Diversity and the Burden of Cancer David C. Momrow, M.P.H. Senior Vice President of Cancer Control...
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Transcript of Diversity and the Burden of Cancer David C. Momrow, M.P.H. Senior Vice President of Cancer Control...
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
• 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
The only reason we exist is to reduce the burden of cancer on the American people.
Distribution ofCancer by Site
Incidence
Mortality
27% Prostate16% Lung & Bronchus12% Colorectal
55%
29% Lung & Bronchus12% Prostate11% Colorectal52%
Incidence
29% Breast13% Colorectal 12% Lung & Bronchus 54%
Mortality
22% Lung & Bronchus 18% Breast12% Colorectal52%
New York
NYS Cancer Registry, 2001
Over 50% of New Cases and Deaths from Cancer Occur in 4 Sites
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 15.9 13.6
Hispanic or Latino 15.1 13.3
Asian 5.5 5.7
Total 36.5 32.6
U.S. Census Bureau, Census 2000
Diversity is…
Secondary Dimension
Primary Dimension
Chronic Diseases and Related Risk FactorsMost Common Causes of Death, U.S., 1998*
0 10 20 30 40 50
Chronic liver disease/cirrhosis
Nephritis and nephrosis
Suicide
Diabetes mellitus
Pneumonia and influenza
Unintentional injuries
Chronic obstructive pulmonary disease
All Cancers
Health disease and stroke
* National Vital Statistics Report, 1998;48:1-10, 26
Chronic Diseases and Related Risk FactorsActual Causes of Death, U.S., 1990
0 5 10 15 20
I llicit drug use
Motor vehicles
Sexual behavior
Firearms
Pollutants and toxins
Infectious agents
Alcohol
Poor diet/ lack of exercise
Tobacco
McGinnis JM, Foege WH, Actual causes of death in the United States. JAMA 1993; 270:2207-12.
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 65 Years
White Males 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)
*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
0
100
200
300
400
500
600 IncidenceMortality
Lung and Bronchus CancerNational Incidence & Mortality by Race - Ethnicity (1992-1999)
0102030405060708090
IncidenceMortality
Prostate Cancer National Incidence & Mortality by Race - Ethnicity (1992-1999)
0
50
100
150
200
250
300
IncidenceMortality
Female Breast Cancer National Incidence & Mortality by Race - Ethnicity (1992-1999)
0
20
40
60
80
100
120
140
WhiteAfrican American
HispanicAsian/Pacific Islander
Amer. Indian/Alaska Native
IncidenceMortality
Colon & Rectum Cancer National Incidence & Mortality by Race - Ethnicity (1992-1999)
*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
0
10
20
30
40
50
60
70IncidenceMortality
Colorectal Carcinoma by Stage of DiseaseHarlem vs. SEER U.S. White
Stage I 8.4% 38%
Stage II 20.8% 38%
Stage III 22.8% 18%
Stage IV 39.0% 5%
Unstaged 8.0%
Harlem SEER (US White)
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
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.
Disease always occurs within a context of human circumstances
Colorectal Carcinoma 5-Year Relative Survival Rate (%)
0
10
20
30
40
50
60
70
1974-76 1977-79 1980-82 1983-85 1986-92
Black HarlemUS WhiteUS Black
Freeman, Cancer, May 1, 2002
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 No person in America with cancer should go untreated.go untreated.
No person in America should be bankrupted No person in America should be bankrupted by a diagnosis of cancerby a diagnosis of cancer
CultureCulture
Social InjusticeSocial Injustice
CAUSES OF HEALTH CAUSES OF HEALTH DISPARITIESDISPARITIES
Low Economic Low Economic Status/PovertyStatus/Poverty
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