Emerging Issues in Cancer Prevention and Control

Transcription

1 Emerging Issues in Cancer Prevention and Control Marcus Plescia, MD, MPH Director, Division of Cancer Prevention and Control Centers for Disease Control & Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control

2 Overview Where are we? Where are we going? What is going to change?

3 Northwest Portland Area Indian Health Board WA National Comprehensive Cancer Control Status of Cancer Plans MT ND ME AK OR CA NV ID AZ HI UT WY NM CO SD NE TX KS OK MN IA MO AR LA WI IL MS IN AL MI TN KY 2001 OH GA WV SC FL PA VA NC VT NH NY MA CT RI NJ DC DE MD Northwest Portland Area Indian Health Board AK CA OR WA NV ID AZ UT MT WY NM CO ND SD NE KS OK MN IA MO AR WI IL IN MI TN KY OH WV SC PA VA NC NY NJ VT NH MA CT DC DE MD ME RI MS AL GA South Puget Intertribal Planning Agency Northwest Portland Area Indian Health Board AK Alaska Native Tribal Health Consortium WA OR NV CA ID AZ HI UT MT WY CO NM ND MN Aberdeen Area Tribal Chairmen s Health Board SD NE TX KS Cherokee Nation OK IA Fond Du Lac Reservation MO AR LA WI IL MS IN AL 2003 TN MI KY OH GA WV SC FL PA VA NC NY NJ VT NH MA CT DC DE MD ME RI HI TX 2002 Updating or Creating New Plan Current Plan LA AMERICAN SAMOA COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS FEDERATED STATES OF MICRONESIA GUAM PUERTO RICO REPUBLIC OF THE MARSHALL ISLANDS REPUBLIC OF PALAU U.S. VIRGIN ISLANDS FL Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Coordinating Center for Health Promotion Centers for Disease Control and Prevention U.S. Department of Health and Human Services

4 2010 National Comprehensive Cancer Control Status of Cancer Plans South Puget Intertribal Planning Agency Northwest Portland Area Indian Health Board CA OR WA OR NV ID UT MT WY CO ND Aberdeen Area Tribal Chairmen s Health Board SD NE KS MN IA Fond Du Lac Reservation MO WI IL IN MI KY OH WV PA VA NY NJ VT NH MA CT DC DE MD ME RI AK AZ Tohono Northwest O Odham Portland Area Indian Nation Health Board NM Cherokee Nation OK AR MS TN AL GA SC NC TX LA Alaska Native Tribal Health Consortium HI FL AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS PUERTO RICO REPUBLIC OF THE MARSHALL ISLANDS REPUBLIC OF PALAU Creating New Plan Current Plan or Updating Plan National Comprehensive Cancer Control Program Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Office of Noncommunicable Diseases, Injury and Environmental Health February 2010

5 Lung Cancer Incidence among US men, 1998 and 2007 Lung Cancer Incidence among US women, 1998 and 2007 WA 1998 WA 1998 MT ND ME MT ND ME OR ID WY SD MN WI MI VT NH NY MA CTRI OR ID WY SD MN WI MI VT NH NY MA CTRI CA NV UT CO NE KS IA MO IL IN OH KY WV PA NJ MD DE VA ^_ DC CA NV UT CO NE KS IA MO IL IN OH KY WV PA NJ MD DE VA ^_ DC AZ NM OK AR TN NC SC AZ NM OK AR TN NC SC MS AL GA MS AL GA TX LA TX LA HI AK FL HI AK FL OR WA ID MT WY ND SD 2007 MN WI MI ME VT NH NY MA CTRI OR WA ID MT WY ND SD 2007 MN WI MI ME VT NH NY MA CTRI CA NV AZ UT CO NM NE KS OK IA MO AR IL IN TN KY OH PA NJ MD DE WV VA NC SC ^_ DC CA NV AZ UT CO NM NE KS OK IA MO AR IL IN TN KY OH PA NJ MD DE WV VA NC SC ^_ DC MS AL GA MS AL GA TX LA TX LA HI AK FL HI AK FL no data no data

6 Cancer screening in the U.S. Most women are up to date with pap smear screening Eighty percent of women are up to date with mamography screening One-in-three adults age are not up-to-date with colon cancer screening Insured are almost twice as likely to get screened as uninsured CDC. Surveillance of Screening-Detected Cancers (Colon and Rectum, Breast, and Cervix) US, MMWR 2010;59(No. SS-9):[1-25].

