Strategic Plan Progress Report

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1 2007 Strategic Plan Progress Report

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3 Table of Contents Leadership Message... 3 Introduction... 5 Cancer All Sites Leadership Roles Information and Quality of Life Research Prevention and Early Detection Colorectal Cancer Lung Cancer Breast Cancer Collaborative Roles Prostate Cancer Nutrition and Physical Activity Skin Cancer Comprehensive School Health Education Global Cancer Control Income Development Historical Change

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5 Leadership Message I find the great thing in this world is not so much where we stand, as in what direction we are moving. Johann Wolfgang von Goethe As it has throughout its 94-year history, the American Cancer Society is moving aggressively forward in its fight against cancer. As 2007 draws to a close, our organization has every reason to be proud. We have achieved measurable progress toward our 2015 challenge goals for the nation and toward fulfilling our leadership roles, and we have undertaken a bold new initiative that our studies show has lifesaving potential. And as always our every accomplishment is making a lasting and tangible difference for people touched by cancer worldwide. Of course, success for the American Cancer Society is ultimately measured in terms of lives saved. This year again gave us cause for celebration as cancer mortality rates continued to measurably drop, and as we achieved a second consecutive annual decline in the actual number of cancer deaths a particularly challenging feat given our growing and aging population. Nearly 11 million cancer survivors are living proof that we are indeed making life-affirming progress. We achieve this ultimate bottom line through our continued global leadership in the areas of cancer information, quality of life, research, prevention and early detection. This report chronicles many milestones as well as challenges that demand additional attention. We are justly proud of the Society s many accomplishments, but this is not the time to rest on our laurels. As long as people are still needlessly suffering and dying from cancer and as long as there are disparities in the cancer burden, we still have much work to do. As long as our nation s broken health care system remains a critical barrier to achieving our goals, we must not rest. That s why we have launched a bold and innovative new initiative designed to educate the public about our nation s health care crisis, give them the tools they need to make informed decisions, and encourage them to work with their lawmakers to find solutions that work. As you will read within the pages of this report, 2007 has been a year characterized by positive change and measurable progress. Thank you for all that you do to ensure that your American Cancer Society continues moving forward toward achieving its worthy mission. Anna Johnson-Winegar, PhD Richard C. Wender, MD John R. Seffrin, PhD Chair, National Board of Directors President Chief Executive Officer This progress report shows the many ways our dedicated volunteers and staff and our generous donors are making a lifesaving difference in the fight against cancer. 3

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7 Introduction The 2007 American Cancer Society Progress Report is organized around and illustrates progress toward the outcome statements described in the Society s 2007 Strategic Plan. It presents significant achievements by the Society and by the larger cancer community, as well as areas of challenge where future improvements are critical. It clearly shows that if we do the right things, cancer is potentially the most preventable and the most curable of the chronic, life-threatening diseases facing Americans. The National Board of Directors develops and approves a strategic plan annually. It is developed with input from volunteers and staff nationwide, and it sets forth a framework within which the American Cancer Society will both lead and act. The plan consists of several connected but discrete elements and integrates mission delivery, income development, and global cancer control. It serves not only as a reference and guide for decisionmaking and the development of operational plans, but also as an organizer for measuring and reporting progress. 5

8 Introduction Mission Statement All elements of the strategic plan are driven by the Society s mission: The American Cancer Society is the nationwide community-based voluntary organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service Goals Our challenge goals for the nation include reducing cancer incidence and mortality and improving quality of life for people touched by cancer. These goals articulate the aspirations of the entire cancer community and cannot be achieved by the American Cancer Society alone. Nationwide Objectives These specific targets for the cancer community address areas designed to impact the 2015 goals for incidence, mortality, and quality of life. American Cancer Society Leadership Roles The leadership roles identify the Society s chosen areas of focus in support of the 2015 goals and nationwide objectives. They define our optimal role in the fight against cancer and are based on our unique capabilities. The four leadership roles and two supporting pillars direct the strategies we pursue to accelerate progress toward the 2015 goals. Global Cancer Control By 2010, the World Health Organization estimates that cancer will become the leading cause of death globally, followed by heart disease and then stroke. Its control is difficult and complex, requiring shared knowledge and experience. The Society s international program leverages our institutional knowledge, assets, and infrastructure to develop and implement unique evidence-based cancer control programming and responds to global trends that are rapidly changing the NGO sector throughout the world. Income Development Fundraising is the foundation that underpins our ability to achieve our strategic plan. The Integrated Fundraising Plan supports and intersects with our mission activities to accomplish our leadership roles and contribute to the success of the 2015 goals. Disparities The American Cancer Society s executive leadership has made a commitment to reducing cancer disparities whether they occur in access to information and screening services, quality care and treatment, or end-oflife support. In accordance with this commitment, the Society has formed an Office of Health Disparities and has adopted the National Cancer Institute (NCI) definition of cancer health disparities: Cancer health disparities are differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific population groups in the United States. These population groups may be characterized by gender, age, race/ethnicity, education, income, social class, disability, geographic location, or sexual orientation. Our initial focus is on the low SES, African Americans, Hispanics, Asians, Native Americans, and the rural poor. During fiscal year 2008, the Society will establish an overarching strategic framework to set goals for reducing cancer disparities. Specific measures will be developed so that progress can be reported in future editions of this report. What to Expect in the Report The first chapter of the progress report lists the outcome statements described in the strategic plan. Progress toward these statements is measured using graphs and text to highlight current trends and challenges that demand attention. Information used in the progress report reflects data available as of September 1, A series of chapters highlight progress being made toward the 2015 goals and leadership roles. Progress is measured against the Nationwide Mission Dashboard Metrics, the agreed upon indicators to measure nationwide progress toward the leadership roles and focus areas. Dashboard metrics will always be highlighted in gray and will be presented first in a chapter, followed by any other information relevant to a specific nationwide objective, cancer site, or risk factor. The next chapters highlight progress toward nationwide objectives that are not directly tied to the leadership roles, as well as our global cancer control and income development efforts. Progress in income development is measured against indicators outlined in the Nationwide Income Development Dashboard. The final chapter illustrates the historical change in our outcome statements from 1996 to November

9 Outcome Statements Principles Information BY 2015: By 2015, state-of-the-art information on issues related to incidence, mortality, risk factors, treatment, survivorship, and quality of life (physical, social, psychological, and spiritual) will be available and accessible through all appropriate channels to all people. Measurement Monitoring systems that track relevant incidence, mortality, risk factor and screening prevalence, and quality of life dimensions should be available nationwide. BY 2008: By 2008, all states will have cancer registries that meet NAACR silver or gold certification standards. Disparities BY 2015: By 2015, disparities in the cancer burden among population groups will be eliminated by reducing age-adjusted cancer incidence and mortality rates and by improving quality of life in the poor and medically underserved Goals 50% reduction in ageadjusted cancer mortality rates by % reduction in ageadjusted cancer incidence rates by 2015 Measurable improvement in the quality of life (physical, psychological, social, and spiritual) from the time of diagnosis and for the balance of life of all cancer survivors by 2015 Collaboration Efforts should be increased at all levels of the American Cancer Society for working with other organizations and agencies to achieve our common cancer control goals and objectives. Access to Quality Treatment BY 2015: By 2015, assure that all people diagnosed with cancer have access to appropriate, quality treatment and follow up, achieving 0% disparities in treatment outcomes. 7

10 Nationwide Objectives Outcome Statements Colorectal Cancer BY 2015: Incidence: By 2015, reduce the age-adjusted incidence rate of colorectal cancer by 40%. Mortality: By 2015, reduce the age-adjusted mortality rate of colorectal cancer by 50%. Early Detection: By 2015, increase to 75% the proportion of people aged 50 and older who have colorectal screening consistent with American Cancer Society guidelines. BY 2010: Incidence: By 2010, reduce the age-adjusted incidence rate of colorectal cancer by 30%. Mortality: By 2010, reduce the age-adjusted mortality rate of colorectal cancer by 40%. Behavior Change: By 2010, 60% of people aged 50 and older will have received colorectal screening consistent with American Cancer Society guidelines. Lung Cancer/Adult and Youth Tobacco Use BY 2015: Incidence: By 2015, reduce the age-adjusted incidence rate of lung cancer by 45%. Mortality: By 2015, reduce the age-adjusted mortality rate of lung cancer by 50%. Adult Tobacco Use: By 2015, reduce to 12% the proportion of adults aged 18 and older who are current cigarette smokers. Adult Smokeless Tobacco Use: By 2015, reduce to 0.4% the proportion of adults aged 18 and older who are current users of smokeless tobacco. Youth Tobacco Use: By 2015, reduce to 10% the proportion of high school students (younger than 18) who are current cigarette smokers. Youth Smokeless Tobacco Use: By 2015, reduce to 1% the proportion of high school students (younger than 18) who are current users of smokeless tobacco. BY 2010: Adult Tobacco Use: By 2010, reduce to 18.5% the proportion of adults aged 18 and older who are current cigarette smokers. Adult Tobacco Use: By 2010, reduce by 25% (from 2000 baseline prevalence rate) the proportion of low socioeconomic status adults aged 18 and older who are current cigarette smokers. Youth Tobacco Use: By 2010, reduce to 15% the proportion of high school students (younger than 18) who are current cigarette smokers. 8

11 Nationwide Objectives Outcome Statements Breast Cancer BY 2015: Incidence: By 2015, reduce the age-adjusted incidence rate of breast cancer by 15%. Mortality: By 2015, reduce the age-adjusted mortality rate of breast cancer by 50%. BY 2010: Early Detection: By 2010, increase to 90% the proportion of women aged 40 and older who have breast screening consistent with American Cancer Society guidelines. Prostate Cancer BY 2015: Incidence: By 2015, reduce the age-adjusted incidence rate of prostate cancer by 15%. Mortality: By 2015, reduce the age-adjusted mortality rate of prostate cancer by 50%. Early Detection: By 2015, increase to 90% the proportion of men who follow age-appropriate American Cancer Society detection guidelines for prostate cancer. BY 2010: Mortality: By 2010, reduce the age-adjusted mortality rate of prostate cancer by 40%. Behavior Change: By 2010, increase the percentage of men who have been offered age-appropriate prostate specific antigen (PSA) screening to 75%. 9

12 Nationwide Objectives Outcome Statements Nutrition and Physical Activity BY 2015: Overweight/Obesity: By 2015, the trend of increasing prevalence of overweight and obesity among US adults and youth will have been reversed and by 2015, the prevalence of overweight and obesity will be no higher than in Behavior Change: By 2015, increase to 70% the proportion of adults and youth who follow American Cancer Society guidelines with respect to the appropriate level of physical activity, as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. Behavior Change: By 2015, increase to 75% the proportion of persons who follow American Cancer Society guidelines with respect to consumption of fruits and vegetables, as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. BY 2010: Overweight/Obesity: By 2010, the increasing trends in overweight and obesity for both US adults and youth will have stopped. Behavior Change: By 2010, increase to 60% the proportion of adults and youth who meet American Cancer Society guidelines for physical activity, as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. Behavior Change: By 2010, increase to 45% the proportion of adults and youth who meet American Cancer Society guidelines for fruit and vegetable consumption, as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. Skin Cancer BY 2015: Behavior Change: By 2015, increase to 75% the proportion of people of all ages who use at least two or more of the following protective measures which may reduce the risk of skin cancer: avoiding the sun between 10:00 a.m. and 4:00 p.m., wearing sun-protective clothing when exposed to sunlight, properly applying sunscreen (SPF-15 or higher), and avoiding artificial sources of ultraviolet light (e.g., sun lamps, tanning booths). 10

13 Nationwide Objectives Outcome Statements Comprehensive School Health Education BY 2015: Comprehensive School Health Education: By 2015, increase to 50% the proportion of school districts that provide a comprehensive or coordinated school health education program. BY 2010: Comprehensive School Health Education: By 2010, 35% of school districts will provide comprehensive or coordinated school health education. School Health Councils: By 2010, 75% of school districts will have active school health councils. School Health Coordinators: By 2010, 50% of school districts will have school health coordinators. Quality of Life BY 2015: Access to Care: By 2015, the proportion of individuals without any type of health care coverage will decrease to 0%. Out-of-Pocket Costs: By 2015, the proportion of individuals diagnosed with cancer who report difficulties in obtaining medical care due to high out-of-pocket costs will decrease to 2%. Pain Control: By 2015, all 50 states and the District of Columbia will have received a grade of B or higher on the Pain Policy Report Card, and 10 states will have received a grade of A. Measurement: By 2015, there will be national surveillance systems to monitor quality of life for those affected by cancer. 11

14 Outcome Statements Leadership Roles, Supporting Pillars, Focus Areas Leadership Role Information Support better decisions by making available high-quality, timely, understandable information, especially to newly diagnosed cancer patients and their caregivers. Focus Areas: Being a trusted provider of unbiased, general information Being a trusted provider of interactive, personal information and guidance Leadership Role Research Leverage the Society s scientific credibility and unique position to support innovative, high-impact research through both direct funding and the ability to influence the amount and direction of research funding from other sources. Focus Areas: Extramural funding of innovative and high-impact research Intramural funding to conduct, collaborate, and publish high-impact research, assisting both internal and external cancer control strategies Influence the amount and direction of funding and policy changes that support research. Leadership Role Quality of Life Improve quality of life of cancer patients, caregivers, and survivors by assisting primarily with service referral, community mobilization, collaboration, advocacy, and, where appropriate, directly providing services. Focus Areas: Refer patients and caregivers to optimal local services via multiple channels. Influence investment by local communities in high-impact quality of life services and policies through community mobilization, collaboration, and advocacy. Where necessary, directly provide services where the Society is uniquely able to do so. 12

15 Outcome Statements Leadership Role Prevention and Early Detection Increase the prevention and early detection of cancer. Focus Areas: Prevent and detect, as early as possible, colorectal cancer through increased screening rates, including addressing disparities. Prevent lung cancer through legislative advocacy and smoking cessation activities. Reduce disparities in the early detection of breast cancer, primarily through advocacy and partnerships. Leadership Roles Supporting Pillars Advocacy The leadership roles will be supported by a clear focus and investment in advocacy. Advocacy will be supported at the local, state, and national level with dedicated staff, direct funding, and volunteer involvement. Disparities The American Cancer Society recognizes the importance of disparities in each of its leadership roles and will focus its efforts on them. Disparities will be addressed through direct service delivery, advocacy efforts, and direct outreach to underserved communities. Global Cancer Control The American Cancer Society s International Program works to: Empower individuals and institutions in the fight against cancer. Strengthen regional and country-based cancer control. Mobilize resources to fight cancer by creating awareness about the cancer pandemic. 13

