examining the evidence & strategies to prepare for a successful fight against cancer in arkansas...

Examining the Evidence & Strategies to Prepare for a Successful Fight Against Cancer in ArkansasDeborah O. Erwin, PhDRoswell Park Cancer InstituteBuffalo, NY

What do you think is the single most important cancer we should prevent/target to lower cancer incidence in Arkansas?

1. Breast2. Cervix 3. Colorectal4. Lung 5. Melanoma/Skin6. Prostate

Breast

Cervix

Colorectal

Lung

Melanoma/S

kin

Prosta

te

0% 0% 0%0%0%0%

If we select ….[from responses]What population group may need to be the focus forour efforts? 1. White Males2. White Females3. African American Males4. African American Females5. Youth – any race/ethnicity6. Adult- any race/ethnicity7. Other… W

hite M

ales

White

Females

Africa

n American M

ales

Africa

n American Females

Youth – any ra

ce/e

thnici

ty

Adult- any ra

ce/e

thnici

ty

Other…

0% 0% 0% 0%0%0%0%

What do you think is the second most important cancer we should prevent/target to lower the cancer incidence in Arkansas?


Breast

Cervix

Colorectal

Lung

Melanoma/S

kin

Prosta

te

0% 0% 0%0%0%0%

If we select ….[from responses]What population group may need to be the focus for our efforts? 1. White Males2. White Females3. African American Males4. African American Females5. Youth – any race/ethnicity6. Adult- any race/ethnicity7. Other…

White

Males

White

Females

Africa

n American M

ales

Africa

n American Females

Youth – any ra

ce/e

thnici

ty

Adult- any ra

ce/e

thnici

ty

Other…

0% 0% 0% 0%0%0%0%

What do you think is the single most important cancer we should prevent/target to lower the cancer death rate in Arkansas? 1. Breast2. Cervix 3. Colorectal4. Lung 5. Melanoma/Skin6. Prostate

Breast

Cervix

Colorectal

Lung

Melanoma/S

kin

Prosta

te

0% 0% 0%0%0%0%

If we select ….[from responses]What population group may need to be the focus for our efforts?

1. White Males2. White Females3. African American Males4. African American Females5. Youth – any race/ethnicity6. Adult- any race/ethnicity7. Other…

White

Males

White

Females

Africa

n American M

ales

Africa

n American Females

Youth – any ra

ce/e

thnici

ty

Adult- any ra

ce/e

thnici

ty

Other…

0% 0% 0% 0%0%0%0%

What do you think is the second most important cancer we should prevent/target to lower the cancer death rate in Arkansas? 1. Breast2. Cervix 3. Colorectal4. Lung 5. Melanoma/Skin6. Prostate

Breast

Cervix

Colorectal

Lung

Melanoma/S

kin

Prosta

te

0% 0% 0%0%0%0%


White

Males

White

Females

Africa

n American M

ales

Africa

n American Females

Youth – any ra

ce/e

thnici

ty

Adult- any ra

ce/e

thnici

ty

Other…

0% 0% 0% 0%0%0%0%

I would like to see the Arkansas Cancer Coalition members prioritize…

1. Increasing Screening2. Increasing Tobacco Cessation 3. Increasing Taxes on Tobacco products4. Disparities & improving cancer inequities5. Addressing Obesity & Nutrition issues6. Increasing Access to Treatment7. Addressing Palliative Care issues

Increasin

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Increasin

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...

Increasin

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Dispariti

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Addressi

ng Obesit

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ut...

Increasin

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Addressi

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iative Care

...

0% 0% 0% 0%0%0%0%

ARKANSASCancer Facts & Figures 2011

Breast Cancer Arkansas & U.S. rates13% of new cancers (8.937)7% of cancer deaths (2,079)

Slightly higher incidence for white women, but lower overall incidence than U.S.

However, African American women had much higher death rates and later stage at diagnosis, for more than the past decade

2007 Death rate: 26.1 per100,00 in2007

Cancer Plan Goal: 23.5 per100,000 in2020

To accomplish this goal, you will need to address the death rates in Black women…

New risk models for Breast Cancer in Black Women? Victoria Seewaldt, MD, (Duke Univ)

Low effectiveness of mammograms for diagnosing triple-negative BC (TNBC)

Improved outcomes with MRI Christine Ambrosone, PhD (Roswell Park)

Parity increased risk of TNBC in Black women

These TNBC risks completely reduced in Black women if they breastfeed

Palmer, J. R. et al. (2014). Parity, lactation, and breast cancer subtypes in African American women: Results from the AMBER consortium. Journal of the National Cancer Institute, 106(10), 10.1093/jnci/dju237. Print 2014

Seewaldt VL, Weitzel J. Predicting risk in underserved populations. Podium Presentation at the American Association for Cancer Research; November 2014; San Antonio, Texas.

