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Collaborating For Cancer Control:
A National Perspective
Laura Seeff, MD
Chief, Comprehensive Cancer Control Branch
Division of Cancer Prevention and Control
Centers for Disease Control & Prevention
Iowa Cancer Summit
October 4, 2011
National Center for Chronic Disease Prevention and Health Promotion
Place Descriptor Here
Outline

Recent Iowa cancer control successes
 Updated Iowa Cancer Plan
 Community Transformation Grant (CTG) recipient
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CDC Priorities and Winnable Battles
Federal funding
Health reform opportunities
 Coordinated Chronic Disease Program
 Community Transformation Grants

National Comprehensive Cancer Control Program
Priorities
 Alignment with Iowa Cancer Plan
 Specific examples to collaboratively advance cancer control
Recent cancer control opportunities in Iowa
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Updated Cancer Plan
Recent CTG grantee
Fantastic opportunity to leverage CCC accomplishments
to help build CTG, achieve outcomes in cancer control
as well as other chronic diseases
CDC Public Health Priorities

Strengthen surveillance and epidemiology

Support state, tribal, and local health departments

Improve global health

Advance evidence-based health policies

Prevent illness, injury, disability, and premature death
Winnable Battles

Healthcare- Associated Infections

HIV

Motor Vehicle Injuries

Nutrition, Physical Activity, Obesity & Food Safety

Teen Pregnancy

Tobacco
Interventions to Improve Health
Low Impact
High Resource
Behavioral
Interventions
E.g., Counseling, Education
Clinical
Interventions
Surveillance
Epidemiology
Evaluation
Research
E.g., Rx for HBP, diabetes,
Disease Management
One Time/Long-lasting
Interventions
E.g., Immunization, colonoscopy
Change the Context
“Making the Default Option the Healthful Option”
High Impact
Low Resource
E.g., Fluoridation, Smokefree Air, Trans Fat Ban
Frieden TR. AJPH. 2010; 100 (4)
Federal Funding
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11% reduction in 2011 CDC budget
Additional reductions anticipated in 2012 and 2013
All funded activities must demonstrate greatest possible
impact/return on investment
New opportunities from Affordable Care Act beginning in
2011
Health Reform Opportunity:
Chronic Disease Prevention and Health
Promotion Program

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Comprehensive approach to chronic disease control
Support to state health departments, territories and tribes to
strengthen leadership and coordination of program,
surveillance, epidemiology, evaluation, policy and
communication
Support for key areas including:
 policy and environmental approaches to reduce chronic disease
risk factors
 interventions to improve delivery of clinical preventive services
 chronic disease self management to improve quality of life for
people with chronic disease

Fully coordinated chronic disease program a possibility
Health Reform Opportunity:
Community Transformation Grants (CTG)

Create healthier communities by:
o Building capacity to implement evidence-and practice-based policy,
environmental, programmatic, and infrastructure changes
o Reducing health disparities
o Supporting implementation of interventions in five strategic
directions
CTG Strategic Directions

Tobacco –Free Living
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Active Living and Healthy Eating
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High Impact Quality Clinical Preventive Services
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Social and Emotional Wellness
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Healthy and Safe Physical Environment
CTG Grantees

~ $103 million was awarded to a total of 61 states and
communities throughout the US to serve approximately 120
million Americans.

26 states and communities will build capacity to implement
changes by laying a solid foundation for community
prevention efforts. Funding amounts range from $147,000 to
$500,000.
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35 states and communities will implement evidence- and
practice-based programs designed to improve health and
wellness. Funding amounts range from $500,000 to $10
million.
CTG Activities

All 61 grantees will address:
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Implementation grantees may also address:
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1) tobacco-free living; 2) active living and healthy eating; and 3)
clinical and other preventive services, specifically high blood
pressure and high cholesterol control.
social and emotional wellness (ie facilitating early identification of
mental health needs and access to quality services), and healthy and
safe physical environments.
Awardees include many communities with a disproportionate health
burden, including:
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15 states and communities in the southern United States, an area with
the highest rates of obesity and cardiovascular disease.
29 of the nation's large counties and urban areas.
7 tribes and 1 territory (the Republic of Palau).
20% of funds are for rural and frontier populations,
which have disproportionate burdens of chronic disease.
Community Transformation Grant recipient

Iowa Department of Public Health will receive
$3,007,856 to serve the entire state of Iowa, an
estimated population of over 3,000,000 including a rural
population of over 1,300,000.

