CDC’s Division of Cancer Prevention and Control

CDC’s Division of Cancer Prevention and Control

National Center for Chronic Disease Prevention and Health Promotion

Coordinating Center for Health PromotionCenters for Disease Control and Prevention

Atlanta, Georgia

National Center for Chronic Disease Prevention and Health Promotion

Coordinating Center for Health PromotionCenters for Disease Control and Prevention

Atlanta, Georgia

CDC-DCPC MissionThe Division of Cancer Prevention and Control reduces the burden of cancer in the United States through cancer prevention and reduction of risk for cancer, through early detection of cancer, through better treatment, and by improving the quality of life for cancer survivors.

CDC-DCPC Background

Lead authority for all cancer matters within CDC

Priority topics (funding): Cancer registries Comprehensive cancer control Survivorship and end-of-life Colorectal, prostate, breast, cervical, ovarian,

skin, hematologic, and gynecologic cancers

DCPC Focus: Public Health Action

Cancer surveillance

Education for health care providers and the public

Screening and early detection

Risk reduction

Access to care

Survivorship and end of life care

Reduction in health disparities

Comprehensive cancer control

Genomics

Dissemination science for cancer

National Breast and Cervical Cancer Early Detection Program

Provides breast and cervical cancer screening & diagnosis to poor, uninsured women

Screening support in all 50 states, the District of Columbia, 4 US territories, and 13 American Indian/Alaska Native organizations

Services include Clinical breast examination Mammograms Pap tests Diagnostic testing for women with abnormal results Surgical consultation Referrals to treatment

Interagency Agreement with IHS

Through an agreement in place for over 15 years, CDC provides direct technical assistance and consultation to the tribes and tribal organizations funded through the National Breast & Cervical Cancer Early Detection Program (NBCCEDP) and the National Comprehensive Cancer Control Program (NCCCP).

Ongoing program activities include the following:

1. Facilitate and enhance collaborative relationships and partnerships.

2. Monitor the progress of all states in developing plans that specifically address outreach to AI/AN women for breast and cervical cancer screening.

Interagency Agreement with IHS

Ongoing program activities continued…

3. Identify a national organization or organizations (i.e. the National Indian Health Board) with which DCPC can establish collaborative relations to address cancer-related outreach, service delivery, and policy issues.

4. Participate in annual conferences, meetings and workshops with Indian organizations and AI/AN people.

5. Coordinate efforts with state cancer registries, IHS, and tribal data systems to build infrastructure needed for surveillance and evaluation of the impact of cancer prevention and control initiatives.

Cancer Occurrence in AI/AN populations

Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives, JNCI (forthcoming)

Special monograph (12 manuscripts) supplement in Cancer (2008)

Applied research with the Indian Health Service and local partners to address disparities in CRC mortality among Alaska Natives

Record Linkage between NPCR Program Registries and IHS Administrative Records

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pre-link added by linkage

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The National Comprehensive Cancer The National Comprehensive Cancer Control ProgramControl Program

Sharon Sharpe, Assistant ChiefSharon Sharpe, Assistant ChiefComprehensive Cancer Control Comprehensive Cancer Control

BranchBranch

COMPREHENSIVE CANCER CONTROL:

CCCB Mission StatementCCCB Mission Statement

• To provide unsurpassed programmatic, To provide unsurpassed programmatic, scientific, and financial support to States, scientific, and financial support to States, Tribes, Tribal Organizations, and US Territories Tribes, Tribal Organizations, and US Territories to advance the principles of comprehensive to advance the principles of comprehensive cancer control to reduce the cancer burden.cancer control to reduce the cancer burden.

COMPREHENSIVE CANCER CONTROL:

DefinitionDefinition

Comprehensive Cancer Control is Comprehensive Cancer Control is a collaborative process through a collaborative process through which a community pools which a community pools resources to reduce the burden of resources to reduce the burden of cancer that results incancer that results in

•Risk reductionRisk reduction• Early detectionEarly detection•Better treatmentBetter treatment• Enhanced survivorshipEnhanced survivorship

COMPREHENSIVE CANCER CONTROL:

AI/AN CCC Workgroup for the AI/AN CCC Workgroup for the National PartnersNational Partners

• Formulated in early 2006

• Comprised of seven members all of American Indian or Alaska Native heritage.

• Major emphasis was on participating in the National Partner Leadership Institute Initiatives to establish ongoing positive communication and collaborative processes, between Tribes, States, and Urban Health Centers/Clinics for CCC programming.

• The workgroup created a workplan/action plan for long term inclusion of the AI/AN constituency in the National CCC arena.

• A representative from the AI/AN Workgroup will participate in the National Partner’s planning process to develop a five year CCC action plan.

