Cancer Prevention and Control in Arkansas

Transcription

1 Cancer Prevention and Control in Arkansas Abby Holt, MPH Director, Arkansas Central Cancer Registry & Appathurai Balamurugan, MD, DrPH, MPH, FAAFP State Chronic Disease Director/Medical Director Arkansas Department of Health

2 Overview History of Cancer Prevention and Control in Arkansas Epidemiology of Cancers in Arkansas Present and Future Direction of Cancer Prevention and Control in Arkansas

3 Trends in Age-adjusted Cancer Death Rates by Site, Males, US

4 Trends in Age-adjusted Cancer Death Rates by Site, Females, US

5 Leading Sites of New Cancer and Deaths in the US 2018 Estimates

6 History of Cancer Prevention and Control in Arkansas Arkansas legislature authorized a state cancer registry A freestanding Cancer Commission through Act 277.» 11 major hospitals around the state gathered information on cancer and performed follow-up» Registry created using paper and pencil recording 1970s Registry was computerized, reporting was voluntary, and data quality was poor. State funding cuts led to discontinuation of the cancer registry in Act 435 authorized creation of a Central Cancer Registry to be housed at the Arkansas Department of Health.

7 History of Cancer Prevention and Control in Arkansas 1970 Bureau of Cancer and Special Services within the Division of Health Maintenance housed Cancer Registry and Cancer Screening divisions. 1980s Division of Health Maintenance was eliminated due to lack of funding. 1990s Division of Chronic Disease and Disability Prevention included programs such as Breast and Cervical Cancer Control (including BreastCare and the Arkansas Central Cancer Registry)

8 History of Cancer Prevention and Control in Arkansas 1992 CDC Federal Breast and Cervical Cancer Early Detection Program Capacity building funds 1995 CDC Federal Breast and Cervical Cancer Early Detection Program Implementation funds 1997 Breast Cancer Act was adopted by the legislature 1999 Arkansas BreastCare Program at ADH became fully operational

9 History of Cancer Prevention and Control in Arkansas 2001 Arkansas Cancer Control Taskforce created 2001 Arkansas Cancer Plan: A Framework for Action was written CDC Cancer Prevention funds to Arkansas Arkansas Cancer Control Taskforce eventually evolved into the Arkansas Cancer Coalition CDC funds Colorectal Cancer and Comprehensive Cancer to Arkansas

10 Cancer in Arkansas, 2014 Source: Centers for Disease Control and Prevention,

11 Contains the most recent data available on commonly diagnosed cancers in Arkansas, describes disparities in incidence and mortality, and indicates early and late stage diagnoses with an emphasis on survival. ns/details/cancer-registry

12 Epidemiology of Preventable Cancers Preventable Cancer Deaths Cancers where screening, early identification, and treatment has shown to decrease mortality Preventable Cancers - Breast Cancer - Cervical Cancer - Colorectal Cancer - Lung Cancer

13 Breast cancer Cancer of the female breast remains the 2 nd most common cancer Third leading cause of cancer death 2,100 new cases and 400 deaths per year due to female breast cancer in Arkansas Mammography has been a validated screening tool for female breast cancer

14 Age-standardized female breast cancer mortality trends, AR and US,

15 Age-standardized female breast cancer mortality rates, by race, AR,

16 Age-standardized female breast cancer incidence trends, AR and US,

17 Age-standardized female breast cancer incidence rates, by race, AR,

18 Invasive female breast cancer survival by Stage at Diagnosis, AR, Overall percent surviving after 10-years is 62%

19 Cervical Cancer Cervical cancer is less common with 150 new cases and 50 deaths per year in Arkansas The primary cause of cervical cancer is infection with certain types of human papillomavirus (HPV). The best way to prevent the HPV infections that cause cervical cancer is through vaccination. Pap tests and HPV testing are validated screening tools.

