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.

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New York

Distribution of Cancer by Site

Incidence 27% Prostate 16% Lung & Bronchus 12% Colorectal 55% Mortality 29% Lung & Bronchus 12% Prostate 11% Colorectal 52%

NYS Cancer Registry, 2001

Over 50% of New Cases and Deaths from Cancer Occur in 4 Sites Incidence 29% Breast 13% Colorectal 12% Lung & Bronchus 54% Mortality 22% Lung & Bronchus 18% Breast 12% Colorectal 52%

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 U.S. Census Bureau, Census 2000 36.5

32.6

Diversity is…

Primary Dimension Secondary 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 * National Vital Statistics Report, 1998;48:1-10, 26 0 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 .

600 500 400 300 200 100 0 National Incidence & Mortality - All cancers by Race - Ethnicity (1992-1999) White Incidence Mortality African Ameri Hispan ic can Asian/P acific I Amer. I slander ndian/A laska 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

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 Afric an A Hisp meri anic can Asia n/Pa cific Am er. In Isla nder dian /Ala ska N ative

Prostate Cancer National Incidence & Mortality by Race - Ethnicity (1992-1999) 300 250 200 150 100 50 0 Incidence Mortality White African Americ an ic Asian/P acific Is lander laska N ative

Female Breast Cancer National Incidence & Mortality by Race - Ethnicity (1992-1999) 140 120 100 80 60 40 20 0 Incidence Mortality White African Americ Hispan ic an Asian /Pacific Amer. I Islande r ndian/A laska N ative

Colon & Rectum Cancer National Incidence & Mortality by Race - Ethnicity (1992-1999) 70 60 50 40 30 20 10 0 Incidence Mortality White African Americ Hispan ic an Asian /Pacific Amer. I Islande r ndian/A laska 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 Stage I Stage II Stage III Stage IV Unstaged Harlem 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 40 30 20 10 0 1974-76 1977-79 1980-82 1983-85 1986-92

Freeman, Cancer, May 1, 2002

Black Harlem US White US Black

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