2000 NCCCP Status of Cancer Plans

CA

ID

NM

TX

OK

NE

SD

ND

MN

WI

IL

KYVA

NC

GAALMS

LA

MI

PA

NYCT

MA

VTNH

ME

TN

SC

AZ

NV

MT

WY

CO

UT

IA

MO

AR

KS

IN

WV

FL

NJ

Updating or Creating New PlanCurrent Plan

OR

Northwest Portland Area Indian Health Board

AK

HI

MDDE

RI

DC

WA

OH

Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board

CA

ID

NM

TX

OK

NE

SD

ND

MN

WI

ILOH

KYVA

NC

GAALMS

LA

MI

PA

NYCT

MA

VTNH

ME

TN

SC

OR

NV

MT

WY

CO

UT

IA

MO

AR

KS

IN

WV

FL

NJ

Updating or Creating New PlanCurrent Plan

OR

Northwest Portland Area Indian Health Board

South Puget Intertribal Planning Agency

Cherokee Nation

Fond Du Lac Reservation

Aberdeen Area Tribal Chairmen’s Health Board

AK

Alaska Native Tribal Health Consortium

HI

National Comprehensive Cancer Control ProgramDivision of Cancer Prevention and ControlNational Center for Chronic Disease Prevention and Health PromotionCoordinating Center for Health PromotionJanuary 2008

National Comprehensive Cancer Control ProgramDivision of Cancer Prevention and ControlNational Center for Chronic Disease Prevention and Health PromotionCoordinating Center for Health PromotionJanuary 2008

MDDE

RI

DC

WA

AMERICAN SAMOA

FEDERATED STATES OF MICRONESIA

GUAM

COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS

PUERTO RICO

REPUBLIC OF THE MARSHALL ISLANDS

REPUBLIC OF PALAU

U.S. VIRGIN ISLANDS

AZTohono O’Odham Nation

2008 NCCCP Status of Cancer Plans

COMPREHENSIVE CANCER CONTROL:

Scope of National Scope of National Comprehensive Cancer Control Comprehensive Cancer Control ProgramProgram

• As of October 2006As of October 2006– 54 CCC plans completed 54 CCC plans completed

and being put into actionand being put into action

– 64 CCC programs funded64 CCC programs funded

– 50-600 members in each 50-600 members in each coalitioncoalition

Planning Component:Planning Component: The “Planning” component of this initiative supports The “Planning” component of this initiative supports

the development of model comprehensive state the development of model comprehensive state cancer control plans and descriptive evaluation of cancer control plans and descriptive evaluation of comprehensive cancer control planning.comprehensive cancer control planning.

Comprehensive Cancer ControlComprehensive Cancer ControlPlanning ComponentPlanning Component

Implementation Component:Implementation Component: The “Implementation” component is designed to The “Implementation” component is designed to

provide startup and operational support to provide startup and operational support to states/tribes/tribal organizations and territories with states/tribes/tribal organizations and territories with existing, up to date comprehensive cancer control existing, up to date comprehensive cancer control plansplans

CDC CCC Program ComponentsCDC CCC Program ComponentsImplementation ComponentImplementation Component

CDC Comprehensive Cancer CDC Comprehensive Cancer Control ProgramControl Program

Operationalizing CCC involves:Operationalizing CCC involves:• A systematic data- and science-based A systematic data- and science-based

planning processplanning process• A broad-based and active coalition of A broad-based and active coalition of

stakeholders collaborating in meaningful stakeholders collaborating in meaningful waysways

• A public health, “whole person” approach A public health, “whole person” approach to service deliveryto service delivery

• A strong focus on infrastructure A strong focus on infrastructure developmentdevelopment

• A long-term view of costs and benefits.A long-term view of costs and benefits.

COMPREHENSIVE CANCER CONTROL:

PotentialPotential Gains from Declining Gains from Declining MortalityMortality

• From 1970 to 2000, gains in life expectancy From 1970 to 2000, gains in life expectancy added $3.2 trillion per year to national wealthadded $3.2 trillion per year to national wealth– ½ gains due to progress against heart disease½ gains due to progress against heart disease

• Modest progress against major diseases Modest progress against major diseases extremely valuableextremely valuable– Prospectively, 1% reduction in mortality from cancer Prospectively, 1% reduction in mortality from cancer

worth nearly $500 billion to current and future worth nearly $500 billion to current and future AmericansAmericans

– Cure for cancer worth about $50 trillionCure for cancer worth about $50 trillion

Source: Murphy KM, Topel RH. The Value of Health and Longevity; Jouranl of Politcal Economy, 2006, (114); 871-903

Tohono O’Odham NationAgreement # U55-CCU000840

Vicky D’Alfonso, Program Consultant Comprehensive Cancer Control Branch

Management Office

Tohono O’Odham NationAgreement # U55-CCU000840

• Through FOA #DP07-703, Tohono O’Odham Nation was selected for funding as a planning program to begin their development of a Comprehensive Cancer Prevention & Control Plan.