20 Age-standardized cervical cancer mortality trends, AR and US,

21 Age-standardized cervical cancer mortality rates, by race, AR,

22 Age-standardized cervical cancer incidence trends, AR and US,

23 Age-standardized cervical cancer incidence rates, AR,

24 Cervical cancer survival by Stage at Diagnosis, AR, Overall percent surviving after 10-years is 53%

25 Colorectal Cancer Colorectal cancer (aka, Colon cancer) is a cancer of colon and rectum 3 rd most common cancer, and 2 nd leading cause of cancer death 1,400 new cases and 600 deaths per year due to colorectal cancer in Arkansas Colonoscopy and FOBT/FIT has been validated screening tools for colorectal cancer

26 Age-standardized colorectal cancer mortality trends, AR and US,

27 Age-standardized colorectal cancer mortality rates, by race and sex, AR,

28 Age-standardized colorectal cancer incidence trends, AR,

29 Age-standardized colorectal cancer incidence rates, by race and sex, AR,

30 Colorectal cancer survival by Stage at Diagnosis, AR, Overall percent surviving after 10-years is 35%

31 Lung Cancer Lung cancer is the 2 nd common cancer in both men and women, and leading cause of cancer death 2,800 new cases and 2,100 deaths per year due to lung cancer in Arkansas Annual screening with low-dose CT in adults aged who have a 30 pack-year smoking history is recommended Prevention, through smoking cessation efforts, has played a larger role in reducing lung cancer deaths than screening

32 Age-standardized lung cancer mortality trends, AR and US,

33 Age-standardized lung cancer mortality rates, by race and sex, AR,

34 Age-standardized lung cancer incidence trends, AR,

35 Age-standardized lung cancer incidence rates, by race and sex, AR,

36 Lung cancer survival by Stage at Diagnosis, AR, Overall percent surviving after 10-years is 7%

37 Present and Future Direction of Cancer Prevention and Control in Arkansas

38 Numbers of BreastCare Enrollees BreastCare Program Enrollees, ,000 4,500 December 2013: Cessation of AR Medicaid 07 treatment options for breast & cervical CA January 2014: ACA Medicaid Expansion 4,000 3,500 3,000 3,225 3,012 3,224 2,689 3,648 September 2014: Eligibility criteria changes to include breast symptomatic women <40 years of age and women at FPL <250% March 2016: Cervical CA screening expansion for women ages years and inclusion of underinsured women 2,500 2,000 1,500 2,179 1,891 1,546 1,417 1,317 1,182 1,343 1,401 1,389 1,756 2,175 2,271 1,951 2,114 1,000 1,

39 Percentage 90.0% Women aged who had a mammogram within the past two years - AR vs US, % 80.0% 79.3% 79.7% 80.0% 79.5% 76.2% 78.1% 77.9% 77.0% 75.6% 77.5% 75.0% Arkansas 74.8% 74.1% 74.3% 72.6% 73.0% US 70.0% 70.2% 69.1% 70.0% 69.2% 65.0% 66.5% 60.0%

40 Percentage 100.0% Women aged 18+ who had a Pap test within the past three years - AR vs US, * 95.0% 90.0% 85.5% 86.8% 87.2% 86.0% 85.0% 84.0% 82.9% 80.0% 82.7% 83.6% 83.2% 81.8% 80.5% 80.8% 81.3% 78.0% Arkansas US 75.2% 75.0% 74.8% 70.0% 73.0% 72.6% 65.0% 60.0%

41 Hotspots

42 Why? Who are we missing? Hard-to-Reach Populations

43 What is Hotspotting? A method to identify areas with disproportionately high cancer mortality to low incidence, adjusted to the baseline risk of the population

44 Hotspotting The mortality-to-incidence ratio (MIR) provides a population-based indicator of survival, and is used to identify Hotspots Cancer incidence, specifically, early-stage compared to late-stage denotes benefits of screening

45 County Mortality: Incidence ratios for Female Breast Cancer:

46 County Mortality: Incidence ratios for Cervical Cancer: NA implies no deaths and/or no cases Cervical cancer is too rare for our method to work very well

47 County Mortality: Incidence ratios for Colorectal Cancer:

48 Implications of Hotspotting Preventable Cancers

49 Targeted Outreach Efforts Strategies for Hard-to-reach populations - Mobile mammography - After hour and weekend mammography facilities - Patient navigation - Case management

50 Targeted Outreach Efforts contd. Non-traditional screening venues: - Churches (Pink Carnation Sunday) - Worksites Communication strategies: Mass media, Billboards in hotspots

51 Road ahead for Cancer Prevention and Control in Arkansas Continued screening, early detection, and treatment efforts Bringing together all Cancer Prevention and Control partners through Arkansas Cancer Coalition All Hands-on-Deck approach

52 Questions?!