Download Diversity and Cancer

Diversity and the Burden of Cancer
David C. Momrow, M.P.H.
Senior Vice President of Cancer Control
American Cancer Society – Eastern Division
January 21, 2004
The only reason we exist is to reduce the
burden of cancer on the American people.
• It’s all about YOU. You are telling the story; the
slides are there to keep the room rapt in
attention. Too much stuff can get boring.
A Few Simple Ideas to Make
PowerPoint Easy
New York
Distribution of
Cancer by Site
Over 50% of New Cases and
Deaths from Cancer Occur in 4 Sites
Incidence
Incidence
27% Prostate
16% Lung & Bronchus
12% Colorectal
55%
29% Breast
13% Colorectal
12% Lung & Bronchus
54%
Mortality
Mortality
29% Lung & Bronchus
12% Prostate
11% Colorectal
52%
NYS Cancer Registry, 2001
22%
18%
12%
52%
Lung & Bronchus
Breast
Colorectal
Defining Diversity
“Diversity refers to any mixture of
items characterized by differences
and similarities.”
Population of Eastern
Division by Race/Ethnicity
Black or African American
Hispanic or Latino
Asian
15.9
15.1
5.5
13.6
13.3
5.7
Total
36.5
32.6
U.S. Census Bureau, Census 2000
Diversity is…
Secondary
Dimension
Primary
Dimension
Chronic Diseases and Related Risk Factors
Most Common Causes of Death, U.S., 1998*
Health disease and stroke
All Cancers
Chronic obstructive pulmonary disease
Unintentional injuries
Pneumonia and influenza
Diabetes mellitus
Suicide
Nephritis and nephrosis
Chronic liver disease/cirrhosis
0
* National Vital Statistics Report, 1998;48:1-10, 26
10
20
30
40
50
Chronic Diseases and Related Risk Factors
Actual Causes of Death, U.S., 1990
Tobacco
Poor diet/lack of exercise
Alcohol
Infectious agents
Pollutants and toxins
Firearms
Sexual behavior
Motor vehicles
Illicit drug use
0
5
10
15
McGinnis JM, Foege WH, Actual causes of death in the United States. JAMA 1993; 270:2207-12.
20
U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority Groups— A Report of the
Surgeon General, 1998.
Life Expectancy
Black Males
White Males
65 Years
73 Years
Black Females 73 Years
White Females 78 Years
The Need for Strategies
• It is well known that the cancer burden in this country is
borne inequitably by different populations, particularly
among minorities, the poor and medically underserved.
• The current health system does not adequately address these
disparities.
• There is a great need for innovative strategies to increase
cancer screening/early detection Early detection leads to
better health outcomes, including prevention and cure.
National Incidence & Mortality - All cancers
by Race - Ethnicity (1992-1999)
600
Incidence
Mortality
500
400
300
200
100
0
Whi
te
Afri c
an A
Hisp
meri
ca
n
anic
Asia
A me
n/ Pa
r. In
cif ic
di an
/Alas
I slan
ka N
der
ative
*Per 100,000, age-adjusted to the 2000 US standard population. Hispanics are not mutually exclusive from other racial/ethnic
categories. Source: American Cancer Society, Surveillance Research, 2003
Lung and Bronchus Cancer
National Incidence & Mortality by
Race - Ethnicity (1992-1999)
90
80
70
60
50
40
30
20
10
0
Incidence
Mortality
Wh
ite
Afr
ica
n
Am
His
pan
eri c
a
n
ic
Asi
an/
Pac
i
Am
er.
In
di a
fic
n/A
Isla
lask
nde
aN
r
ati v
e
Prostate Cancer
National Incidence & Mortality by
Race - Ethnicity (1992-1999)
300
250
Incidence
Mortality
200
150
100
50
0
Whit
e
Afri c
an A
Hisp
anic
meri
can
Asian
A me
r
/ Paci
f ic I s . Indi an/A
lande
las ka
r
Nativ
e
Female Breast Cancer
National Incidence & Mortality by
Race - Ethnicity (1992-1999)
140
120
Incidence
Mortality
100
80
60
40
20
0
Whit
e
Afric
an A
Hi sp
an
mer i
can
ic
Asian
/ Paci
Ame
r. Ind
i an/ A
fi c Is
l ande
l aska
r
N
ative
Colon & Rectum Cancer
National Incidence & Mortality by
Race - Ethnicity (1992-1999)
70
Incidence
Mortality
60
50
40
30
20
10
0
Whit
e
Afric
an A
Hi sp
an
mer i
can
ic
Asian
/ Paci
Ame
r. Ind
i an/ A
fi c Is
l ande
l aska
r
N
ative
*Per 100,000, age-adjusted to the 2000 US standard population. Hispanics are not mutually exclusive from other
racial/ethnic categories. Source: American Cancer Society, Surveillance Research, 2003
Colorectal Carcinoma
by Stage of Disease
Harlem vs. SEER U.S. White
Harlem
Stage I
Stage II
Stage III
Stage IV
Unstaged
8.4%
20.8%
22.8%
39.0%
8.0%
SEER (US White)
38%
38%
18%
5%
Comparison of Five-year Survival Rates for
Colorectal Cancer according to Race
• Five-year survival rate for US whites is 62%
• Five-year survival rate for US Blacks is 52%
• Five-year survival rate for poor Blacks in Harlem is
20%
Major Cause of Disparity:
Late diagnosis at the time of initial treatment
Disease always occurs
within a context of human
circumstances
Social position, economic status, culture, and environment
are critical determinants of:
who is born healthy,
who grows up healthy,
who sustains health throughout his or
her life span,
who survives disease, and,
who maintains a good quality of life after
diagnosis and treatment.
Colorectal Carcinoma
5-Year Relative Survival Rate (%)
70
60
50
Black Harlem
US White
US Black
40
30
20
10
0
1974-76
1977-79
1980-82
Freeman, Cancer, May 1, 2002
1983-85
1986-92
Tobacco Use – a cause of health
disparities
Need strategies to target tobacco use
reduction to specific populations
Need for stewardship of tobacco industry
marketing efforts focused on specific
populations
Obesity, Diet, and
Physical Exercise
Need more research on how these factors
impact health disparities
Develop effective interventions to
encourage lifestyle changes that impact
health disparities
Health Care Delivery
Improve the infrastructure related to health care
systems delivery in screening, early detection, and
treatment.
Provide access to treatment and other direct and
timely services to ALL persons with a suspicious
finding for cancer.
In every corner of the Nation, patients and
professionals alike echo the same moral
tenet:
No person in America with cancer should
go untreated.
No person in America should be bankrupted
by a diagnosis of cancer
CAUSES OF HEALTH
DISPARITIES
Low Economic
Status/Poverty
Culture
Social Injustice
Freeman, Cancer Epidemiology Biomarkers & Prevention, April 2003
Acknowledgements
Durado Brooks, M.D., M.P.H.
Director, Prostate and Colorectal Cancers
American Cancer Society
Harold Freeman, M.D.
Medical Director, Ralph Lauren Cancer Center
Director, NCI Center to Reduce Cancer Health Disparities