16 Income Development Outcome Statements BY 2015: By 2015, increase total public revenue to $1.531 billion, annually. By 2010: By 2010, increase total public revenue to $1.242 billion, annually Target 2015 Target Relay For Life $488 million $643 million Other Community-Based Events $90 million $116 million (Making Strides Against Breast Cancer, Daffodil Days, Others) Distinguished Events $81 million $114 million (Gala and Golf) Direct Response Strategies $74 million $83 million (Direct Mail, Telemarketing, E-Revenue) Employer-Based Strategies $56 million $76 million (Workplace Giving, Corporate Promotions) Cause Marketing $8 million $9 million (not included in public support) Major Gifts/Campaigns* $118 million $109 million Planned Giving $208 million $245 million (Legacies, Bequests, & Other Planned Gifts) Other $127 million $145 million (Memorials, Cars, Discovery Shops, Unsolicited, Team ACS, Other) Total Public Support per Division Plans $1.242 billion $1.531 billion *Growth rates are likely to be higher than 4% through 2015, but many Divisions have not built their major campaigns out beyond

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19 Cancer All Sites Despite remarkable advances in prevention, early detection, and treatment, cancer remains the second leading cause of death in the United States. Trends: Death rates are declining in measurable, inspiring numbers. The actual number of cancer deaths has declined for the second consecutive year. Cancer incidence rates have been relatively stable since the mid-1990s. The probability that a person with cancer will survive at least five years after diagnosis has improved steadily over the last several decades. How successful we are at transferring existing knowledge into everyday, community-level practice will make all the difference in the number of lives saved from cancer in the years to come. Challenges: Eliminating disparities in the cancer burden by race, ethnicity, and socioeconomic status remains a challenge. There are no population-based surveillance data to adequately measure elements directly related to quality of life. Bottom Line: Between now and 2015, many more new cancers and cancer deaths can be averted by concerted action to control tobacco and obesity, by redoubling efforts in mammography and colorectal screening, and by enacting policies to close gaps in access to cancer prevention, early detection, and treatment services. Progress toward the Nationwide Goals at a Glance 2015 Goals By 2015 Progress 2015 Trends Incidence: 25% reduction Mortality: 50% reduction Quality of Life: Measurable improvement for all cancer survivors Baseline 1992 to 2004: 10.2% reduction Baseline 1991 to 2004: 13.7% reduction No population-based surveillance data sets currently exist to provide reliable baseline measurements and ongoing assessments of progress toward this goal.? Likely to meet goal Possible to meet goal Unlikely to meet goal? Unknown Dashboard Metric 17

20 Age-Adjusted Incidence Rates 2015 Goal 25% Reduction Cancer All Sites Overall Age-adjusted incidence rates have been slightly declining since 1992, showing a 0.3% annual percent decrease. About 1,444,920 new cases are expected to be diagnosed in Given the current trends in overall cancer incidence, and in consideration of trends in major cancer risk factors, it is unlikely that we will meet the 2015 goal. By Gender Cancer incidence rates are consistently higher in men than in women. In the United States, men have a slightly less than one in two lifetime risk of developing cancer; for women, the risk is a little more than one in three. Our work to expand access to health care for all Americans has never been more urgent. Fortyseven million Americans are uninsured, and millions more have inadequate insurance and limited access to medical care, including prevention, early detection, and appropriate treatment. 18

21 Cancer All Sites Overall, racial and ethnic minorities face numerous obstacles in receiving health care services, including cancer prevention, early detection, and quality treatment. Factors that contribute to disparities in health care access include low income; low education; inadequate health insurance; geographic, cultural, and language barriers; racial bias; and stereotyping. By Gender and Race/Ethnicity Cancer incidence rates are consistently higher in African American men than in white men and have widened over the past thirty years. Cancer incidence rates are generally higher in white women than in African American women. By Race/Ethnicity African Americans have the highest cancer incidence rate. In 2004, incidence rates among African Americans were approximately 6% higher than those in whites. Asian Americans/Pacific Islanders have the lowest cancer incidence rates. 19

22 Age-Adjusted Mortality Rates 2015 Objective 50% Reduction Cancer All Sites Overall More than 1,500 people die of cancer every day. From , cancer mortality rates declined 1.1% annually. The latest joinpoint trend shows an acceleration of the decline to 2.1% per year from Fully reaching the 2015 goal will require substantial breakthroughs in early detection and/or in cancer therapy. Current trends will achieve a 36.8% reduction by By Gender The declines in death rates were greater in men than in women, due in large part to the substantial decrease in tobacco-related cancer among men. Death rates decreased for 12 of the 15 most common cancers in men and for 10 of the 15 most common cancers in women. The National Institutes of Health estimate overall costs for cancer in 2007 at $219.2 billion: $89 billion for direct medical costs; $18.2 billion for lost productivity due to illness; and $112 billion for lost productivity due to premature death. The Society s sister advocacy organization, the American Cancer Society Cancer Action Network SM (ACS CAN), launched a historic access to health care collaboration with the American Association of Retired Persons, the American Heart Association, the Alzheimer s Association, and the American Diabetes Association. The Are You Covered campaign will educate political candidates and the public about the importance of access to care and health insurance reform. 20

23 Age-Adjusted Mortality Rates Cancer All Sites The American Cancer Society Mission Delivery Council awarded $8 million to the Society s Divisions through mission integration grants, of which 60% addressed disparities. By Gender and Race/Ethnicity Overall, cancer death rates are higher in African American men than in white men and in African American women than in white women. By Race/Ethnicity African Americans have a substantially higher death rate than all other races or ethnicities. In 1992, the mortality rates for African Americans were 31% higher than for whites; in 2004, this disparity was 24%. Asian Americans/Pacific Islanders have the lowest cancer death rates, about half the rate of African Americans. 21

24 Cancer All Sites Survival Rates Continued increases in cancer survival are expected as a result of improvements in treatment, as well as advanced methods for and better participation in early detection. Overall The probability that a person with cancer will survive has improved considerably over time. This improvement reflects progress in diagnosing certain cancers at an earlier stage, as well as advances in treatment. By Race/Ethnicity The five-year relative survival rate for African Americans remains lower than that of whites, although significant progress has been made over the past 25 years. Among the four major cancer sites, the five-year relative survival rate is highest for prostate cancer (99%), and lowest for lung cancer (16%). Most of the leading cancer sites have experienced significant increases in patient survival. Approximately million Americans with a history of cancer were alive in 2004 according to the NCI. Some of these individuals were cancer-free, while others still had evidence of cancer and may have been undergoing treatment. By Site 22

25 Cancer All Sites Leading Causes of Death and Life Years Lost Leading Causes of Death in the United States Cancer, the second leading cause of death, was responsible for approximately 19% of all deaths in 1975 and 23% of all deaths in Actual Causes of Death in the United States, 2000 The most prominent contributors to all causes of death in 2000 were tobacco (18%), diet and activity patterns (17%), and alcohol use (4%). As of 2007, all 50 states, 10 US territories, five tribes, and the District of Columbia have published comprehensive cancer control plans. This is a substantial increase from just five states and one tribal consortium with comprehensive cancer control plans in The overall number of persons in the United States living after a cancer diagnosis can be expected to increase greatly over the next decade due to the aging and growth of the population. 23

26 Cancer All Sites Leading Causes of Death and Life Years Lost Person-Years of Life Lost, 2004 Of the major causes of death, cancer has the most significant impact on person-years of life lost. Person-Years of Life Lost Due to Cancer, 2004 It is estimated that more person-years of life are lost due to lung and bronchus cancer than breast, colorectal, prostate, and skin cancers combined. The estimated average number of years of life lost per person for all cancers combined is approximately 15.5 years. Average Years of Life Lost, 2004 Every day, in more than 3,400 communities nationwide, the American Cancer Society is a beacon of hope for cancer survivors and their loved ones. 24

27 Leadership Roles In June 2004, the National Board of Directors, Division Board Chairs, Division Chief Executive Officers, and the National Home Office Executive Team adopted four leadership roles, 11 focus areas, and two overarching pillars where, on a nationwide basis, we believe we can have the greatest degree of impact. These leadership roles, focus areas, and pillars define the areas within the 2015 challenge goals where the American Cancer Society will explicitly and specifically focus its efforts over the next three to five years. Information Quality of Life Research Prevention and Detection Colorectal Cancer Lung Cancer Breast Cancer 25

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29 Leadership Roles Information and Quality of Life The leadership roles commit the American Cancer Society to a broad-based effort to prevent and search for cures for cancer and advocate effectively at all levels of government for policies that will help advance the fight against cancer, and to work to eliminate disparities in the cancer burden. Information and Quality of Life Information Leadership Role: Support better decisions by making available high-quality, timely, understandable information, especially to newly diagnosed cancer patients and their caregivers. Informed decision making is critical to cancer prevention, early detection, treatment, and improved quality of life. The American Cancer Society, through emphasis on information as a leadership role, strives to deliver accurate, unbiased information in a timely fashion and in a form that is easily accessed and understood. This is a fundamental service of the American Cancer Society. In 2006, American Cancer Society researchers published more than 835 articles in peerreviewed journals. Quality of Life Leadership Role: Improve quality of life of cancer patients, caregivers, and survivors by assisting primarily with service referral, community mobilization, collaboration, advocacy, and where appropriate, directly providing services. The tremendous growth in the number of cancer survivors expected by 2015 underscores the need to improve quality of life for all survivors throughout the survival continuum. Attending to the lifelong needs of cancer survivors and their loved ones has been a central focus of the American Cancer Society for many years, and its designation as a leadership role ensures that it will remain so. The American Cancer Society Cancer Resource Network was launched nationwide in It encompasses multiple delivery channels that allow cancer patients, survivors, and caregivers to reach the Society and receive help with managing their cancer experience. 27

30 Leadership Roles Information and Quality of Life The American Cancer Society served more than 330,000 unique constituents with patient-related information and patient program referrals in fiscal year 2006, an increase of approximately 6,000 constituents from The number of newly diagnosed constituents and uninsured or Medicaid constituents increased even more dramatically by 34,000 and 16,000, respectively. This reflects a combination of improvements in outreach and in data capture for diagnosis date and insurance status. The Society continues to develop and publish lowliteracy documents in a variety of languages that address prevention, early detection, treatment, and survivorship issues. Constituents Served with Patient-Related Information* This year, the Society continues its collaboration with the National Cancer Institute to provide training to approximately 200 patient navigators nationwide. Targeted donations enable the launch of 50 new American Cancer Society Patient Navigator sites throughout the country over the next five years. The Society continues to work with Congress to secure sufficient funding for the patient navigator bill that was signed into law in This important legislation will help reduce disparities in care by improving access to cancer treatment and programs among the medically underserved. 28 All channels except the National Cancer Information Center (NCIC) increased during the year, with the Division Patient Service Center channel experiencing the most growth. The decrease in NCIC volume reflects a change in call management scripts giving constituents an option to contact their local office, with growth in the local office channel as a result. It appears that constituents may also be shifting toward the Web as a resource for their cancer information. Constituents Served with Patient-Related Information* by Channel Dashboard metrics

31 Leadership Roles Information and Quality of Life The American Cancer Society Behavioral Research Center is dedicated to preventing or decreasing suffering and enhancing the quality of life of all individuals affected by cancer through interventions research. Unique Views of Cancer Information and Patient Support Online Dashboard metrics The Cancer Reference Information section on cancer.org received more than 18 million unique views, and 900,000 unique constituents viewed online American Cancer Society Cancer Survivors Network content during fiscal year (This activity is not included in the total constituents served with information and program referrals shown previously.) Fiscal year 2005 content-specific data are not available, but overall Web volume has increased dramatically. The Personal Health Manager launched in This important new constituent tool helps newly-diagnosed cancer patients and their caregivers manage and organize the information about diagnosis and treatment that they receive from various sources. The Health Insurance Assistance Service expanded to 27 states in 2006, up from 11 states in 2005, and has answered calls from more than 10,000 constituents. 29

32 Leadership Roles Information and Quality of Life The number of constituents who could not be provided with a referral to an American Cancer Society or community patient program at the time of their initial request declined in 2006, reflecting nationwide focus on improving the quality of resources in the Cancer Resource Connection. Number and Percent of Constituents with Needs that Could Not Be Met when First Requested Dashboard metric So far this fiscal year, cancer.org has received nearly 24 million visits, with more than14 million visits coming from search engines and four million from referring sites. The Society continues to publish the most current cancer statistics and trend information in a variety of Cancer Facts & Figures publications. These publications are the most widely cited source for cancer statistics. In 2006, the Society provided transportation services to approximately 26,000 constituents, including 14,000 who were newly diagnosed and 3,200 who were uninsured or on Medicaid. These constituents received a combined total of 371,000 trips. This year, there were 11.8 million hits to the Look Good Feel Better Web site and more than 8,000 calls to their tollfree number. 30

33 Leadership Roles Information and Quality of Life An individual doesn t get cancer a family does. While the American Cancer Society cannot hope to directly provide all the services needed by cancer patients and their families, we can become experts on community cancer resources, information, and guidance. Number and Percent of Constituents with Needs that Were Ultimately Left Unmet The National Cancer Information Center handles approximately one million calls annually, or about 3,000 calls per day. NCIC services are now available in 91 languages. Most constituents with requests that were initially unmet were eventually served. Only 2.3% of constituents requesting a service had needs that were never met by the Society or by referral to a community organization. Fiscal year 2005 data are not available. Call Back Initiative Number of Constituents Contacted Dashboard metrics The Call Back Initiative is part of the Society s strategy to strengthen its relationship with key audiences, especially newly diagnosed patients, by monitoring the consistency and quality of service provided and to generate demand by offering additional services. The total number of constituents contacted as a result of the Call Back Initiative more than doubled, from 21,285 in fiscal year 2005 to 49,639 in fiscal year Average satisfaction scores for constituents completing each type of Call Back survey were strong and consistent across strategies. 31

34 Nationwide Objectives Related to Leadership Roles Access to Care 2015 Objective Proportion of individuals without any type of health insurance will decrease to 0%. Percent Reporting No Health Care Coverage The percentage of persons in the United States between the ages of 18 and 64 who report being uninsured continues to rise and is now at 20.02%. Reversing this trend will require coordinated efforts across the public, private, and nonprofit sectors. The Society defines meaningful health insurance as being: Adequate Access is timely and coverage offers the full range of health care services, including prevention and early detection. Affordable Costs are not excessive and are based on the patient s ability to pay. Available Coverage is available regardless of health status or claims history. Administratively simple Processes are easy to understand and systems are easy to navigate. Patients and families who stayed at a Hope Lodge in 2006 saved more than $18 million. Twenty-two Hope Lodges are currently operating, with 12 new facilities in development. The average occupancy rate for all Hope Lodges is 85%-90%, although many operate at 100% occupancy and have waiting lists. Out-of-Pocket Costs 2015 Objective: Proportion of individuals diagnosed with cancer who report difficulties obtaining care due to high out-of-pocket costs will decrease to 2%. Percent Report High Out of Pocket Costs The percentage of persons in the United States who report problems with out-of-pocket health care costs continues to rise and is now at 7.62%. At least 17 million adults are underinsured, meaning their insurance does not adequately protect them against catastrophic health care expenditures. 32