• The Tohono O’Odham Nation will use this plan to reduce the cancer burden for its tribal members, as well as enhance the quality of life of cancer victims and their families.

Tohono O’Odham NationAgreement # U55-CCU000840

• The program is in its first year of funding - $120,484. The project period is 6/30/2007 – 6/29/2008.

• Multiple partners will join together as a Cancer Planning Committee (CPC) to pursue a collaborative planning process.

• The CPC will consist of the following partners: – Tohono O’Odham Department of Health & Human

Services (TODHHS), – Tucson Area Indian Health Service, – Arizona Comprehensive Cancer Control Program,– Tribal leaders, community members, cancer survivors,

and cancer co-survivors, – Southwest American Indian Collaborative Network/Inter

Tribal Council of Arizona, – Arizona Cancer Center, and– University of Arizona Mel and Enid Zuckerman College of

Public Health.

• The first CPC meeting was held January 8, 2008. The CPC has set up (3) sub-committees who will be working on setting goals.

• The next CPC meeting is scheduled for January 30, 2008.

• Program Director: Christina Andrews• CCC Project Coordinators: Jane Latane’ & Teresa

Wall• NCCCB Assistant Branch Chief: Sharon Sharpe• NCCCP Program Consultant: Vicky D’Alfonso

Tohono O’Odham NationAgreement # U55-CCU000840

• The age-adjusted incidence rates for the Tohono O’odham Reservation for a five-year period between 1996-2000 show five types of cancers (brain, cervical, leukemia, multiple myeloma, prostate) are higher than the incidence rate for the State of Arizona.

• Recent strategic planning during 2005 has identified new health concerns for capacity building and cancer is one of these.

Tohono O’Odham NationAgreement # U55-CCU000840

• Based on the successful experience addressing other public health issues, a good planning and assessment process is needed as the foundation for comprehensive cancer services.

• TODHHS participated in the Arizona Department of Health Services Comprehensive Cancer Control Plan process in 2005 and has continued to participate in implementation activities.

Tohono O’Odham NationAgreement # U55-CCU000840

• This planning grant will fulfill the following six goals: (1) Coordination - Foster coordination and integration among

cancer programs that serve Tohono O’odham tribal members in the form of a Cancer Planning Committee (CPC) in order to develop a comprehensive plan for cancer prevention and control.

(2) Prevention - Plan to increase the capacity to provide broad community education and outreach for those cancers with known means of prevention through lifestyle change.

(3) Early Detection - Plan how to maximize community acceptance and timely utilization of available cancer screening to increase the likelihood of early diagnosis and treatment.

Tohono O’Odham NationAgreement # CCU000840

• Goals continued:

(4) Diagnosis & Treatment - Plan how to increase access to appropriate & effective diagnosis and treatment services.

(5) End of Life Care - Plan how to improve the quality of life for tribal members whose live are shortened by cancer.

(6) Survivorship - Plan how to improve support available to cancer survivors and their family members as co-survivors.

Tohono O’Odham NationAgreement # U55-CCU000840

We’re not there yet…We’re not there yet…

In In Ensuring Quality Cancer CareEnsuring Quality Cancer Care, the National Cancer , the National Cancer Policy Board of the Institute of Medicine identified a gap Policy Board of the Institute of Medicine identified a gap between practice and the quality care that could be between practice and the quality care that could be provided to cancer patients, and estimated that by provided to cancer patients, and estimated that by 2015, if proven methods to change risky behaviors and 2015, if proven methods to change risky behaviors and increase screening were implemented in communities, increase screening were implemented in communities, the nation would see a 19% decline in the rate at which the nation would see a 19% decline in the rate at which new cancer cases occur and a 29% decline in the rate new cancer cases occur and a 29% decline in the rate of cancer deaths. of cancer deaths.

CDC Comprehensive Cancer CDC Comprehensive Cancer Control ProgramControl Program

National Comprehensive Cancer Control Program

For more information, please contact:• Vicky D’Alfonso, Program Consultant, DCPC/CCCB

Phone: (770) 488-4243Email: VCD3@cdc.gov

• Annie Fair, Tribal Liaison, DCPCPhone: (602) 263-1200, ext. 1351 Email: ggv3@cdc.govPhoenix Indian Medical Center4212 N. 16th StreetPhoenix, AZ 85016