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 of Cancer by Site Incidence Mortality 27% Prostate 16% Lung & Bronchus 12% Colorectal 55% 29% Lung & Bronchus 12% Prostate 11% Colorectal 52% Incidence 29% Breast 13% Colorectal 12% Lung & Bronchus 54% Mortality 22% Lung & Bronchus 18% Breast 12% Colorectal 52% 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 Hispanic or Latino Asian Total 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* * National Vital Statistics Report, 1998;48:1-10, 26

Chronic Diseases and Related Risk Factors Actual Causes of Death, U.S., 1990 McGinnis JM, Foege WH, Actual causes of death in the United States. JAMA 1993; 270:

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 Males65 Years White Males73 Years Black Females73 Years White Females78 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 ( ) *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 ( )

Prostate Cancer National Incidence & Mortality by Race - Ethnicity ( )

Female Breast Cancer National Incidence & Mortality by Race - Ethnicity ( )

Colon & Rectum Cancer National Incidence & Mortality by Race - Ethnicity ( ) *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 Stage I 8.4%38% Stage II20.8%38% Stage III22.8%18% Stage IV39.0% 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 (%) 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.

No person in America with cancer should go untreated. No person in America should be bankrupted by a diagnosis of 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

Culture Social Injustice CAUSES OF HEALTH DISPARITIES Low Economic Status/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