35 Nationwide Objectives Related to Leadership Roles Pain Control 2015 Objective: All 50 states and the District of Columbia will receive a grade of B or higher on the Pain Policy Report Card, and 10 states will receive an A. Pain Policy Report Card An estimated 30% of newly diagnosed cancer patients, 30%-50% of patients undergoing treatment, and 70%-90% of patients with advanced disease experience pain. In 2007, 32 states received a grade of B or higher on the Pain Policy Report Card; only 12 states received a grade of B or higher in In 2007, four states (KS, MI, VA, WI) received a grade of A; in 2000, no states received a score of A. Pain policies are becoming more balanced, even compared with last year. Since 2006, 23 states had policy change, and in eight of those states the change was sufficient to improve the grade. No state s grade decreased in the last year or even since 2000, and 86% of states now have a grade of at least C+. Measurement 2015 Objective: There will be national surveillance systems to monitor quality of life for those affected by cancer. Progress: Quality of life is an increasingly important outcome among persons affected by cancer. However, measurement and surveillance of quality of life remains a challenging area, as a result of inadequate systems, poor consensus on measurement tools, and limited funding and national attention. Despite these challenges, the Society continues to lead the charge in exploring ways to maximize both the quantity and quality of relevant data. At the present time, there are no national cancer surveillance systems that include both subjective outcomes collected directly from cancer survivors and verified clinical data regarding cancer diagnosis, treatment, and disease status. State policies aimed at preventing drug abuse, regulating professional practice, and improving patient care can either enhance or interfere with pain management. It is clear that arbitrary or outdated standards can create policy requirements that restrict patients access to treatment. 33

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37 Leadership Roles Research The aim of the American Cancer Society s research program is to determine the causes of cancer and to support efforts to prevent, detect, and cure the disease. The Society is the largest source of private, nonprofit cancer research funds in the United States, second only to the federal government in dollars spent. Research Leadership Role: Leverage the Society s scientific credibility and unique position to support innovative, high-impact research both through direct funding and the ability to influence the amount and direction of research funding from other sources. In 2006, the Society spent an estimated $136 million on research and health professional training and has invested approximately $3.1 billion in cancer research since the program began in The Society s comprehensive research program consists of extramural grants, as well as intramural programs in epidemiology and surveillance research, behavioral research, and statistics and evaluation. Intramural programs are led by the Society s own staff scientists. 35

38 Leadership Roles Research Federal Research Budgets The research leadership role also focuses on influencing the amount and direction of funding for cancer research, with research advocacy being one of the Society s key strategies. Federal funding for research was cut by $34 million and $32 million, respectively, at the National Institutes of Health and the National Cancer Institute. Dashboard metric The American Cancer Society concentrates on funding a niche of beginning researchers and innovative research opportunities. American Cancer Society researchers have concluded that there is a direct correlation between insurance status and disease severity. Their studies find that uninsured and Medicaid patients are significantly more likely to be diagnosed with more advanced cancer, which requires harsher treatment and is more likely to be fatal. The American Cancer Society provides targeted research funding in areas of special need, such as cancer in the poor and underserved, health policy outcomes, and palliative care research, in both the extramural and intramural programs. Awards for cancer in the poor and underserved represented 10.3% of the total grants expenditures last year. 36

39 Leadership Roles Research The American Cancer Society continues to launch Cancer Prevention Study-3 (CPS-3), a large cohort study that will further our understanding of factors that cause or prevent cancer. The Society s epidemiologists are recruiting volunteers for a study of lifestyle, behavioral, environmental, and genetic factors that cause or prevent cancer in partnership with Relay For Life events across the country. More than 20,000 volunteers have been enrolled in the study to date. As of October 2007, the American Cancer Society is supporting 938 current multi-year grants totaling more than $457 million. In fiscal year 2006, 32 pay-ifs were funded at $10,902,043; of those, 17 were funded with special gifts that were restricted to pay grants that would not have been funded otherwise, adding $3,653,500 to the research operations budget, an increase of 41% over the previous year. In 2006, 12,681 constituents created profiles to search for treatment and prevention/ detection clinical trials as part of our Clinical Trials Matching Service. Clinical Trials Specialists helped 5,482 constituents explore options for clinical trial enrollment. Eightyfour constituents enrolled in clinical trials. 37

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41 Leadership Role Prevention and Early Detection Prevention and Early Detection Leadership Role: Increase the prevention and early detection of cancer. Current knowledge indicates that up to 70% of all cancers may be prevented through widespread implementation of effective interventions. Tobacco use, physical inactivity, obesity, and poor nutrition are major preventable causes of cancer and other diseases in the United States. Current scientific evidence indicates that the wider application of available screening and early detection techniques can significantly reduce the number of deaths from breast, cervical, and colorectal cancers. Aside from avoiding tobacco and maintaining a healthy weight, getting recommended cancer screenings is the most important thing people can do to reduce their risk of dying from cancer. Colorectal Cancer Lung Cancer Breast Cancer 39

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43 Colorectal Cancer Leadership Role Focus Area: Prevent and detect, as early as possible, colorectal cancer through increased screening rates, including addressing disparities. Colorectal cancer is the third most common cancer in both men and women and accounts for almost 10% of all cancer deaths. Trends: Incidence rates continue to decline, currently at a rate of 2.3% annually. Mortality rates continue to decline, currently at a rate of 4.7% annually. Challenges: Screening for colorectal cancer among all populations remains low, despite its proven effectiveness. The disparity in both incidence and mortality rates between African Americans and other groups has increased substantially since the early 1990s and does not appear to be lessening. Bottom Line: People who follow recommended screening guidelines, maintain a healthy weight, engage in regular physical activity, and consume a healthy diet can reduce their risk of developing colorectal cancer. As more people follow the Society s prevention and early detection guidelines, colorectal cancer incidence and mortality will continue to drop. Progress toward Nationwide Objectives at a Glance Colorectal Cancer By 2015 Progress 2015 Trends Incidence: Reduce by 40% Mortality: Reduce by 50% Early Detection: 75% of people aged 50 and older have colorectal screening Baseline 1992 to 2004: 16.9% reduction Baseline 1991 to 2004: 25.4% reduction 2006 screening rate: 55.1% (BRFSS: Combined FOBT or endoscopy Adult 50+) BY 2010: Incidence: Reduce by 30% Mortality: Reduce by 40% Behavior Change: 60% of people aged 50 and older have colorectal screening Baseline 1992 to 2004: 16.9% reduction Baseline 1991 to 2004: 25.4% reduction 2006 screening rate: 55.1% (BRFSS: Combined FOBT or endoscopy Adult 50+) Likely to meet goal Possible to meet goal Unlikely to meet goal? Unknown Dashboard Metric 41

44 Colorectal Cancer Early Detection 2015 Objective 75% Screened 2010 Objective 60% Screened Colorectal Screening* While screening rates have increased over the past several years, they still remain around 50%, even though screening tests are proven effective in preventing and detecting colon cancer early. Recent increases in colorectal cancer screening may be related to increased awareness efforts, expansions in health care coverage by states and Medicare, and the establishment of screening programs in certain states. There is significant need for improvement in rates among uninsured adults; this population segment is being screened at less than half the rate of the general population. Trend to 2010: Likely to meet objective Trend to 2015: Possible to meet objective Providing insurance coverage of the full range of colorectal cancer screening tests has been shown to increase screening rates. Improving insurance coverage for the full range of colorectal screening tests is a high priority for the Society. This year, three more states joined 19 states and the District of Columbia, in passing legislation to ensure insurance coverage of colon cancer screening. In addition, eight states now have programs to provide colorectal cancer screening for low-income, uninsured, and underinsured men and women. The number of states receiving a gold, silver, or bronze rating for advocacy in support of colorectal cancer screening coverage increased in This increase primarily reflects more accurate reporting, but several states passed additional legislation in Number of States Achieving Colorectal Screening Coverage Advocacy Ratings* Dashboard metrics 42

45 Colorectal Cancer Other Nationwide Objectives Related to the Leadership Role Age-Adjusted Incidence Rates 2015 Objective 40% Reduction 2010 Objective 30% Reduction The Society and ACS CAN worked to introduce legislation known as Michelle s Law, after college student Michelle Morse that would protect vulnerable college students from losing their health insurance when they take medical leave from school. Overall The more rapid decrease in the most recent time period (2.3% per year from ) partly reflects an increase in screening, which can detect and remove colorectal polyps before they progress to cancer. If recent decreases continue, it is likely that we will meet our 2010 and 2015 goals. By Race/Ethnicity African Americans have a greater risk of developing colorectal cancer than any other racial or ethnic group in the United States, and the gap is widening. In 1992, the gap between incidence rates for African Americans and whites was 13%; this gap increased to 24% in

46 Colorectal Cancer Age-Adjusted Mortality Rates 2015 Objective 50% Reduction 2010 Objective 40% Reduction Overall Colorectal cancer death rates decreased 25.4% from This decrease reflects declining incidence rates and improvements in early detection and treatment. If recent decreases continue, we will exceed the 2010 and 2015 goals. Preserving existing coverage and avoiding the creation of barriers to screening will ensure that consumers have access to the screenings that could save their lives. Six states currently have laws allowing insurance policies to circumvent state insurance coverage requirements. The Society s 2007 colorectal cancer public awareness campaign targeting women aged was extremely successful at generating increased awareness. Sixty-one percent of respondents who saw the campaign particularly African American women showed significant, positive changes in their beliefs and knowledge about testing and prevention. As with other major cancer sites, colorectal cancer mortality rates among African Americans remain consistently higher than mortality rates for other racial and ethnic groups. In 1991, the mortality rate for African Americans was 27% higher than whites; in 2004, this disparity grew to 43%. By Race/Ethnicity 44

47 Colorectal Cancer Survival Rates Three new evidence-based initiatives that can be implemented at the community level support the Society s colorectal cancer objectives. The purpose of these initiatives is to identify and enhance strategic relationships through targeted collaboration with health care professionals, health plans, and communities. Overall While survival rates for both whites and African Americans have increased in the past two decades, the disparity between these two groups has increased. African Americans are less likely to be diagnosed at the localized stage and have lower survival rates than whites at all stages of the disease. 45

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49 Lung Cancer Leadership Role Focus Area: Prevent lung cancer through legislative advocacy and smoking cessation activities. Lung cancer is the leading cause of cancer death in both men and women, accounting for about 29% of all cancer deaths and 15% of all cancer diagnoses. Since 87% of cases are linked to tobacco use, lung cancer is one of the most preventable of all cancers. Trends: Incidence and death rates continue to decline significantly in men. Incidence and death rates in women are approaching a plateau after continuously increasing for several decades. Advocacy efforts continue to be successful in increasing the number of smoke-free laws, increasing state excise taxes, and fighting tobacco industry advertising and promotion efforts. Challenges: Progress in reducing smoking among adults and high school students has slowed considerably in the last few years. There is still a disproportionately high level of tobacco use among less educated adults. Average funding levels by state for comprehensive tobacco control remains less than half the minimum levels recommended by the CDC. Smokeless tobacco products are increasing in popularity among both adults and youth. Bottom Line: Stopping tobacco use, or not starting, is the single most important action that can be taken to reduce cancer suffering and premature death in the United States. Progress toward Nationwide Objectives at a Glance Lung Cancer/Adult and Youth Tobacco Use By 2015 Progress 2015 Trends Mortality: Reduce by 50% Adult Tobacco Use: Reduce to 12% Adult Smokeless Tobacco Use: Reduce to 0.4% Youth Tobacco Use: Reduce to 10% By 2010 Incidence: Reduce by 45% Youth Smokeless Tobacco Use: Reduce to 1% Adult Tobacco Use: Reduce to 18.5% Adult Tobacco Use: Reduce by 25% from 2000 baseline for low socioeconomic status adults Baseline 1992 to 2004: 13.5% reduction Baseline 1991 to 2004: 9.7% reduction 2005 prevalence rate: 20.9% (NHIS) 2005 prevalence rate: 2.3% (NHIS) 2005 prevalence rate: 23% (YRBS) 2005 prevalence rate: 8.0% (YRBS) 2005 prevalence rate: 20.9% (NHIS) 2005 prevalence rate: 32.6% (NHIS) Youth Tobacco Use: Reduce to 15% 2005 prevalence rate: 23% (YRBS) Likely to meet goal Possible to meet goal Unlikely to meet goal? Unknown Dashboard Metric 47

50 Lung Cancer Tobacco Use Adult Prevalence Objectives Youth Prevalence Objectives % (Current smokers) % (current smokers) % (Current smokers) % (current smokers) 2010 Reduce by 25% (low socioeconomic status) In 1965, 42.4% of adults smoked; by 2005 that number had dropped to 20.9%. However, progress in rate reduction has essentially stalled, likely reflecting increased tobacco industry expenditures on marketing and promotion and declines in funding for comprehensive tobacco control programs. In 2005, more adults with lower education smoked (32.6%) compared to all adults. While 2006 National Health Interview Survey data are not yet available, 2006 Behavioral Risk Factor Surveillance System data show that 19.7% of adults are current smokers and 27.7% of adults with low education are smokers. Trends to 2010/2015: Possible to meet objective Significant progress has been made since the early 1990s, but rates of youth who are current smokers may be rising once again based on most recent data. Trends to 2010/2015: Unlikely to meet objectives Adults Current Smokers Youth Current Smokers Tobacco Control Funding* Funding levels for comprehensive tobacco control increased, but were still less than half the minimum levels recommended by the Centers for Disease Control and Prevention (CDC). On average in 2006, states funded 39.5% of the minimum for tobacco control established by CDC, up from 33.6% in Dashboard metrics 48