Will focus on expanding efforts in tobacco-free living,
active living and healthy eating, and quality clinical and
other preventive services.
CCC National Partners
American Cancer Society
LIVESTRONG
ACS Cancer Action Network
American College of Surgeons,
Commission on Cancer
Association of State and Territorial Health
Officers
C-Change
Centers for Disease Control
and Prevention
Health Resources Services
Administration
Intercultural Cancer Council
The Leukemia &
Lymphoma Society
North American Association of
Chronic Central Cancer
Registries
National Association of
Chronic Disease Directors
National Association of County
and City Health Officials
National Cancer Institute
Susan G. Komen for the Cure
CDC’s National Comprehensive Cancer Control
(CCC) Program

Programs funded to convene statewide coalitions to
develop, implement, and evaluate data-driven cancer
control plans

65 programs with 69 cancer plans: 50 US states, DC, 7
territories, 7 tribal organizations

Work from prevention through survivorship, use policy
interventions
2011 National Comprehensive Cancer Control
Status of Cancer Plans
South Puget
Intertribal Planning
Agency
WA
Fond Du Lac
Reservation
Northwest Portland
Area Indian Health
Board
MT
ME
ND
MN
OR
ID
OR
VT
Aberdeen Area
Tribal Chairmen’s
Health Board
SD
WY
NH
WI
MI
CT
IA
PA
NE
NV
IL
UT
OH
IN
CO
CA
AZ
Tohono
N orthwest Portland Area
O’Odham
I ndian H ealth Board
Nation
VA
MO
KY
NC
Cherokee
Nation
OK
NM
TN
AR
SC
AK
MS
TX
Alaska Native
Tribal Health
Consortium
AL
GA
LA
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
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
RI
NJ
DC
DE
MD
WV
KS
MA
NY
Creating New Plan
Current Plan or Updating Plan
CDC-funded NCCC Program Priorities
2010
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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
Updated Iowa Cancer Plan, 2012-2017
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Aligns with NCCCP Priorities
Four goals
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Primary prevention
Screening (secondary prevention and early detection)
Increased access to treatment services
Increased quality of life
Cross cutting areas
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Collaboration
Reduce disparities
Workforce
Policy and systems
Research
Evaluation
Excerpted from Iowa Cancer Plan
“It is impossible for this plan to address every issue
and need existing in comprehensive cancer control.
The goals, priorities, strategies and action
steps…have been determined…to be the leading
evidence-based methods to reduce the burden of
cancer in Iowa.”
Focus on high burden cancers for which intervention
is available
Emphasize Primary Prevention of Cancer
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Strategy 1: Coordinate with relevant partners such as
tobacco, physical activity, nutrition, obesity, vaccine,
diabetes to implement evidence-based primary
prevention interventions
Strategy 2: Develop primary prevention policy agenda
as part of an overall cancer policy agenda
Strategy 3: Develop and promote primary prevention
messages consistent with chronic disease partner
messages
Strategy 4: Ensure that effective programmatic
interventions contribute to the evidence base
Iowa Plan Goal 1
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Coordinate with other groups focusing on primary prevention
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Decrease tobacco use
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Use established guidance from other chronic disease efforts
Improve physical activity and nutrition
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Consider how Cancer Coalition and Cancer Plan fit into broader
chronic disease coalition and plan; Consider CTG Leadership Team
Use established guidance from other chronic disease efforts
Increase vaccination rates for vaccine preventable cancers
Increase sun protective behaviors
Decrease radon exposure
Increase number of people with cancer risk assessments
The Burden of Tobacco Use
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46.6 million U.S. adults smoke cigarettes
Single most preventable cause of disease, disability, and
death in the United States
>$96 billion a year in medical costs and another $97 billion a
year from lost productivity
~ 443,000 annual deaths prematurely from smoking or
exposure to secondhand smoke
~8.6 million live with serious smoking-related illness
~88 million nonsmoking Americans, including 54% of children
aged 3–11 years, are exposed to secondhand smoke

