7th in the country for the percentage of women older than age 50 who have had a mammogram in the last 2 years and 11th for the percentage of women aged 18 or older who have had a Pap smear in the last 3 years.
The DCC's efforts also have helped to reduce health disparities and cancer risk factors among population groups at higher risk. For example, smoking among Delaware adults is at an all-time low of 18.9%, and cancer incidence is declining three times faster among African Americans than among whites. By implementing a strategic plan and creating sustainable partnerships with other groups, public health officials in Delaware have been able to make tangible policy and system changes. The state serves as a model for other CCC programs throughout the United States.
Texas Cancer Programs: Working Together to Expand Breast Cancer Screening Services
The Texas Cancer Registry is a statewide, population-based registry that collects data to measure the state's cancer burden, as well as its progress in preventing, diagnosing, and treating cancer among residents. In 2009, data from the registry showed that six counties in the western Dallas-Fort Worth area had the highest incidence of invasive breast cancer in the state. These counties are Tarrant (which includes the city of Fort Worth), Denton, Wise, Parker, Hood, and Johnson. These 6 counties cover about 5,000 square miles and have a combined population of nearly 3 million people. Registry data also indicated that access to mammography screening in these counties was limited and that screening rates for breast cancer were low.
To address this public health problem, researchers at the University of Texas Southwestern Medical Center's Moncrief Cancer Institute proposed expanding the institute's Breast Cancer Screening and Patient Navigation (BSPAN) program. The BSPAN program works to remove geographic and financial barriers that prevent women from getting the services they need and helps patients navigate the health care system. It was developed on the basis of guidelines from the 2005 Texas Cancer Plan, which is the foundation of the Texas CCC Program.
Because of the BSPAN program's success in the primarily urban Tarrant County, researchers proposed expanding it into Tarrant's rural, underserved neighboring counties. Staff working in the BSPAN program and the Moncrief Cancer Institute met with epidemiologists in the Texas Cancer Registry and the Texas Breast and Cervical Cancer Screening program to discuss the best way to analyze registry data and coordinate their efforts. BSPAN program staff also applied for funding from the new Cancer Prevention and Research Institute of Texas.
The application for this funding highlighted the program's collaborations with other state organizations and provided data from the Texas Cancer Registry to demonstrate the need for expanded services in areas with high rates of disease and low rates of screening. It also proposed that registry data be used to monitor and evaluate the program's success.
The application was successful, and the BSPAN program received more than $900,000 to expand its services into Denton, Wise, Parker, Hood, and Johnson counties. This expansion will increase access to breast cancer screening, diagnostic mammograms, and biopsies, which should help to reduce cancer rates among women in these counties.
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