51 Lung Cancer Medicaid Coverage for Smoking Cessation The number of states reporting full Medicaid smoking cessation coverage increased slightly, from 11 states in 2002 to 14 states in In 2003, 24 states and the District of Columbia had partial coverage and 13 states had no coverage. State Smoke-Free Laws Grade A 100% increase in the number of states receiving an A grade was accompanied by a decrease in B and F ratings. One state s Incomplete ranking will convert to an A in 2007 when legislation is implemented. As of July 2007, 23 states, the District of Columbia, Puerto Rico, and 2,617 municipalities have smoke-free laws in effect that require 100% smoke-free workplaces and/or restaurants and/or bars. Percent of Population Covered by Smoke-Free Laws Dashboard metrics The percentage of the population protected by smoking restrictions in bars, restaurants, and workplaces, as well as comprehensive smokefree laws, showed significant increases in the past two years. Thirty-five states have no preemption laws, up from 29 states in The Society and ACS CAN have advocated vigorously for smoke-free laws to reduce the incidence of lung cancer and other smokingattributable diseases. 49

52 Lung Cancer In 2007, 22 states and the District of Columbia have tobacco tax greater than or equal to $1.00, up slightly from 21 in The Society and ACS CAN lobbied successfully for increases in tobacco excise taxes, resulting in 11 states increasing their excise taxes this year; however nearly all of these occurred in states already above the $1.00 tax threshold. The Society and ACS CAN continue to urge Congress to substantially increase the federal tobacco tax. Tobacco Excise Taxes, 2007 Dashboard metrics Among current adult smokers, 70% report that they want to quit smoking. In 2005, an estimated 19.2 million adult smokers (42.5%) had stopped smoking for at least one day during the preceding 12 months because they were trying to quit. More than 54% of current high school smokers tried to quit within the preceding year. The American Cancer Society has 12 state Quitline contracts plus the District of Columbia representing 37% of the US population. The Society conducts approximately 64,000 Quitline sessions per year. Forty new employer contracts were added in 2007 for a total of 77 contracts. Raising tobacco taxes is one of the most effective measures to stop children from starting to smoke, as well as to reduce overall tobacco consumption. A 10% increase in the price of a pack of cigarettes will reduce youth smoking by 7% and overall consumption by approximately 4%. Quitting smoking, or not starting at all, is by far the best way to prevent lung cancer. 50

53 Lung Cancer Other Nationwide Objectives Related to the Leadership Role Age-Adjusted Incidence Rates 2015 Objective 45% Reduction The tobacco industry heavily markets smokeless tobacco products as harm-reduction agents, although there is no evidence that smokers are able to fully switch to smokeless tobacco and not return to smoking. On the 30 th anniversary of the Great American Smokeout, the Society s Quitline broke an intake call volume record for a single day with 1,441 calls. Overall Lung cancer incidence rates decreased 13.5% from Trend to 2015: Unlikely to meet objective The per capita yearly consumption of cigarettes for adults has changed dramatically over the last four decades from a high of 4,345 cigarettes per capita in 1963 to 1,814 cigarettes per capita in Smoke-free laws reduce cigarette consumption and save health care dollars. They encourage smokers to quit, increase the number of successful quit attempts, and reduce the total number of cigarettes smoked. 51

54 Other Nationwide Objectives Related to Leadership Role Age-Adjusted Incidence Rates 2015 Objective 45% Reduction Lung Cancer Among men, lung cancer incidence has been declining since the early 1980s; among women, the rates have been essentially stable since 1998 after a long period of increase. The downward trend in men is on track to meet the 45% reduction goal, but the trend among women is not. In 2004, rates were approximately 1.7 times higher in men than in women. The primary cause (87%) of lung cancer is tobacco use, so incidence trends are largely a reflection of tobacco use trends over the preceding 20-year period. In 2005, cigarette companies spent $13.11 billion on advertising and promotional expenses, down from $15.12 billion in 2003, but nearly double what was spent in This amounted to more than $36 million per day, more than $45 for every person in the United States, and more than $290 for each US adult smoker. Additionally, certain tobacco products are advertised and promoted disproportionately to racial and ethnic minority communities. By Gender Incidence rates for African Americans remain consistently higher than for other racial groups; however, a steeper decline has been observed for African Americans as compared to whites in recent years, likely due to historical changes in tobacco consumption. In 2004, the lung cancer incidence rate for African Americans was approximately 20% higher than the rate for whites, due to higher rates in African American men. By Race/Ethnicity 52

55 Lung Cancer Age-Adjusted Mortality Rates 2015 Objective 50% Reduction Overall Lung cancer death rates decreased 9.7% from Trend to 2015: Unlikely to meet objective During 2005, the five largest tobacco manufacturers spent a new record of $ million on smokeless tobacco advertising and promotion. By Gender Lung cancer death rates among men decreased 21.8% between Death rates for women appear to be plateauing, although the most recent statistical trend shows a slight increase. By Race/Ethnicity African Americans have a higher lung cancer death rate than any other racial or ethnic group, but the gap has narrowed. In 1991, the mortality rate for African Americans was 23% higher than for whites; in 2004, the gap was 12%. 53

56 Lung Cancer Survival Rates The Society and ACS CAN are urging Congress to grant the US Food and Drug Administration the authority to regulate tobacco products and their marketing. This legislation is essential to stop tobacco manufacturers from marketing their products to children or making false or misleading claims that their products are low-risk or safer, and would force the disclosure of the ingredients in tobacco products. Survival rates for both African Americans and whites remain low; most lung cancers are not detected at an early stage, when chances of survival are greatest. The five-year relative survival rate is 49% for cases detected in the localized stage; however, only 16% of lung cancers are diagnosed this early. Overall Tobacco prevention works. By even the most conservative estimate, more than 40% of the reduction in male cancer death rates between 1991 and 2003 can be attributed to declines in smoking in the last half century. We now know with certainty that consistent efforts and focused resources can make a difference in saving lives from cancer. Grassroots advocacy efforts continue to protect millions of dollars in funds from state tobacco settlements from being diverted away from tobacco control programs. 54

57 Lung Cancer Tobacco Use Adult Prevalence Objectives Youth Prevalence Objectives % (Smokeless) % (Smokeless) Adults Smokeless Tobacco Use Smokeless tobacco use among adults in the United States has remained essentially flat for more than a decade. Trend to 2015: Unlikely to meet objective Youth Smokeless Tobacco Use The smokeless tobacco industry has recently reported a sharp upturn in US sales, possibly reflecting an increase in use due to the increasing number of smoke-free environments and a lag in prevalence survey data reporting. While there is progress compared to the mid-1990s, smokeless tobacco use among youth was essentially flat between Trend to 2015: Unlikely to meet objective 12 th Graders Smokeless Tobacco Use Daily use of smokeless tobacco among 12 th grade students has decreased significantly from 4.3% in 1992 to 2.5% in While the percentages are small, this is still a significant concern as adolescents who use smokeless tobacco are more likely to become cigarette smokers. 55

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59 Breast Cancer Leadership Role Focus Area: Reduce disparities in the early detection of breast cancer, primarily through advocacy and partnerships. Breast cancer affects more women in the United States than any other cancer except skin cancer. And only lung cancer kills more women than breast cancer. Trends: Incidence rates have started to decline after continuously increasing for more than two decades. Mortality rates continue to decrease by more than 2% per year. According to Behavioral Risk Factor Surveillance Survey (BRFSS) data, mammography screening rates have been essentially flat since Challenges: A substantial number of women are still not getting recommended mammograms. Overweight and obesity rates are not improving. Disparities in the breast cancer burden continue to exist. Bottom Line: The greatest opportunity to save lives from breast cancer continues to be timely, high-quality mammography screening by all eligible women. Nearly all breast cancers can be treated successfully if detected early. Breast Cancer Progress toward Nationwide Objectives at a Glance By 2015 Progress 2015 Trends BY 2010: Incidence: Reduce by 15% Mortality: Reduce by 50% Early Detection: Increase to 90% women aged 40 and older who have breast screening. Baseline 1992 to 2004: 5.7% reduction Baseline 1991 to 2004: 25.4% reduction 2006 Screening rate: 61.2% (BRFSS: mammography within the past year) Likely to meet goal Possible to meet goal Unlikely to meet goal? Unknown Dashboard Metric 57

60 Breast Cancer Early Detection 2010 Objective Screening Rates at 90% Mammography rates have remained Mammography* stable at around 60% over the past five years. There is a screening disparity between women who have health insurance and those who don t. Uninsured women have substantially lower rates of mammography use than women with insurance. Screening rates among women ages was 60.5% in 2002; 56.8% in 2004; and 59.7% in Trend to 2010: Unlikely to meet objective CDC funding for the NBCCEDP in states, tribes, and territories increased only slightly (by $3 million) in Generally, flat funding levels have significantly affected the program s ability to enroll new eligible women. Flat funding rates typically allow maintenance for screening women currently enrolled in the program. Administrative costs continue to increase during the same period. NBCCEDP Funding Levels CDC Award Dashboard metrics On April 20, 2007, representatives from the American Cancer Society and its sister advocacy organization, ACS CAN, joined President Bush as he signed the NBCCEDP Reauthorization Act into law. The legislation allows for greater flexibility in the program so it can reach more eligible women and also sets increased funding targets over the next five years. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides lowincome, uninsured, and underinsured women access to lifesaving breast and cervical cancer screening tests and follow-up services. To date, NBCCEDP has provided more than 6.9 million screening exams to underserved women. However, because of a lack of funding, four out of every five eligible women are still not being screened and treated. 58

61 Other Nationwide Objectives Related to the Leadership Role Age-Adjusted Incidence Rates 2015 Objective 15% Reduction Breast Cancer The American Cancer Society continues to be a strong community partner in supporting outreach for NBCCEDP in states. To date, 35 state program retreats, composed of both American Cancer Society and state and local health department representatives, have been held across the country. Overall Breast cancer incidence rates increased by 0.5% per year between However, in the most recent time period, ( ) incidence rates have been declining by 3.5% annually. The steep recent decline may be due to the combined effects of decreased mammography screening rates and the sudden decline in the use of hormone therapy following the publication of results from the Women s Health Initiative for combined estrogen and progestin. While it is too early to determine whether the recent decline is real or random, if the trend continues, we would far exceed the 2015 goal of a 15% decrease. By Race/Ethnicity Although breast cancer incidence rates are lower among African Americans compared to whites, African American women have significantly higher mortality rates. 59

62 Age-Adjusted Mortality Rates 2015 Objective 50% Reduction Breast Cancer Breast cancer death rates decreased 25.4% from The decline can largely be attributed to earlier detection and more effective treatment. The decline is approximately 2.2% per year; if this trend continues, we are likely to meet the 2015 goal. Overall Increasing the proportion of women who receive annual mammography screening can further reduce breast cancer death rates. By Race/Ethnicity African American women have substantially higher death rates compared to other racial and ethnic groups. In 1991, African American mortality rates were 18% higher than rates for whites; in 2004 they were 36% higher. 60

63 Breast Cancer Survival Rates Overall Survival rates among both African American women and white women significantly increased from ; nonetheless there remains a substantial gap. Team Up is a pilot project in which the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the US Department of Agriculture have joined forces to determine the effectiveness of adapting and using evidence-based outreach interventions to serve rarely or never screened populations with breast and cervical cancer screening. The pilot is finishing up its fourth and final year of work in six states. As of June 2007, all six states successfully implemented the intervention. 61

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65 Collaborative Roles The American Cancer Society cannot achieve the 2015 challenge goals and nationwide objectives entirely on its own. Instead, we must collaborate with others in productive ways. Even though the recent nationwide prioritization process, which resulted in our leadership roles and focus areas, did not establish specific programs of work for each site and/or risk factor, the Society still has a responsibility to be a catalyst, primarily through collaboration, to ensure that the resources of our cancer control partners address any gaps. Prostate Cancer Nutrition and Physical Activity Skin Cancer Comprehensive School Health Education 63

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67 Prostate Cancer Prostate cancer is the most frequently diagnosed cancer in American men and the second deadliest. Trends: The long-term incidence trend is difficult to interpret because it is substantially influenced by PSA testing. The mortality trend shows a 4.1% annual reduction for Challenges: For reasons that remain unclear, prostate cancer incidence rates are significantly higher in African American men than in white men. Mortality rates in African American men remain more than twice as high as those of white men. There is presently not sufficient data to recommend for or against prostate cancer testing in men at average risk of developing the disease. Bottom Line: The only well-established risk factors for prostate cancer are age, ethnicity, and family history of the disease. Early detection may increase survival and treatment options. High-risk men (African Americans or men with a strong family history) should begin screening at age 45. All men aged 50 and older should be offered annual digital rectal exam (DRE) and prostate specific antigen (PSA) testing, and should talk with their doctors about the benefits and limitations of prostate cancer screening so they can make informed decisions. Progress toward Nationwide Objectives at a Glance Prostate Cancer By 2015 Progress 2015 Trends Incidence: Reduce by 15% Baseline 1992 to 2004: 32.7% reduction Mortality: Reduce by 50% Baseline 1991 to 2004: 35.4% reduction? Early Detection: 90% follow detection guidelines 2006 prevalence rate: 53.8% (BRFSS: men 50+ with recent PSA) BY 2010: Mortality: Reduce by 40% Baseline to 2004: 35.4% reduction Behavior Change: 75% offered ageappropriate PSA screening 2006 prevalence rate: 53.8% (BRFSS: men 50+ with recent PSA) Likely to meet goal Possible to meet goal Unlikely to meet goal? Unknown Dashboard Metric 65

68 Age-Adjusted Incidence Rates 2015 Objective 15% Reduction Prostate Cancer Overall Prostate cancer incidence rates decreased 32.7% from Prostate cancer incidence has been extremely variable in the past 20 years, largely due to the advent of PSA screening. Declining prostate cancer incidence trends will be largely dependent on the rates of PSA testing in the years to come. The long-term trend is unknown. By Race/Ethnicity African American men have one of the highest documented prostate cancer incidence rates in the world. In 2004, the incidence rate for African American men was 53% higher than the incidence rate for white men; the reasons for this substantial gap remain unclear. Twenty states have laws requiring insurers to cover clinical trials, and four states have special agreements with insurers to voluntarily cover clinical trials. Prostate cancer accounts for approximately 37% of all cancers diagnosed in African American men. 66

69 Age-Adjusted Mortality Rates 2015 Objective 50% Reduction 2010 Objective 40% Reduction Prostate Cancer Overall The huge difference in prostate cancer mortality rates between African American men and white men accounts for about 40% of the overall cancer mortality disparity between African American men and white men. Prostate cancer mortality rates decreased 35.4% from The latest joinpoint trend ( ) shows a 4.1% annual decrease; if this trend continues, we will far exceed the 2015 goal. The reasons for this trend are uncertain, but the measured time period closely followed the introduction of PSA screening in the United States and the advent of more effective treatments. Although indirect evidence suggests there will be mortality benefits from PSA screening, no trials have been completed yet to demonstrate the scale of the benefit. By Race/Ethnicity Although death rates have been declining among white men and African American men since the early 1990s, rates in African American men remain more than twice as high as those in white men. 67