~3,000 nonsmoking Americans die of lung cancer, >46,000 die of heart
disease, and ~150,000–300,000 children <18 months old have lower
respiratory tract infections
For tobacco control, state and community
leaders can…
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Enact 100% smoke-free indoor air policies that include workplaces,
restaurants, and bars
Increase the price of all tobacco products
Implement hard-hitting media campaigns that raise public awareness of
the dangers of tobacco use and secondhand smoke exposure
Use the World Health Organization's (WHO's)
MPOWER strategies to prevent and reduce tobacco use and to make
tobacco products less accessible, affordable, attractive, and accepted
M=Monitor tobacco use and prevention policies
P=Protect people from tobacco smoke
O=Offer help to quit
W=Warn about the dangers of tobacco use
E=Enforce restrictions on tobacco advertising
R= Raise taxes on tobacco
The Obesity Epidemic
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>1/3 of U.S. adults (> 72 million people) and 17% of U.S. children are
obese
During 1980–2008, obesity rates doubled for adults and tripled for
children
Obesity rates for all population groups increased markedly
Obesity increases the risk of many health conditions:
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Coronary heart disease, stroke, and high blood pressure
Type 2 diabetes
Cancers, such as endometrial, breast, and colon cancer
High total cholesterol or high levels of triglycerides
Liver and gallbladder disease
Sleep apnea and respiratory problems
Degeneration of cartilage and underlying bone within a joint (osteoarthritis)
Reproductive health complications such as infertility
Mental health conditions
Obesity Is Costly

In 2008, overall medical care costs related to obesity for
U.S. adults estimated to be ~$147 billion.

People who were obese had medical costs $1,429
higher than the cost for people of normal body weight.

Obesity also has been linked with reduced worker
productivity and chronic absence from work.
For obesity control, state and community
leaders can…
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Increase consumption of fruits and vegetables.
Increase physical activity.
Increase breastfeeding initiation, duration, and exclusivity.
Decrease consumption of sugar drinks.
Decrease consumption of high-energy-dense foods, which are
high in calories.
Create, maintain, and enhance parks, recreation, sports, and
fitness facilities to provide various physical activity options for
all populations that are safe, appealing, and supervised.
Form partnerships with organizations for the development of
interconnected parks and open space systems.
Balancing Calories
•Enjoy your food, but eat less.
•Avoid oversized portions
Foods to Increase
•Make half your plate fruits and vegetables
•Make at least half your grains whole grains
•Switch to fat free or low-fat (1%) milk
Foods to Reduce
•Compare sodium in foods like soup, bread, and frozen meals—
and choose the foods with lower numbers
•Drink water instead of sugary drinks
2008 Physical Activity Guidelines for Americans

Children should be active at least 60 minutes or more daily.
 Most of the 60 minutes should be either moderate- or vigorousintensity physical activity.
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Adults should do at least 150 minutes of moderate intensity or
75 minutes of vigorous intensity physical activity per week or
an equivalent combination.
For additional health benefits, adults should do more than 300
minutes of moderate intensity or 150 minutes of vigorous
intensity activity per week or an equivalent combination.
Support Early Detection and Treatment Activities
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Strategy 1: Sustain coalitions with key stakeholders who
can help enhance early detection and treatment activities
Strategy 2: Coordinate with cancer control programs,
chronic disease programs, clinical and public health
settings, and other key community sectors supporting such
interventions as community health workers
Strategy 3: Support policy, systems, and environmental
(PSE) approaches to expand access to and utilization of
early detection and treatment programs
Iowa Plan Goals 2 and 3