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9 CDC Strategic Focus Areas Excellence in surveillance, epidemiology, laboratory services Strengthen support for state, tribal, local, and territorial public health Use scientific and program expertise to advance policy change that promotes health Better prevent illness, injury, disability, and death

10 CDC Winnable Battles Healthcare- Associated Infections Nutrition, Physical Activity, Obesity & Food Safety HIV Teen Pregnancy Motor Vehicle Injuries Tobacco

11 Comprehensive Cancer Control (CCC) Priority Setting Process, 2010: Build on success of NCCCP and long standing focus areas Emphasis on measurable outcomes, value of efforts, and highest impact Support CDC priorities

12 CDC-funded NCCC Program Priorities 2010 Emphasize Primary Prevention of Cancer Support Early Detection and Treatment Activities Address Public Health Needs of Cancer Survivors Implement Policy, Systems, and Environmental Changes to Guide Sustainable Cancer Control Promote Health Equity as it Relates to Cancer Control Demonstrate Outcomes through Evaluation

13 Demonstrating the Capacity of Comprehensive Cancer Control Programs to Implement Policy and Environmental Cancer Control Interventions Implement 3-5 proposed interventions over 5-yr program period Must address primary prevention Link with other chronic disease programs and partners, CCC coalition, and Communities Putting Prevention to Work (CPPW)

14 Summary of Proposed Grantee Policies Primary prevention 12 of 13 programs proposed tobacco PSE interventions 11 of 13 programs had nutrition/physical activity PSE interventions Secondary prevention Support patient navigation Reduce structural barriers to cancer screening Implement reminder systems Interface with health systems Tertiary prevention Cancer Treatment Summaries/Care Plans for Cancer Survivors

15 Cancer Registry: Advocacy Tools

16 Figure 1 Late Stage CRC Incidence Rates, Men Aged 50+ Years, , United States* WA MT ND ME OR ID WY SD MN WI MI NY VT NH MA CT RI CA NV UT CO NE KS IA MO IL IN OH KY WV PA VA NJ DC DE MD AZ NM OK AR TN NC SC MS AL GA AK TX LA FL HI Area did not meet USCS data quality criteria Rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups Census P ) standard *US is NPCR and SEER registries meeting USCS publication criteria, and covers ~96.1% of the US population (ref 27)

17 Things come at you fast! Changing Demographics Budget Challenges Health Reform Program Integration

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20 One in Five Think the Health Law Has Been Repealed, Another Quarter Not Sure Q: As far as you know, which comes closest to describing the current status of the health reform law that was passed last year?: 22% 48% It has been repealed and is no longer law 26% Don t know/ Refused 52% It is still the law of the land Source: Kaiser Family Foundation Health Tracking Poll (conducted February 3-6, 2011)

21 Health Reform will expand insurance coverage Individual mandate everyone must have insurance Employers incentivized to offer insurance Elimination of practices that undermine coverage Medicaid expansion, including all adults Coverage for incomes below 133% Federal Poverty Level Optional coverage for incomes above 133% FPL Insurance exchanges Allow group rate purchasing for individuals, small businesses Subsidies for individuals with incomes up to 400% FPL

22 Health Reform mandates coverage of preventive services Mandated coverage of preventive services Private insurers, Medicare Coverage without consumer cost-sharing Medicaid incentivized to cover preventive services Increased Federal Medical Assistance Percentage 1% ~15 million newly eligible Preventive services includes: Services with A or B USPSTF recommendation Private insurers required to cover mammography for women 40+

23 Health Reform supports prevention and public health Grows from $500m to $2b annually: $500m $750m $1b $1.25b $1.5b $2b In FY 2010 support is provided for PH activities: $250M for primary care workforce $250M for prevention and public health: $126m Community and Clinical Prevention $70m Public Health Infrastructure $31m Research and Tracking $23m Public Health Training

24 National Breast and Cervical Cancer Screening Program Since 1991: >3.6 million women screened 42,208 breast cancers detected 2,395 invasive cervical cancers detected

25 Future Directions in Cancer Screening Public Education, Outreach, Care Management Quality Assurance, Surveillance, Monitoring Organized Clinical Services

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27 Community Transformation Grants Authorized under the Affordable Care Act Evidence-based policy, environmental, programmatic, and infrastructure changes to promote healthy living Reductions in prevalence of chronic disease risk factors, including: Poor nutrition and physical inactivity Tobacco use Excessive alcohol use Clinical Preventive Services Strategies should be prioritized to reduce health disparities

28 Chronic Disease Prevention Grants Comprehensive approach to chronic disease Increase cooperation and integration across related programs Provide more coordinated technical assistance Includes a Base award to every state Could include more funding than is currently available for the various programs combined

29 Potential Performance Indicators Intermediate Measures Number, reach and quality of policies to reduce tobacco, alcohol and tanning bed use, promote physical activity and increase protective immunization; Number, reach and quality of systems to expand screening participation in state Medicaid programs and FQHCs; Incentives and regulations to assure electronic reporting of screening data from clinical and diagnostic providers. Increased cancer screening rates

30 For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control