70 Prostate Cancer Survival Rates The five-year relative survival rate is 99% for white men and 95% for African American men. More than 90% of all prostate cancers are discovered in the local and regional stages; the five-year relative survival rate for patients whose tumors are diagnosed at these stages approaches 100%. The dramatic improvements in survival are partly attributable to earlier diagnosis and improvements in treatment. Overall American Cancer Society-funded research discovered the prostate-specific antigen (PSA) test for prostate cancer screening. Early Detection Although not conclusive, there is evidence that early detection has resulted in men being diagnosed at earlier stages and at younger ages, which could ultimately decrease mortality rates and improve the opportunity for successful treatment. PSA screening rates have remained essentially flat over the last five years at just above 50%. However, screening rates among men without insurance are almost half those of men with insurance. Trend to 2010: Possible to meet objective Trend to 2015: Unlikely to meet objective 2015 Objective 90% follow guidelines 2010 Objective 75% offered PSA Screening* 68

71 Nutrition and Physical Activity Each year, roughly one-third of all cancer deaths in the United States are due to nutrition and physical activity factors, including excess weight. For the majority of Americans who do not smoke, maintaining a healthy weight, increasing physical activity, and eating a healthy diet are the most important ways to reduce cancer risk. Trends: Overweight and obesity are increasing among all ages, both genders, and all ethnic groups. Currently, two-thirds of adults are overweight, including one-third who are obese. Currently, approximately 16% of youth aged 6 to 19 are overweight, and one-third are at risk of becoming overweight; obesity rates have doubled in children and tripled in teens over the last 20 years. Challenges: It is difficult to combat perceptions that eating and exercise behaviors are only individual concerns and that environments in which we live, work, play, and go to school do not affect individual behavior. Translation of research to support practical application of science into policies and programs is limited. Bottom Line: The obesity epidemic threatens to jeopardize the incidence and mortality decreases seen for many cancers since the early 1990s. The tobacco control experience has taught us that policy and environmental changes are highly effective in deterring tobacco use. To avert an epidemic of obesity-related disease, similar purposeful changes in public policy and in the community environment will be required to help individuals maintain a healthy body weight and remain physically active throughout life. Nutrition and Physical Activity Progress toward Nationwide Objectives at a Glance By 2015 Progress 2015 Trends Overweight/Obesity: Trends reversed and prevalence no higher than in 2005 Nutrition: 75% of population follow guidelines for fruit and vegetable consumption Physical Activity: 70% of population follow guidelines 2006 adult rate: 61.3% (BRFSS) 2005 youth rate: 16% (YRBS) 2005 adult rate: 24.3% (BRFSS) 2005 youth rate: 20.1% (YRBS) 2005 adult rate: 48.3% (BRFSS) 2005 youth rate: 68.7% (YRBS) By 2010: Overweight/Obesity: Increasing trends stopped Nutrition: 45% of population follow guidelines for fruit and vegetable consumption Physical Activity: 60% of population follow guidelines 2006 adult rate: 61.3% (BRFSS) 2005 youth rate: 16% (YRBS) 2005 adult rate: 24.3% (BRFSS) 2005 youth rate: 20.1% (YRBS) 2005 adult rate: 48.3% (BRFSS) 2005 youth rate: 68.7%(YRBS) Likely to meet goal Possible to meet goal Unlikely to meet goal? Unknown Dashboard Metric 69

72 Overweight and Obesity Nutrition and Physical Activity Obesity Trends Among US Adults 1991 Obesity is the nation s fastest rising public health problem. Obesity rates among US adults increased by more than 75% between , and rates doubled in children and tripled in teens over the past 20 years. One in seven young people is obese and one in three is overweight. The prevalence of overweight/obesity among ethnic/racial groups does not differ significantly for men; in women, prevalence is highest among African Americans (more than half of African American women aged 40 and older are obese and 80% are overweight). Trends to 2010 and 2015: Unlikely to meet objectives By 2015, it is projected that overall, the prevalence of overweight adults will be 75% and obese adults will be 41%, compared to 66% and 32%, respectively, in By 2015, it is projected that for children aged 6-11, the prevalence of overweight will be 23%, and for adolescents aged it will be 24%. In 2006, 16% of adolescents were overweight. Obesity Trends Among Adults 1995 Obesity Trends Among Adults 2006 More than half the adult population in every state is overweight; the percentage of adults who are overweight exceeds 60% in 28 states. 70

73 Overweight and Obesity Nutrition and Physical Activity Twenty two states have taken legislative action to set nutrition standards on foods sold outside the school meal program. Current patterns of overweight and obesity in the United States could account for up to 14% of cancer deaths in men and 20% in women, and contribute to 90,000 cancer deaths each year. About half of youth who are overweight as children and about 70% of those who are overweight by adolescence will remain overweight as adults. Twenty six states have taken legislative action to limit when and where foods that are not part of the school meal program can be sold during school hours. Through the Preventive Health Partnership between American Cancer Society, American Diabetes Association, and the American Heart Association, the Society is working collaboratively to increase the public s awareness and utilization of preventive services and screenings for chronic disease. The Preventive Health Partnership will provide a platform for exploring the new and better models for the delivery of preventive services that would improve the quality of life and other health outcomes for millions of people over time while simultaneously making more efficient use of our nation s health care resources by avoiding expenses for preventable chronic conditions. 71

74 Nutrition Nutrition and Physical Activity 2015 Adult and Youth Objective 75% consume five fruits and vegetables daily 2010 Adult and Youth Objective 45% consume five fruits and vegetables daily Most urban and rural areas have limited access to supermarkets with nutritious foods. Low-income zip codes tend to have fewer and smaller grocery stores than higher-income zip codes. People in low-income areas often pay more for nutritious foods such as fresh fruits and vegetables. Seventeen states have taken legislative action to require higher nutritional standards on school meals than minimum USDA requirements. Fruits and Vegetables Adults In 2005, fewer than one in four adults (24.3%) reported eating five or more servings of fruits and vegetables a day; this percentage has remained essentially the same for the last decade. Trend to 2010 and 2015: Unlikely to meet objectives The 2005 Youth Risk Behavior Surveillance System (YRBSS) showed that only 20.1% of US high school students ate five or more fruits and vegetables per day; again, like adults, this percentage has remained essentially unchanged for years Trend to 2010 and 2015: Unlikely to meet objectives Fruits and Vegetables Youth 72

75 Physical Activity Nutrition and Physical Activity 2015 Adult and Youth Objective 70% follow guidelines 2010 Adult and Youth Objective 60% follow guidelines Physical Activity Adults Based on the 2005 Behavioral Risk Factor Surveillance System, 48.3% of adults met moderate physical activity recommendations. The state median for vigorous physical activity is 27.6%. Trend to 2015: Possible to meet objective Trend to 2010: Likely to meet objective Physical Activity Youth The 2005 YRBSS data showed moderate physical activity is 68.7%. This percentage has increased very little over the past five years. Trend to 2015: Likely to meet objective Trend to 2010: Objective already met In 2005, 37% of high school students reported watching three or more hours of television each day, and only 33% attended physical education daily. 73

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77 Skin Cancer More than one million cases of skin cancer are diagnosed each year. Most are basal and squamous cell cancers that are highly curable if detected early. However, about 59,940 skin cancer cases in 2007 will be malignant melanoma the most serious skin cancer. While melanoma is also highly curable if detected early (the five-year relative survival rate is 91%), it will cause an estimated 8,110 deaths in Melanoma affects mostly whites, who are 10 times more likely to develop the disease than African Americans. Trends: During the 1970s, melanoma incidence rates increased by about 6% per year. Between , however, the rate of increase slowed to 3% per year. Since 2000, rates have remained stable. After increasing for several decades, the death rate for melanoma has stabilized since 1990 in white men and has been decreasing since 1988 in white women. Challenges: Adults and adolescents do not regularly protect themselves from ultraviolet (UV) exposure when outside on sunny days. Bottom Line: Nearly all skin cancers are caused by excessive exposure to ultraviolet (UV) radiation. Reducing sun exposure, wearing protective clothing, and properly using adequate sunscreen are the best ways to reduce skin cancer risk. This is especially true for children, as childhood sunburns can increase the risk of skin cancer later in life. Overall, there was rather limited progress in improving sun protection practices and reducing sunburns among US youth between , despite widespread sun protection campaigns. Skin Cancer Progress toward Nationwide Objectives at a Glance By 2015 Progress 2015 Trends Behavior Change: 75% of people use at least two protective measures Adult: 2005 HINTS 19% to 50% Youth: 2005 YRBS 9% to 18% Likely to meet goal Possible to meet goal Unlikely to meet goal? Unknown Dashboard Metric 75

78 Skin Cancer Skin Protection Behavior Change 2015 Objective 75% of people use at least two protective measures Progress Most governmental and nongovernmental efforts to prevent skin cancer in the United States have sought to change the individual behaviors of parents and children, without a concomitant emphasis on sun protection policies, such as those used effectively in Australia. The 2005 Youth Risk Behavior Survey (YRBS) found that only 9% of high school students used sunscreen of SPF-15 or higher most of the time or always when they were outdoors in the sun for more than an hour; this was down from 14% reported in the 2001 YRBS. Nationwide, according to the 2005 YRBS, 18% of high school students most of the time or always stayed in the shade, wore long pants, wore a long-sleeved shirt, or wore a hat that shaded their face, ears, and neck when outside for more than one hour on a sunny day. According to the 2005 Health Information National Trends Survey (HINTS), adults reported engaging in the following sun protection measures: 50.4% used sunscreen always or often; 46.3% used a hat always or often; 19.2% used shade always or often; 61.9% used long-sleeved shirts always or often; 28.3% used long pants always or often. According to the 2005 BRFSS, the percentage of adults who were sunburned during the past 12 months was 41.2%, an increase from 34.5% in In 2004, 69% of youth aged reported having been sunburned during the summer, not significantly less than in 1998 (72%) based on Society surveys. There was a significant decrease in the percentage of those aged who reported sunburns and a nonsignificant increase among year-olds. The proportion of youth who reported regular sunscreen use in the past summer increased significantly from 31% in 1998 to 39% in The School Health Policies and Programs Study (SHPPS) conducted by CDC in 2000 indicates that policies for sun safety programs do not exist in the majority of elementary, junior/middle, or senior high schools in the United States. Twelve states and the District of Columbia have policies that require sun safety or skin cancer prevention in elementary schools. Fifteen states and the District of Columbia have policies that require sun safety or skin cancer prevention in middle or high schools SHPPS data is not yet available. If these current trends continue, we are unlikely to meet the 2015 objective. New American Cancer Society guidelines on skin cancer prevention and early detection will be released in

79 Comprehensive School Health Education Much of the progress against cancer that we see today is the result of interventions begun 30 to 40 years ago. The present generation of young people exhibit behaviors that are linked to increased cancer risk in the future, including tobacco use, poor diet, lack of physical activity, drug and alcohol use, and certain sexual behaviors. If these young people can be influenced to change their behaviors, more than 60% of cancers known to be preventable and caused by habits formed in childhood could potentially be eliminated. The effort to improve youth health choices could yield additional health benefits, since many of the behaviors that increase cancer risk also increase the risk of heart disease, diabetes, and stroke later in life. Trends: While the percentage of schools that require health education increases by grade from 33% in kindergarten to 44% in grade five, the percentage decreases to 27% in grade six and only 2% in grade 12. Thus, during the grades when the prevalence of health risk behaviors increases among students, schools progressively provide less health education. Challenges: Lack of curriculum and lack of understanding what works are not the main barriers to comprehensive school health education. Instead, the primary obstacles are a lack of resources, trained personnel, and policies in school systems that address health in a coordinated and comprehensive way. At the local level, few required health education classes or courses are taught by a teacher who majored or minored in health education or health and physical education combined. Bottom Line: More than 53 million young people are enrolled in 14,000 school districts across the United States. Comprehensive school health education in grades K-12 can provide students the knowledge and skills necessary to help them adopt and maintain healthy lifestyles. If adopted and implemented nationwide, comprehensive school health education, coordinated with other health enhancing school programs and policies, could shape the future health of the nation. Progress toward Nationwide Objectives at a Glance Comprehensive School Health Education (CHSE) By 2015 Progress 2015 Trends CSHE: 50% of school districts provide CSHE 2000 SHPPS data: 14.9%? BY 2010: CSHE: 35% of school districts provide CSHE School Health Councils: 75% of school districts have active school health councils School Health Coordinators: 50% of school districts have school health coordinators 2000 SHPPS data: 14.9% 2000 SHPPS data: 88% have some type of council No data point until 2006 SHPPS data is released??? Likely to meet goal Possible to meet goal Unlikely to meet goal? Unknown Dashboard Metric 77

80 Comprehensive School Health Education Comprehensive School Health Education 2015 Objective 50% of school districts 2010 Objective 35% of school districts Progress The American Cancer Society is in the final year of a fiveyear initiative to implement the Urban School Health Leadership Institute within six large urban school districts. This initiative is designed to strengthen school health programs and policies within these urban school districts. The American Cancer Society collaborated with the CDC to define a measure for Comprehensive School Health Education (CSHE) from the 2000 School Health Policies and Programs Study (SHPPS) data. The SHPPS data showed that 14.9% of school districts conduct CSHE according to the Society s definition. The Society worked with CDC s Division of Adolescent and School Health (DASH) to further refine SHPPS measures for the 2006 survey to more accurately capture CSHE at the school district level. The 2006 data will be released in October The Society supported the recent review and revision of the National Health Education Standards released in February The National Health Education Standards, originally developed in 1995 with the Society s support, have significantly influenced the quality and quantity of health education taught in US schools in the past 12 years. The standards are now the recognized health education reference in the United States and have been referenced internationally. This is a significant contribution by the American Cancer Society to school health nationwide. Thirty-eight states have adopted or adapted the standards as a framework for K-12 health education. With renewed commitment, the Society continues to work with other national youth and school health organizations to promote the use and adoption of the National Health Education Standards. Trend to 2010 and 2015: Unknown until 2006 data is available SHHPS 2006 data will be released by the Centers for Disease Control and Prevention Division of Adolescent and School Health in October Comprehensive school health education refers to K-12 classroom instruction just one component of the larger school health program that includes food services, the school environment, student services, staff wellness, student counseling, and community and parent involvement. 78