Cervical Cancer Arkansas & U.S. rates Only 1% of incidence and mortality, but…

The incidence and higher mortality rates are driven by the disease impact in Black women

Cancer Plan: Reduce the death rate from cancerof the uterine cervix.3.1 per100,000 to2.8 per100,000

Cancer Plan…. To reduce the death rate from cancer of the

uterine cervix. 3.1 per 100,000 to 2.8 per 100,000 Increase the proportion of women aged 18

years and older who receive a cervical cancer screening based on the most recent guidelines.

80.8 percent 88.9 percent

Increasing HPV VACCINATIONS in process …

(AR Cancer Plan 3)

Colorectal CancerArkansas & U.S. rates 11% of new cancers (7,490) 10% of cancer deaths (2,964)

Cancer Plan: Increase screening from 55.3% to 60.8%. Decrease incidence of invasive colorectal cancer45.3 per 100,000 in 2007 to 40.8 per 100,000 in 2020.

Colorectal Cancer

Cancer Plan: Reduce deaths from colorectal cancer.18.5 per 100,000(colon, rectum, anus) in 200716.7 per100,000 in 2020

So, again, addressing the racial inequities may need to be a priority… for screening & treatment

Additional evidence for addressing colorectal cancer screening/treatment practices among Black Arkansans….Especially since colonoscopy can prevent invasive cancers

Prostate CancerArkansas & U.S. rates 16% of new cancer cases (11,217)6% of deaths (1,653)

Arkansas rates of new prostate cancers and death rates are comparable to US Rates

New cases are decreasing, but Black men continue to have higher incidence rates than white men

Death rates continue to decline for all men …but remain 186% higher for Black men than white men (3 x more likely to die)

Prostate Cancer Challenges for Cancer Control Screening/treatment protocols

controversial Over 80% of cases are diagnosed at an

early stage (All races/ethnicities) Steps to change behavior to impact

incidence and/or mortality are unclear… May be more in the area of treatment &

research to determine most lethal variants

Lung CancerArkansas & U.S. rates19% new cancer cases (12,935)37% cancer deaths (10,384)

Lung cancer death rates in Arkansas are over 25% higher than in the U.S. in general

Cancer Control Plan: Reduce the lungcancer death rates57.2 per100,000

Is this enough ???

Arkansas Cancer Control PlanGOAL for Tobacco/Lung Cancer: De-normalize all forms of nicotine addiction

through comprehensive evidence-based plans to reduce the tobacco industry’s influence on the community and thereby to reduce the future incidence of lung cancer.

NO SPECIFIC PLAN FOR GREATER TAXATION OR FUNDING OF QUITLINE & MARKETING OR SMOKE-LIMITING LEGISLATION

Purple counties > SMR

Smoke-free laws reduce exposure to secondhand smoke, encourage and increase quitting and cutting back among current smokers, and reduce health care, cleaning and lost productivity costs.

Tobacco Cost & Taxation Arkansas

$6.07 (66% of smokers paid <$4.)

Ranked 32nd – Lowest: Virginia & Missouri at $5.25

2008 Survey: 29.5% no tax increase 25.2% .25- .75/pack 16.4%

$1.00-$2.00/pack 28.9% $3.00 or more

New York $9 - $12.85 retail Tax is $4.35 per

pack, Fed is $1.01 Much cheaper for

native brands on the reservation (maybe $4 a pack or less).

What happens when you tax cigarettes at $5.36/pack…?

For more detail http://www.tax.ny.gov/bus/cig/cigidx.htm

http://www.tax.ny.gov/bus/cig/cigidx.htm

Arkansas (2008)• 20.7% current

smokers• Since 2002, down

18%• 63.4% seriously

considering stopping within next 6 months

New York (2013)• 16.6%

smokers

The best news…

Smoking rates among high school students in 2012 are down to 11.9%, the lowest in NY since health officials began keeping track in 1997.

Arkansas: • 23.5% high school

students• 6.9% middle school

students (2010)• 34% decrease since 2007• 26% of 18-24 y.o

High school youth smoking is down by 56% (2000 to 2012) Middle school youth declined by 70%

For every 10% increase in the retail price of a pack of cigarettes, youth smoking rates drop by 6.5% and overall cigarette consumption declines by 4%

Reducing Smoking & Cancer Rates in Spite of SES... 21 percent of New Yorkers have incomes

below the poverty level 21 percent of New Yorkers are enrolled

in Medicaid 68 percent of New Yorkers are without a

bachelor’s degree 33 percent of New Yorkers report poor

mental health All of these features of New York’s

population affect cancer prevention

Requiring that health insurance plans for all state employees, Medicaid beneficiaries and other tobacco users cover a comprehensive cessation benefit, including a range of treatment options, will curb tobacco-related death and disease in states and ultimately save money.