Encourage the public to be screened

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Increase access to high quality screening
Implement health systems strategies to increase cancer
screening
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Focus on high burden screenable cancers
Ensure that members of Primary Care Associations, Federally
Qualified Health Centers, Large employers, and payors are part of
coalitions
Use Community Guide recommendations (reminder systems, etc)
Utilize patient navigators
Increase coordination of screening and treatment activities
Increase access and availability to treatment
Implement health systems strategies to improve quality of care
Increase participation in clinical trials
Address Public Health Needs of
Cancer Survivors
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Strategy 1: Use the continuum of cancer survivorship
(diagnosis/treatment, secondary prevention, post-treatment,
tertiary prevention, palliation) as a framework for
interventions
Strategy 2: Assess and enhance capacity to support
survivorship interventions
Strategy 3: Develop, enhance, and use survivorship
surveillance data to define the scope, needs, and health
behaviors of the cancer survivor population
Strategy 4: Use and contribute to evidence base of
survivorship interventions
Strategy 5: Increase awareness and knowledge of issues
relevant to cancer survivors
Iowa Plan Goal 4

Increase awareness and knowledge of issues relevant to
people impacted by cancer
 Increase use of treatment summaries and care plans
 Clearly articulate public health relevance of survivorship
 Emphasize post treatment issues (primary, secondary, tertiary
prevention and post-treatment care plans)
 Develop model chronic disease self-management with attention
to policy and health systems

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Increase access to quality of life services
Enhance the quality and research of survivorship
research
Use Policy, Systems, and Environmental (PSE)
Change To Guide Sustainable Cancer Control
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Strategy 1: Develop or refine overall cancer policy agenda
Strategy 2: Engage the community, including
representatives communities living with disparities, to
identify evidence based cancer control PSE interventions at
the state and local level
Strategy 3: Include coalition members who can effectively
implement PSE interventions
Strategy 4: Effectively communicate the need for PSE
intervention to key stakeholders
Strategy 5: Implement PSE interventions that link with
cancer control plan goals
Strategy 6: Evaluate effectiveness of PSE interventions
Promote Health Equity as it Relates
to Cancer Control
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Strategies 1 and 2: Enhance existing data sources and
methods to collect and report incidence, prevalence,
morbidity and mortality among subpopulations
Strategy 3: Promote equitable distribution of resources,
services, and processes that influence health disparities to
achieve health equity
Strategy 4: Support workforce development
Strategy 5: Build and sustain diversity within the coalition
and coalition leadership
Demonstrate Outcomes Through Evaluation
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Strategy 1: Ensure that all CCC interventions reflect most
current data (incidence, mortality, behavioral, risk factors);
scale efforts to address the 3-4 highest burden cancers in
each state/tribe/territory/jurisdiction
Strategy 2: Ensure that all comprehensive cancer control
interventions are evidence based or contribute to the
evidence base
Strategy 3: Develop and enhance capacity to evaluate
outcome and impact
Strategy 4: Evaluate CCC partnerships, plan, and
program interventions
National Program of Cancer Registries
Lung Cancer Incidence, US Men, 1998
WA
ME
MT
ND
MN
OR
VT NH
ID
SD
WI
NY
MI
CT
WY
NJ
PA
IA
MA
RI
NE
NV
OH
UT
IL
CA
MD
DC
IN
WV
CO
KS
VA
MO
DE
^_ DC
KY
NC
TN
OK
AZ
AR
NM
SC
MS
TX
AL
GA
LA
FL
AK
HI
no data
30.0 - 74.9
75.0 - 84.9
85.0 - 94.9
95.0 - 104.9
105.0 - 136.0
Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1998–2007 Incidence and Mortality. Atlanta: U.S.
Department of Health and Human Services, CDC and NCI; 2010. Available at: www.cdc.gov/uscs.
Lung Cancer Incidence, US Men, 2007
WA
ME
MT
ND
MN
OR
VT NH
ID
SD
WI
NY
MI
CT
WY
NJ
PA
IA
MA
RI
NE
NV
OH
UT
IL
CA
MD
DC
IN
DE
WV
CO
KS
VA
MO
^_ DC
KY
NC
TN
OK
AZ
AR
NM
SC
MS
TX
AL
GA
LA
FL
AK
HI
30.0 - 74.9
75.0 - 84.9
85.0 - 94.9
95.0 - 104.9
105.0 - 136.0
Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1998–2007 Incidence and Mortality. Atlanta: U.S.
Department of Health and Human Services, CDC and NCI; 2010. Available at: www.cdc.gov/uscs.
For more information on CDC’s cancer
prevention and control programs:
www.cdc.gov/cancer
For more information please contact Centers for Disease Control and
Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.cdc.gov
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.
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