81 Comprehensive School Health Education School Health Councils School Health Coordinators 2010 Objective 75% of school districts with active councils Progress 2010 Objective 50% of school districts with coordinators Progress Based on data from the 2000 SHPPS survey, some type of council exists in 88% of school districts. Recent federal regulations associated with the Federal Free and Reduced School Meal Authorization required that all school districts use representatives from both school and the community to develop School Wellness Policies related to nutrition and physical activity. Schools with school health councils, many formed due to the Society s advocacy efforts, were well positioned to develop policies outlined in the regulations. Those that did not have councils had to create them to serve the district. The expectation is that 2006 SHPPS data will show significant growth for school health councils. Trend to 2010: Unknown until 2006 data is available SHHPS 2006 data will be released by the Centers for Disease Control and Prevention Division of Adolescent and School Health in October The Society worked with CDC DASH to include new questions on the 2006 SHPPS in order to capture the percentage of school districts with school health coordinators. Previous SHPPS data captured the prevalence of coordinators nationwide, but the question did not distinguish between district and school building-level coordinators. In addition, the Society worked with CDC DASH to include questions to capture the impact of leadership training targeting school health coordinators nationwide. Since the inception of the American Cancer Society School Health Leadership Institutes in 1999, many Society Divisions and state departments of health and/or education have sponsored trainings targeting school health coordinators and other school and community members who share and influence decisions that impact school health programs. School Health Leadership Institutes conducted at the national, state, and regional levels over the past eight years have reached school health leadership teams in more than 250 school districts that represent some five million K-12 students just fewer than 10% of the total US student population. Trend to 2010: Unknown The present generation of adolescents is heavier, less physically active, and, especially among girls, smokes more than its parents did at the same age. This backslide in the status of our national health has tremendous negative implications for society. 79

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85 Global Cancer Control Cancer is potentially the most preventable and the most curable of all chronic, life-threatening diseases facing the world today. In the United States and many other developed countries, the last century has witnessed incredible advances in the fight against cancer. For the first time in history, age-adjusted mortality rates have been on the decline for more than a decade in the United States. We have seen a 1% to 1.2% per year reduction in cancer mortality since this downturn first began in the early 1990s, which has resulted in hundreds of thousands of lives being saved. However, globally, the story is far different. This year, cancer will claim some seven million lives worldwide, and another 11 million new cases will be diagnosed. Cancer accounts for one in eight deaths worldwide more than HIV-AIDS, tuberculosis, and malaria combined. Already, 70 percent of all cancer deaths occur in low-and middle-income countries, and without immediate intervention, the situation will grow much worse. The World Health Organization (WHO) estimates that cancer will become the leading cause of death globally by Projected Global Deaths for Selected Causes of Death, Cancers Projected global deaths (millions) Tuberculosis Malaria Ischaemic heart disease Stroke HIV/AIDS Other infectious diseases Road traffic accidents Year 83

86 Global Cancer Control Cancer.org and Cancer Information Translations The American Cancer Society s Web site, serves millions of individuals throughout the world. Cancer information is currently available in English, Spanish, Mandarin, and several other Asian languages. Approximately 21% of Web traffic to cancer.org comes from outside the United States. Without intervention, more than one billion people will die unnecessarily from cancer this century most of them in low- and middle-income countries. In the last 50 years, science has made remarkable progress toward unraveling the mystery of cancer, yet so much of what we know about cancer is not being adequately translated into what we do. Through its international programs, the American Cancer Society supports the efforts of our global public health partners in their efforts to control cancer. We collaborate actively with the World Health Organization, which has set a goal for reducing cancer deaths by 7.7 million between This is the equivalent of an entire year free of cancer. The American Cancer Society s international program works to empower individuals and institutions in the fight against cancer, to strengthen regional and countrybased cancer control, and to mobilize resources to fight cancer by creating awareness about the cancer pandemic through several programs. Worksite Initiatives The American Cancer Society collaborates with multinational business partners to deliver cancer information and wellness programs to employees throughout the world. The Society s Quitline will be launched internationally in the near future. The American Cancer Society University The American Cancer Society University (ACSU) is an intensive training and development program designed to enhance nonprofit management practices and public health skills among cancer control leaders around the world. To date, more than 500 scholars from over 80 countries have graduated from the American Cancer Society University. International Relay For Life International Relay For Life enables cancer organizations to raise their profiles and increase income and capacity through survivorship programs, volunteerism, and advocacy. More than 20 countries have implemented Relay programs, with more than 525 events annually. Framework Convention on Tobacco Control The American Cancer Society plays a significant role in global tobacco control by supporting the adoption and implementation of the Framework Convention on Tobacco Control (FCTC). In collaboration with Cancer Research UK, Research in Tobacco Control, the Society has funded more than 200 grants in more than 70 countries to support tobacco control advocates. To date, more than three-fourths of the world s countries have ratified the treaty. Global Smokefree Partnership In 2007, the Society became the co-host, along with the Framework Convention Alliance, of the Global Smokefree Partnership (GSP) a multi-partner initiative dedicated to promoting smoke-free policies worldwide. GSP leads efforts to secure strong global guidelines for smoke-free policies and to ensure their implementation. 84

87 Global Cancer Control The American Cancer Society s international program advances our mission globally and allows us to be more competitive in the nonprofit marketplace in a number of important ways: It allows us to better serve the worksite needs of multinational corporate partners. As we expand our portfolio of worksite options, the Society will increasingly be seen as a solutions enterprise. It positions us to receive grants and partnerships from individuals and corporations in the United States that have global interests or aspirations, and from individuals and corporations in regions of the world where we implement our programs. It allows us to more completely address problems that can only be solved globally, such as the multinational tobacco industry. It resonates with immigrant populations here in the United States and helps us build trust through a common interest. It speaks to immigrant populations in the United States. Our market data shows that ethnic populations respond positively to knowledge that the Society is working in their countries of origin. 85

88 Global Cancer Control Challenges: One of the most effective measures we can take to reverse the toll that cancer is taking on the most vulnerable nations in our society is to eliminate the global scourge of tobacco, which is the single most preventable cause of cancer worldwide. At current rates, 650 million people alive today, including 325 million children, will eventually die of tobaccorelated disease. Cancer is absent or low on the health agendas of low- and middle-income countries and is minimally represented in global health efforts in those countries. In all regions of the world, aging populations are a factor in cancer s growth. But it is the preventable causes of cancer tobacco, infection, obesity, and disparities in access to highquality cancer prevention and treatment programs that provide us with a uniquely transformative opportunity to save lives through global advocacy, leadership, and action. Despite global successes such as the WHO Framework Convention on Tobacco Control, the first legal instrument designed to reduce tobacco-related death and disease around the world, chronic diseases have generally been neglected in international health and development work. Despite the recognition from international organizations like WHO that well-designed, comprehensive cancer control plans and programs can save and improve lives, most countries and states both well-developed and developing do not have such plans. The role of international partners is crucial for achieving desired cancer control goals, particularly on transnational issues, where the actions of a single country are insufficient. Coordinated work is needed among organizations of the United Nations System, intergovernmental bodies, nongovernmental organizations, professional associations, patient groups, corporations and foundations, and other key stakeholders. 86

89 Income Development 87

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91 Income Development Fundraising is the foundation on which the American Cancer Society s strategic plan for mission delivery is built. The Society s Integrated Fundraising Plan, implemented through several strategic initiatives, supports and intersects with our mission activities to accomplish our leadership roles and contribute to the success of the 2015 goals. Trends: Rise in disaster relief funding in recent years Increase in large gifts, with emergence of new social investor mega-donors Declining direct marketing campaigns industry-wide Legislative changes affecting donations of merchandise Double-digit growth in Internet contributions (although they still represent a small proportion of overall giving) Challenges: Greater collaboration with mission delivery in persuasively communicating the highest priority restricted funding opportunities to major donors Need for creative, win-win solutions to support the expansion of revenue strategies involving inter- Division and Division-NHO collaborations Greater prioritization of high-potential growth areas for investment Greater public awareness of the Society s fundraising opportunities through expanded strategic marketing efforts Bottom Line: The American Cancer Society is the largest health charity, double the size of its next largest peer and has grown at twice the rate of the health charity sector for the last three years Data 2010 Target 2015 Target Total Public Support $969 M $1.242 B $1.531 B Relay For Life $375.4M $488 M $643M Other community based-events (Making Strides Against Breast Cancer, Daffodil Days, others) $73M $90 M $116 M Distinguished Events (Gala and Golf) $53M $81 M $114 M Direct Response Strategies (Direct Mail, Telemarketing, E-Revenue) $69M $74 M $83 M Employer-Based Strategies (Workplace Giving, Corporate Promotions) $46M $56 M $76 M (Cause Marketing Not included in Public Support) $3M $8M $9M Major Gifts/Campaigns $62M $118 M $109 M Planned Giving (Legacies, Bequests, others) $171M $208 M $245 M Other (Memorials, Cars, Discovery Shops, Unsolicited, Team ACS, other) $120M $129 M $145 M The stated objectives represent an annual average growth rate of 6% through 2010 and 4% through *Growth rates are likely to be higher than 4% through 2015, but many Divisions have not built their major gift campaigns out beyond

92 Income Development Total Public Support The Society raised close to $1 billion in total public support in 2006 and is the fifth largest charity in total public support and the largest health charity twice the size of the next largest health charity. Growth in public support has been strong in each year since the Integrated Fundraising Plan began its phased rollout in Preliminary 2007 results show growth continuing at strong rates. The Best Practices Initiative improves our fundraising success in all strategy areas by analyzing and interpreting data, strengthening management capabilities, developing custom Division plans, and evaluating progress. Cost Per Dollar Raised Following an improvement in 2004, cost per dollar raised has been relatively steady. Dashboard metrics 90

93 Income Development Public Support Growth in Health Charity Sector In 2004, 2005, and 2006, the Society grew at approximately twice or more the rate of its health sector peers. Annual Net Income Dashboard metrics Growth in annual giving was strong in each year since the phased rollout of the Integrated Fundraising Plan in Growth has been driven by improvements in dollar per donor ( from $71 in 2003 to $83 in 2006), reflecting the Society s increasing emphasis on fundraising strategies for cultivating wealthy constituents, especially the Major Gifts Initiative and Distinguished Event strategies, as a complement to traditional mass market strategies. Donor retention has been generally consistent over time at approximately 32%. 91

94 Income Development Strategic Initiative: Relay For Life Relay For Life Relay For Life grew at robust rates each of the last three years, including two years of double digit growth. The event expanded into an additional 829 communities between , with overall growth being driven by continued broadening of the base of participation and support. Relay For Life continues to grow as the Society s signature event and as a key strategy for engaging communities in the fight against cancer. It generates a significant portion of the Society s total annual giving and creates volunteer leadership opportunities, a platform for advocacy and survivor and mission related activities, and a viable community presence at thousands of community events. Relay For Life Moving forward, mission will be more fully incorporated into Relay through the framework of Celebrate. Remember. Fight Back. An increasingly strong field operations relationship will be needed to sustain growth in staff and volunteer leadership as events mature. 92

95 Income Development Strategic Initiative: Fundraising Resources Making Strides Against Breast Cancer In the future, stronger corporate partnerships and broader public awareness of the Strides event will be needed, especially as it expands into mid-sized urban markets and more fully incorporates mission integration strategies. Over time, greater integration of galas with the Society s major gifts program will create fluid opportunities for constituents to move to higher levels of giving and engagement with the organization s mission. Fundraising Resources Fundraising Resources activities appeal to constituents based on their personal areas of interest (cancer site, sports, social, honoring of loved ones, etc.). They build nationwide collaborative relationships to support communication with special interest groups. Priority activities include Making Strides Against Breast Cancer, Distinguished Events (Gala and Golf), Daffodil Days, Coaches vs. Cancer, and the Society s Tribute Program. Making Strides Against Breast Cancer grew at double digit rates in 2004 and 2005, with preliminary 2007 results above 25%. Growth has been driven by a combination of increases in market penetration and dollar per donor, as well as the addition of 12 events between 2003 and Balls and Galas Galas growth has been strong in each year of the Integrated Fundraising Plan. Growth has been driven by an increase in dollar per donor, reflecting access to a wealthier clientele. The number of events has declined by 30 as Divisions transition to a smaller number of higher-end events. 93

96 Income Development Other Fundraising Resources Strategies Golf Growth in golf and Daffodil Days has been relatively modest, as nationwide focus has been on growing priority strategies. Golf has transitioned toward a greater emphasis on reaching a high-end clientele, as seen in a growing dollar per donor. Memorials growth was strong in 2004 and 2005 as the Society expanded its strategic relationship with the National Funeral Directors Association, although revenue declined slightly in The Society is also working to develop new special event strategies, especially those that leverage technology, such as endurance events that cultivate established athletic communities of interest. Daffodil Days Memorials 94

97 Income Development Strategic Initiative: Major Gifts Major Gifts/Campaigns Major Gifts Major Gifts develops meaningful longterm relationships with high net worth individuals and foundations, and provides them a platform for realizing their personal vision of the fight against cancer while investing in the Society s most compelling mission opportunities. Moving forward, close collaboration with Mission Delivery will be needed to identify and communicate the Society s most compelling restricted giving opportunities in a way that is persuasive and motivating to major donors. Major Gifts and Campaigns grew significantly since the initiative kicked off in 2004, with more than 30% growth each year, and continued growth at that rate expected in Gifts of $100,000 and more rose from 78 in fiscal year 2004 to 108 in fiscal year 2006; Gifts of $1 million and more rose from one in fiscal year 2004 to 13 in fiscal year Strategic Initiative: Employer Initiative In fiscal year 2006, 3,427 workplace mission offerings (e.g. Quitline, Active For Life SM ) at 1,599 worksites affected 36.6 million people. Independent Payroll Deduction Employer Initiative The Employer Initiative develops cross- Division relationships with major US employers (e.g., Fortune 1000 companies) and creates mutually beneficial partnerships through a coordinated account management process. It offers those companies customized mission and income offerings to stimulate payroll deduction programs, event sponsorships, matching gifts, cause marketing relationships, and corporate philanthropy. Independent payroll deduction has shown moderate growth, reflecting a two- to four-year cultivation cycle. Several major cultivation wins in 2006 will generate significant revenue growth, with 2007 preliminary results up more than 50%. 95