Other Cancer Control Issues

Nutrition, Obesity & Exercise 1/4 to 1/3 of all cancers are tied to poor

nutrition, physical inactivity and excess weight.

31.5% of adultArkansans are obese (BRFSS

2009)

Goal 28.6%Target setting

method:10%

improvement

Cancer Risk Factors

See Handout…

Policy & Systems Change Primary approach for addressing obesity

Fructose, Sugar, Fructose, Sugar USDA, Big Food Producers… Lobby

nightmare

Fat Chance: Beating the Odds Against Sugar, Processed food, Obesity and Disease. Robert H. Lustig, MD, MSL. New York, NY: Penguin Group, 2014.

Other Cancer Control IssuesNutrition, Obesity & Exercise 1/4 to 1/3 of all cancers are tied to poor


Tanning & Skin Cancers

US rate (men & women) 21.3/100,000

Other Cancer Control IssuesNutrition, Obesity & Exercise 1/4 to 1/3 of all cancers are tied to poor


Tanning & Skin Cancers

Palliative Care

Based on the evidence… Cancer Control Plans may need to include:

Screening, Early Detection & Treatment… 1 in 3 adults from ages 50 to 75 is still

not getting screened as recommendedBecause tobacco use and lung cancer are such a major contributor to disease and death from cancer… Tobacco control programs including

legislation - reduce tobacco use and tobacco-related

disease, resulting in reduced tobacco-related health care costs.

• The overall cancer mortality rate target for Healthy People 2020 is 160.6 per 100,000 population

New York• Lung, colorectal,

prostate and female breast cancers account for approximately half of all cancer cases and deaths in NYS.

• 2009, the age-adjusted cancer mortality rate was 161.9 cases per 100,000 New Yorkers.

Impacting Mortality Rates

Arkansas ca death rate: 200.2 per 100,000 in 2007

Arkansas Cancer Control Plan Goal: 180.2 per

100,000 in 2020Is this enough…?

What do you think is the single most important cancer we should prevent/target to lower the incidence?


Breast

Cervix

Colorectal

Lung

Melanoma/S

kin

Prosta

te

0% 0% 0%0%0%0%



White

Males

White

Females

Africa

n American M

ales

Africa

n American Females

Youth – any ra

ce/e

thnici

ty

Adult- any ra

ce/e

thnici

ty

Other…

0% 0% 0% 0%0%0%0%

What do you think is the second most important cancer we should prevent/target to lower the incidence?


Breast

Cervix

Colorectal

Lung

Melanoma/S

kin

Prosta

te

0% 0% 0%0%0%0%



White

Males

White

Females

Africa

n American M

ales

Africa

n American Females

Youth – any ra

ce/e

thnici

ty

Adult- any ra

ce/e

thnici

ty

Other…

0% 0% 0% 0%0%0%0%

What do you think is the single most important cancer we should prevent/target to lower the cancer death rate in Arkansas?


Breast

Cervix

Colorectal

Lung

Melanoma/S

kin

Prosta

te

0% 0% 0%0%0%0%



White

Males

White

Females

Africa

n American M

ales

Africa

n American Females

Youth – any ra

ce/e

thnici

ty

Adult- any ra

ce/e

thnici

ty

Other…

0% 0% 0% 0%0%0%0%

What do you think is the second most important cancer we should prevent/target to lower the cancer death rate in Arkansas? 1. Breast2. Cervix 3. Colorectal4. Lung 5. Melanoma/Skin6. Prostate

Breast

Cervix

Colorectal

Lung

Melanoma/S

kin

Prosta

te

0% 0% 0%0%0%0%


White

Males

White

Females

Africa

n American M

ales

Africa

n American Females

Youth – any ra

ce/e

thnici

ty

Adult- any ra

ce/e

thnici

ty

Other…

0% 0% 0% 0%0%0%0%

I would like to see the Arkansas Cancer Coalition members prioritize…

1. Increasing Screening2. Increasing Tobacco Cessation 3. Increasing Taxes on Tobacco products4. Disparities & improving cancer inequities5. Addressing Obesity & Nutrition issues6. Increasing Access to Treatment7. Addressing Palliative Care issues

Increasin

g Screening

Increasin

g Tobacco Cessa

...

Increasin

g Taxes o

n Toba...

Dispariti

es & im

provin

g ...

Addressi

ng Obesit

y & N

ut...

Increasin

g Access

to Tr

e...

Addressi

ng Pall

iative Care

...

0% 0% 0% 0%0%0%0%

Questions?

Yes, this is what lake effect snow looks like from the outside…

examining the evidence & strategies to prepare for a successful fight against cancer in arkansas...

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