98 Income Development Strategic Initiatives: Mass Market CRM Mass Market CRM Through an integrated set of direct response strategies, Mass Market CRM strengthens mass market constituent relationships to improve donor retention, constituent loyalty, and gift size and frequency. It focuses on market segmentation, interactive opportunities, and net lifetime value. Direct Marketing Direct Marketing revenue, including all mail and telemarketing revenue, has increased slightly, but has performed better than other health charities whose revenue declined during the same time period. The Society s focus on donor segmentation and donor lifecycles has been a key strategy in revitalizing direct marketing growth in 2006, with larger projected increases in 2007 and beyond. E-Revenue The goal of E-Revenue is to build a powerful online competency that serves as a foundation for a donor care E-Revenue strategy while providing income growth opportunities to all other major Integrated Fundraising Plan initiatives. It creates dynamic new fundraising opportunities using changes in social engagement techniques resulting from technological advances and leverages technology to access a broader group of potential donors, achieve higher levels of giving, increase the efficiency of fundraising, and improve ease of data capture and subsequent constituent relationship management. Strategic Initiative: E-Revenue Of online donors in fiscal year 2006, 73% were first-time donors to the American Cancer Society. Total E-Revenue has shown triple digit growth in 2005 and 2006, contributing to the strong growth shown in special events and other strategies. 96

99 Income Development Strategic Initiatives: Planned Giving Resources Legacies and Bequests Planned Giving Resources Planned Giving Resources develops meaningful personal relationships with individuals of capacity and their financial advisors, enabling them to leverage their assets and make ultimate gifts to the fight against cancer. When possible, it positions the American Cancer Society as a philanthropic advisor and uses direct response strategies to build awareness of planned giving opportunities among a broader audience. Extraordinary bequests and market factors cause fluctuations in Planned Giving revenue, making the average growth of 7% a better indicator than performance in any single year. The impact of the Pension Protection Act is still unfolding, creating the potential for significant future increases in IRA rollover giving. 97

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103 Historical Change Since adopting the 2015 Challenge Goals in and the nationwide objectives in 1999, the American Cancer Society National Board of Directors has annually reviewed progress toward these established outcomes. In response to the annual review, the Board changes or modifies outcome statements, as appropriate. Following is a historical look at the changes from 1996 through November Note that statements outlined in blue are those currently in effect Goals Outcome Statement/Origination Date Rationale for Change 50% reduction in age-adjusted cancer mortality rates by the Year (Adopted 1996) No change since adoption. 25% reduction in age-adjusted cancer incidence rates by the Year (Adopted 1998) Measurable improvement in the quality of life (physical, psychological, social, and spiritual) from the time of diagnosis and for the balance of life of all cancer survivors by the Year (Adopted 1998) No change since adoption. No change since adoption. 101

104 Historical Change Principles Information Outcome Statement/Origination Date Rationale for Change By 2015, state of the art information on issues related to incidence, mortality, risk factors, treatment, survivorship and quality of life (physical, social, psychological and spiritual) will be available and accessible through all appropriate channels to all people. (Adopted 2003) Added the words treatment and survivorship in By 2015, state of the art information on issues related to incidence, mortality, risk factors and quality of life (physical, social, psychological and spiritual) will be available and accessible through all appropriate channels to all people. (Adopted 1999) Added the words treatment and survivorship in By 2004, objectively quantify, prioritize, and create plans to fulfill unmet cancer information needs of constituents. (Adopted 2003) This objective has been completed and the work is ongoing. Specific metrics related to the leadership roles and focus areas address this objective, and NCIC continually collects and evaluates information-related data. By 2002, identify the cancer-related information needs and utilization patterns of users of ACS cancer information services in order to prioritize and develop or assemble information to fill those identified needs. (Adopted 2000) This objective has been mostly completed and was restated for

105 Historical Change Measurements Outcome Statement/Origination Date Monitoring systems that track relevant incidence, mortality, risk factor and screening prevalence, and quality of life dimensions should be available nationwide. (Adopted 2003) By 2008, all states will have cancer registries that meet NAACR silver or gold certification standards. (Adopted 2003) By 2005, tracking systems will be developed or supported to identify and monitor the disparities between population groups in cancer incidence, mortality, risk factor and screening prevalence, and quality of life. (Adopted 2003) By 2005, systems will be developed or supported that track inputs, activities, and outputs towards achievement of Division-specific outcomes and ultimately nationwide objectives. (Adopted 2003) Rationale for Change No change since adoption. No change since adoption. This objective has been mostly completed and the work is ongoing. This objective has been mostly completed and work is ongoing through the Nationwide Dashboard and Division Scorecards. By 2002, nationwide systems will be developed or supported to gather baseline, monitoring, and program evaluation and cost data for all relevant incidence, mortality and quality of life dimensions. (Adopted 1999) This objective has been mostly completed and work is ongoing. This objective was restated in 2003 in the overarching measurement statement. By 2002, develop internal tracking systems for the Nationwide Program of Work. (Adopted 2000) By 2002, conduct surveys to begin to track nationwide interim objectives that are not tracked using external data sources. (Adopted 2000) This objective has been partially completed and work is ongoing. This objective was restated in a 2005 objective. This objective has been mostly completed and was restated in a 2005 objective. 103

106 Historical Change Disparities Outcome Statement/Origination Date Rationale for Change By 2015, eliminate the disparities in cancer burdens among population groups by reducing age-adjusted cancer incidence and mortality rates and improving quality of life in the poor and underserved. (Adopted 2006) Deleted the words to the population average to reduce ambiguity. By 2015, eliminate the disparities in cancer burdens among population groups by reducing age-adjusted cancer incidence and mortality rates and improving quality of life in the poor and underserved to the population average. (Adopted 1999) Wording was refined in 2006 objective to reduce ambiguity. By 2005, conduct or support comprehensive assessments that identify issues and needs for eliminating disparities to guide decisions on objectives, audiences, and interventions. (Adopted 2003) By 2004, ensure that appropriate programs included in the ACS Nationwide Program of Work address cancer disparities and the needs of the underserved. (Adopted 2003) The work in this objective is ongoing through the leadership roles and focus areas. Addressing disparities was established as an overarching pillar for all leadership roles and focus areas. Specific metrics in the leadership roles and focus areas address this objective. This objective has been completed and the work is ongoing. By 2001, develop 5-year action plans by NHO that address the elimination of disparities within each site/risk factor and quality of life area. (Adopted 2000) By 2001, all charter agreements will incorporate an organizational diversity plan. (Adopted 2000) By 2001, diversity training for staff and volunteers will be available nationwide. (Adopted 2000) By 2001, a Clearinghouse for sharing best practices and coordination will be developed. (Adopted 2000) This objective was partially completed in 2001, and restated in a 2004 objective. This objective was completed in This objective was completed in This objective was completed in

107 Historical Change Collaboration Outcome Statement/Origination Date Rationale for Change Efforts should be increased at all levels of the American Cancer Society for working with other organizations and agencies to achieve our common cancer control goals and objectives. (Adopted 1999) No change since adoption. By 2004, identify, enter into, and measure specific collaborations and partnerships with organizations and systems, especially those related to addressing identified cancer disparity issues. (Adopted 2003) This objective has been completed and the work is ongoing. Collaborative relationships continue with numerous leadership organizations in the fight against cancer. A database of collaborative partnerships is now being maintained and regularly updated. By 2002, identify collaborating partners and incorporate roles, based upon collaboration guidelines, in action plans at all levels of the Society. (Adopted 2000) By 2002, collaboration training for staff and volunteers will be available nationwide at all levels of the Society. (Adopted 2000) This objective has been partially completed and was restated in a 2004 objective. This objective was mostly completed in 2002 and work is ongoing. Access to Quality Treatment Outcome Statement/Origination Date Rationale for Change By 2015, assure that all people diagnosed with cancer have access to appropriate, quality treatment and follow-up, achieving 0% disparities in treatment outcomes. (Adopted 2000) No change since adoption. By 2004, develop long-term action plans by NHO, in collaboration with the National Quality Forum and others, that (a) address access to care and (b) define indicators of quality treatment for each major cancer site. (Adopted 2001) This objective has been partially completed and the work is ongoing. Access to care is a current focus for the Society. Collaborative partnerships continue with numerous leadership organizations and others on this issue. 105

108 Nationwide Objectives Colorectal Cancer Historical Change Outcome Statement/Origination Date Rationale for Change Incidence: By 2015, reduce the age-adjusted incidence rate of colorectal cancer by 40%. (Adopted 1999) Mortality: By 2015, reduce the age-adjusted mortality rate of colorectal cancer by 50%. (Adopted 1999) Early Detection: By 2015, increase to 75% the proportion of people aged 50 and older who have colorectal screening consistent with American Cancer Society guidelines. (Adopted 1999) No change since adoption. No change since adoption. No change since adoption. Incidence: By 2010, reduce the age-adjusted incidence rate of colorectal cancer by 30%. (Adopted 2006) Mortality: By 2010, reduce the age-adjusted mortality rate of colorectal cancer by 40%. (Adopted 2006) Behavior Change: By 2010, 60% of people aged 50+ will have received colorectal screening consistent with American Cancer Society guidelines. (Adopted 2006) New objective established in 2006 as interim measure toward 2015 objective. New objective established in 2006 as interim measure toward 2015 objective. Updated the 2005-related objective to a 2010 objective following mid-course assessment. Public Awareness: By 2005, 75% of people aged 50+ will be aware of and have knowledge about the need for colorectal screening. (Adopted 2000) Behavior Change: By 2005, 50% of people aged 50+ will have received colorectal screening following ACS guidelines as measured by the preferred tests of sigmoidoscopy, colonoscopy, or barium enema. (Adopted 2000) Access to Screening: By 2005, 100% of states will have comprehensive insurance laws, which cover the costs of colorectal screening in fully insured and self-insured health plans. (Adopted 2000) This objective was moved to operations in 2006 and is being monitored as a key indicator in business plan activities. This objective was updated in 2006 to a new 2010 objective. Word change adding or cooperative agreements in Access to Screening: By 2005, 100% of states will have comprehensive insurance laws or cooperative agreements that cover the costs of colorectal screening in fully insured and self-insured health plans. (Adopted 2001) This objective was moved to operations in 2006 and is being monitored as an existing Leadership Role metric. 106

109 Historical Change Lung Cancer and Adult and Youth Tobacco Use Outcome Statement/Origination Date Rationale for Change Incidence: By 2015, reduce the age-adjusted incidence rate of lung cancer by 45%. (Adopted 1999) Mortality: By 2015, reduce the age-adjusted mortality rate of lung cancer by 45%. (Adopted 1999) No change since adoption. Restated in 2005 following mid-course assessment to make consistent with overall 2015 goal of a 50% reduction. Mortality: By 2015, reduce the age-adjusted mortality rate of lung cancer by 50%. (Adopted 2005) Restated objective to make consistent with overall 2015 goal of a 50% reduction. Adult Tobacco Use: By 2015, reduce to 12% the proportion of adults (18 and older) who use tobacco products. (Adopted 1999) Changed wording to current cigarette smokers in 2006 to make consistent with survey questions. Adult Tobacco Use: By 2015, reduce to 12% the proportion of adults (18 and older) who are current cigarette smokers. (Adopted 2006) Adult Smokeless Tobacco Use: By 2015, reduce to 0.4% the proportion of adults (18 and older) who are current users of smokeless tobacco. (Adopted 2006) Restated objective to make consistent with survey questions. New objective established in 2006 following mid-course assessment. Youth Tobacco Use: By 2015, reduce to 10% the proportion of young people (under 18) who use tobacco products. (Adopted 1999) Changed wording to high school students who are current cigarette smokers in 2006 to make consistent with survey questions. Youth Tobacco Use: By 2015, reduce to 10% the proportion of high school students (under 18) who are current cigarette smokers. (Adopted 2006) Youth Smokeless Tobacco Use: By 2015, reduce to 1% the proportion of high school students (under 18) who are current users of smokeless tobacco. (Adopted 2006) Restated objective to make consistent with survey questions. New objective established in 2006 following mid-course assessment. 107

110 Historical Change Lung Cancer and Adult and Youth Tobacco Use Outcome Statement/Origination Date Rationale for Change Adult Tobacco Use: By 2010, reduce to 18.5% the proportion of adults (18 and older) who are current cigarette smokers. (Adopted 2006) Adult Tobacco Use: By 2010, reduce by 25% from 2000 baseline prevalence rate the proportion of low SES adults (18 and older) who are current cigarette smokers. (Adopted 2006) Youth Tobacco Use: By 2010, reduce to 15% the proportion of high school students (under 18) who are current cigarette smokers. (Adopted 2006) Updated the 2005-related objective to a 2010 objective following mid-course assessment. Updated the 2005-related objective to a 2010 objective following mid-course assessment. Updated the 2005-related objective to a 2010 objective following mid-course assessment. Adult Tobacco Use: By 2005, reduce to 19% the proportion of adults (18 and older) who use tobacco products. (Adopted 2000) Adult Tobacco Use: By 2005, reduce by 25% from 2000 baseline prevalence rate the proportion of low SES adults (18 and older) who use tobacco products. (Adopted 2000) Youth Tobacco Use: By 2005, reduce to 15% or less the frequent use of cigarettes by young people (under 18). (Adopted 2000) Tobacco Settlement: By 2005, 75% of states will direct available tobacco control funds consistent with CDC guidelines. (Adopted 2000) Clean Indoor Air: By 2005, 50% of U.S. population will reside in communities covered by comprehensive clean indoor air laws/policies. (Adopted 2000) Tobacco-free Schools: By 2005, 100% of schools will have tobacco-free environments. (Adopted 2000) Tobacco Excise Taxes: By 2005, all states will achieve a state excise tax level on cigarettes that is equal to the federal level and 50% of states will achieve a state excise tax level on cigarettes that is equal to or greater than $1.00 per pack. (Adopted 2000) This objective was restated in a 2010 objective following mid-course assessment. This objective was restated in a 2010 objective following mid-course assessment. This objective was restated in a 2010 objective following mid-course assessment. This objective was moved to operations in 2006 and is being monitored as an existing Leadership Role metric. This objective was moved to operations in 2006 and is being monitored as an existing Leadership Role metric. This objective was moved to operations in 2006 and is being monitored as a key indicator in business plan activities. This objective was moved to operations in 2006 and is being monitored as an existing Leadership Role metric. 108

111 Historical Change Breast Cancer Outcome Statement/Origination Date Rationale for Change Incidence: By 2015, reduce the age-adjusted incidence rate of breast cancer by 15%. (Adopted 1999) Mortality: By 2015, reduce the age-adjusted mortality rate of breast cancer by 45%. (Adopted 1999) No change since adoption. Restated in 2005 following mid-course assessment to make consistent with overall 2015 goal of a 50% reduction. Mortality: By 2015, reduce the age-adjusted mortality rate of breast cancer by 50%. (Adopted 2005) Restated objective to make consistent with overall 2015 goal of a 50% reduction. Early Detection: By 2010, increase to 90% the proportion of women aged 40 and older who have breast screening consistent with American Cancer Society guidelines. (Adopted 2006) Updated 2008 and 2005-related objectives following mid-course assessment. Early Detection: By 2008, increase to 90% the proportion of women aged 40 and older who have breast screening consistent with American Cancer Society guidelines. (Adopted 1999) Restated in a 2010 objective following mid-course assessment. Behavior Change: By 2005, the recent screening rates of women aged 40+, women aged 65+, and low SES populations (200% of poverty level and below) will be 70%. (Adopted 2000) Access to Treatment: By 2005, through advocacy at all organizational levels, 100% of women will have access to appropriate treatment. (Adopted 2000) Surveillance: By 2002, include in all state registries DCIS surveillance data as a measurement for evaluating screening. (Adopted 2000) Restated in a 2010 objective following mid-course assessment. This objective was moved to operations in 2006 and is being monitored as an existing Leadership Role metric. This objective was completed in

112 Historical Change Prostate Cancer Outcome Statement/Origination Date Rationale for Change Incidence: By 2015, reduce the age-adjusted incidence rate of prostate cancer by 15%. (Adopted 1999) Mortality: By 2015, reduce the age-adjusted mortality rate of prostate cancer by 20%. (Adopted 1999) No change since adoption. Restated in 2005 following mid-course assessment to make consistent with overall 2015 goal of a 50% reduction. Mortality: By 2015, reduce the age-adjusted mortality rate of prostate cancer by 50%. (Adopted 2005) Restated objective to make consistent with overall 2015 goal of a 50% reduction. Early Detection: By 2015, increase to 90% the proportion of men aged 50 and older who follow American Cancer Society detection guidelines for prostate cancer. (Adopted 1999) Changed wording by adding age-appropriate in 2001 for clarity. Early Detection: By 2015, increase to 90% the proportion of men who follow age-appropriate American Cancer Society detection guidelines for prostate cancer. (Adopted 2001) Restated objective for clarity. Mortality: By 2010, reduce the age-adjusted mortality rate of prostate cancer by 40% (Adopted 2006) Behavior Change: By 2010, increase the percentage of men who have been offered age-appropriate PSA screening to 75%. (Adopted 2006) New objective established in 2006 as interim measure toward 2015 objective. Updated 2005-related objective following midcourse assessment. Behavior Change: By 2005, increase the percentage of age-eligible men who have been offered PSA screening to 75%. (Adopted 2000) Wording change in 2001 for clarity. Behavior Change: By 2005, increase the percentage of men who have been offered age-appropriate PSA screening to 75%. (Adopted 2001) Restated in a 2010 objective following mid-course assessment. Surveillance: By 2002, develop data collection systems to accurately measure the percentage of men screened for prostate cancer as measured by PSA tests. (Adopted 2000) This objective was completed in

113 Historical Change Nutrition and Physical Activity Outcome Statement/Origination Date Behavior Change: By 2015, increase to 75% the proportion of persons who follow American Cancer Society guidelines on diet and nutrition as measured by consumption of fruits and vegetables. (Adopted 1999) Rationale for Change This objective was restated in 2000 for clarity. Behavior Change: By 2015, increase to 75% the proportion of persons who follow American Cancer Society guidelines with respect to consumption of fruits and vegetables as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. (Adopted 2000) Behavior Change: By 2015, increase to 90% the proportion of youth (high school students) and to 60% the proportion of adults who follow American Cancer Society guidelines with respect to the appropriate level of physical activity as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. (Adopted 2000) Restated objective for clarity. This objective was revised in 2006 following midcourse assessment to a new target for youth and adults. Behavior Change: By 2015, increase to 70% the proportion of adults and youth who follow American Cancer Society guidelines with respect to the appropriate level of physical activity as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. (Adopted 2006) Overweight/Obesity: By 2015, the trend of increasing prevalence of overweight and obesity among US adults and youth will have been reversed, and by 2015, the prevalence of overweight and obesity will be no higher than it was in (Adopted 2006) Revised objective with a new target for youth and adults. New objective established in 2006 following midcourse review. 111

114 Historical Change Nutrition and Physical Activity Outcome Statement/Origination Date Rationale for Change Behavior Change: By 2010, increase to 45% the proportion of adults and youth who meet American Cancer Society guidelines for vegetable and fruit consumption, as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. (Adopted 2006) Behavior Change: By 2010, increase to 60% the proportion of adults and youth who meet American Cancer Society guidelines for physical activity, as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. (Adopted 2006) Overweight/Obesity: By 2010, the increasing trends in overweight/obesity for both US adults and youth will have stopped. (Adopted 2006) Updated from a 2005-related objective following midcourse assessment. Updated from a 2005-related objective following midcourse assessment. New objective established in 2006 following midcourse review. Public Awareness: By 2005, 90% of the public will be aware of and have knowledge about the role of a healthy diet and physical activity in preventing cancer. (Adopted 2000) Behavior Change: By 2005, 45% of the population will consume 5 servings of fruits and vegetables daily. (Adopted 2000) Behavior Change: By 2005, increase to 72% the proportion of youth (high school students) and to 30% the proportion of adults who follow American Cancer Society guidelines with respect to the appropriate level of physical activity as published in the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. (Adopted 2000) This objective was moved to operations in 2006 and is being monitored as a key indicator in business plan activities. Restated in a 2010 objective following mid-course assessment. Restated in a 2010 objective following mid-course assessment. 112

115 Historical Change Skin Cancer Outcome Statement/Origination Date Behavior Change: By 2015, increase to 75% the proportion of people of all ages who use at least two or more of the following protective measures which may reduce the risk of skin cancer; avoid the sun between 10 a.m. and 4 p.m., wear sun-protective clothing when exposed to sunlight, use sunscreen with an SPF 15 or higher, and avoid artificial sources of ultraviolet light (e.g., sun lamps, tanning booths). (Adopted 1999) Rationale for Change Revised wording in 2006 by substituting the words properly apply for use. Behavior Change: By 2015, increase to 75% the proportion of people of all ages who use at least two or more of the following protective measures which may reduce the risk of skin cancer; avoid the sun between 10 a.m. and 4 p.m., wear sun-protective clothing when exposed to sunlight, properly apply sunscreen with an SPF 15 or higher, and avoid artificial sources of ultraviolet light (e.g., sun lamps, tanning booths). (Adopted 2006) Revised objective with 2006 wording change. Public Awareness: By 2005, 50% of parents will be aware of and have knowledge about the importance of sun protection for their children. (Adopted 2000) Organizational Awareness: By 2005, 50% of elementary schools, day-care centers, parks/ recreation centers will be aware of and have knowledge about the importance of sun protection. (Adopted 2000) Organizational Policy: By 2005, 50% of elementary schools, day-care centers, parks/recreation centers will have policies to foster skin protection. (Adopted 2000) This objective was eliminated in 2006 as there are currently no existing population-based measures of awareness and knowledge about sun protection in the general public. This objective was deleted in 2001 due to redundancy. This objective was eliminated in 2006 as there are currently no existing measures of numbers of organizations with policies that foster skin protection. School-based policies will continue to be monitored through the School Health Program and Policies Study periodically conducted by CDC. 113

116 Historical Change Comprehensive School Health Education (CSHE) Outcome Statement/Origination Date CSHE: By 2015, increase to 50% the proportion of school districts that provide a comprehensive or coordinated school health education program. (Adopted 1999) Rationale for Change No change since adoption. CSHE: By 2010, 35% of school districts will provide CSHE. (Adopted 2006) School Health Councils: By 2010, 75% of school districts will have active school health councils. (Adopted 2006) School Health Coordinators: By 2010, 50% of school districts will have trained school health coordinators. (Adopted 2006) Updated from 2005-related objective following mid-course assessment. Updated from 2005-related objective following mid-course assessment. Updated from 2005-related objective following mid-course assessment. CSHE: By 2005, 20% of school districts will provide CSHE. (Adopted 2000) School Health Councils: By 2005, 50% of school districts will have active school health councils. (Adopted 2000) School Health Coordinators: By 2005, 50% of school districts will have trained school health coordinators. (Adopted 2000) This objective was updated to a 2010 objective following mid-course assessment. This objective was updated to a 2010 objective following mid-course assessment. This objective was updated to a 2010 objective following mid-course assessment. 114

117 Historical Change Quality of Life Outcome Statement/Origination Date Access to Care: By 2015, the proportion of individuals without any type of health care coverage plan will decrease to 0%. (Adopted 2006) Out of Pocket Costs: By 2015, the proportion of individuals diagnosed with cancer who report difficulties in obtaining medical care due to high out of pocket costs will decrease to 2%. (Adopted 2006) Pain Control: By 2015, all 50 states and the District of Columbia will have received a grade of B or higher and 10 states will have received a grade of A on the Pain Policy Report Card. (Adopted 2006) Measurement: By 2015, there will be national surveillance systems to monitor quality of life for those affected by cancer. (Adopted 2006) Rationale for Change New objective adopted in New objective adopted in New objective adopted in New objective adopted in Physical Effects: By 2015, provide appropriate care for symptom control, emphasizing pain, rehabilitation, and side effects of treatment based upon an appropriate care plan using uniform standards of care for 90% of cancer survivors. (Adopted 1999) Changed wording in 2001 by adding fatigue to the statement. Physical Effects: By 2015, provide appropriate care for symptom control, emphasizing pain, fatigue, rehabilitation, and side effects of treatment based upon an appropriate care plan using uniform standards of care for 90% of cancer survivors. (Adopted 2001) Objective deleted in 2006 as no population-based surveillance data sets currently exist to provide assessments of progress. New objectives were adopted in 2006 based on a new model and available data. 115

118 Historical Change Quality of Life Outcome Statement/Origination Date Pain Control: By 2015, provide appropriate care for the control of pain based upon an appropriate care plan using uniform standards of care for 90% of cancer survivors. (Adopted 1999) Physical Appearance: By 2015, the negative impact of cancer on physical appearance and body image will be substantially reduced in 75% of those affected cancer survivors. (Adopted 1999) Social Support: By 2015, appropriate interventions for socio-economic needs will be received by 90% of cancer survivors, and families and caregivers of those affected by cancer. (Adopted 1999) Rationale for Change Objective deleted in 2006 as no populationbased surveillance data sets currently exist to provide assessments of progress. New objectives were adopted in 2006 based on a new model and available data. Objective deleted in 2006 as no populationbased surveillance data sets currently exist to provide assessments of progress. New objectives were adopted in 2006 based on a new model and available data. This objective was restated in 2001 for clarity. Support Network: By 2015, 90% of cancer survivors and families and caregivers of those affected by cancer will express satisfaction with the available social support network. (Adopted 2001) Objective deleted in 2006 as no populationbased surveillance data sets currently exist to provide assessments of progress. New objectives were adopted in 2006 based on a new model and available data. Social Effects: By 2015, 75% of cancer survivors and their families will be assisted through advocacy, referral, and education in addressing financial, employability, insurability issues, and access to treatment and follow-up care. (Adopted 1999) This objective was restated in 2001 for clarity. Socio-Economic Support: By 2015, 75% of cancer survivors and their families will be assisted through advocacy, referral, and education in addressing financial, employability, insurability issues, and access to treatment and follow-up care. (Adopted 2001) Wording was added to this objective in 2002 for clarity. 116

119 Historical Change Quality of Life Outcome Statement/Origination Date Rationale for Change Socio-Economic Support: By 2015, 75% of cancer survivors and their families will be appropriately assisted at the community level through program/service delivery, advocacy, referral, and education in addressing identified needs related to financial, employability, insurability issues, and access to treatment and follow-up care. (Adopted 2002) Objective deleted in 2006 as no population-based surveillance data sets currently exist to provide assessments of progress. New objectives were adopted in 2006 based on a new model and available data. Psychological, Emotional, Spiritual Effects: By 2015, 90% of cancer survivors and families and caregivers of those affected by cancer will receive appropriate care or appropriate referral to services for identified psychological, emotional, and spiritual problems and/or needs. (Adopted 1999) Wording was changed in 2001 for clarity. Psychological, Emotional, Spiritual Effects: By 2015, 90% of cancer survivors and families and caregivers of those affected by cancer will receive appropriate care or appropriate referral to services for identified psychological, emotional, and spiritual distress and/or needs. (Adopted 2001) Objective deleted in 2006 as no population-based surveillance data sets currently exist to provide assessments of progress. New objectives were adopted in 2006 based on a new model and available data. Provider Education: By 2015, 90% of health care providers will assess psychological, emotional, and spiritual needs of cancer survivors and families and caregivers of those affected by cancer and provide appropriate care or appropriate referral to services. (Adopted 1999) Objective deleted in 2006 as no population-based surveillance data sets currently exist to provide assessments of progress. New objectives were adopted in 2006 based on a new model and available data. Service Delivery Systems: By 2008, 100% of Divisions will develop or have access to a comprehensive service delivery system that addresses the needs of cancer survivors, their families and caregivers through ACS programs/services, or referral to other organizations and resource development to fill gaps in services. (Adopted 2002) This objective was moved to operations in 2005 under the Leadership Roles. 117

120 Historical Change Quality of Life Outcome Statement/Origination Date Rationale for Change Public Awareness: By 2005, 60% of survivors, their families, and caregivers will be aware of and have knowledge about American Cancer Society quality of life education and support services. (Adopted 2000) Health Care Provider Awareness: By 2005, 75% of relevant health care providers (e.g. cancer care providers, primary care providers) will be aware of and express satisfaction with and willingness to refer their patients to American Cancer Society quality of life education and support services. (Adopted 2000) Public Policy/System Change: By 2005, 75% of health care systems will have institutionalized quality standards for the management of pain. (Adopted 2000) ACS Patient Support Programs: By 2005, the number of cancer survivors, their families, and caregivers who participate in appropriate ACS patient support programs or are referred to other community programs will increase by at least 50%. (Adopted 2000) Public Policy/System Change: By 2002, all Divisions and National will have 3-year action plans to influence public policy for priority issues in quality of life, including pain control. (Adopted 2000) Assessment of Need: Every 3 years, the American Cancer Society will document the self-reported needs of cancer survivors, their families, and caregivers to determine ACS roles, collaborative opportunities, and potential ACS programs. (Adopted 2000) This objective was moved to operations in 2005 under the Leadership Roles. This objective was moved to operations in 2005 under the Leadership Roles. Objective deleted in 2006 as no population-based surveillance data sets currently exist to provide assessments of progress. New objectives were adopted in 2006 based on a new model and available data. This objective was moved to operations in 2005 under the Leadership Roles. This objective was mostly completed in Objective deleted in 2006 as no population-based surveillance data sets currently exist to provide assessments of progress. New objectives were adopted in 2006 based on a new model and available data. 118

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