don't give up on cancer (march 2014)

8/12/2019 Don't give up on cancer (March 2014)

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Dont give up on cancer

March 2014

Richard M. Stein


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Highlights 5 points to remember1. Cancer remains a major problem in the United States.

The problem is worse in the African American community.

2. Many cancers can be prevented or treated.

Knowing the factseducationis important.

Eliminating high risk behavior matters.

Early access for screening, detection and treatment matters.

3. Right now, not enough is being done.

Budget reductions are cutting money for research, screeningprograms and more

4. The Presidents Cancer Panel addressed racial disparities for the

first time only recently. The Annual Report is a call to act, now.

5. Greater Philadelphia is a great place to start.

The region is rich in appropriate resources to make a difference. NOW is the time to begin. Philadelphia should lead the way.

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Thisisastoryaboutme.

Itneedsyou.Andme.Us.

Together weneedtodo

somethingtofindanswers.

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Note: While some of the data in thispresentation has not been updated,the key points remain unchanged(March 2014).


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Summary Cancer remains a major problem in the United States.

It is a health tragedy anda financial nightmare.

MORE needs to be done to improve outcomes & survival. More money for research and cancer control programs.

More outreach and greater education efforts to prevent somecancers while detecting and treating others sooner.

More comprehensive cancer screening programs for at riskcommunities and populations.

Surprisingly, right now, LESS is being done.

Budget reductions are cutting money for research, screeningprograms, insurance coverage and more

These savings today will raise public and personal costs in thefuture

NOW is the time to act. NOW is the time to get involved.

Inaction will make things worse.

Doing nothing will result in more cancer cases, more deaths,and economic hardship for families, communities & the public.

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In August 2009, I produced a report for the Economist Intelligence Unit on the globalburden of cancer, with co-authors from the Harvard School of Public Health.

http://www.livestrong.org/What-We-Do/Our-Actions/Programs-Partnerships/LIVESTRONG-Summithttp://www.eiu.com/LAF

The project was sponsored by LIVESTRONG. It was released at LIVESTRONGs first Global

Cancer Summit, in Dublin, Ireland.

The project estimated: The number of new cancer cases (incidence) in

2009 and 2020. The costs (medical, non-medical and lost

productivity) associated with those new

casesthe global economic burden ofcancerfor 2009.

It included important firsts: Estimates of the cost of applying the most

effective cancer treatments on a worldwide

scalea global treatment expenditurestandard. Estimates of the spending gap between

present day spending and what it would cost toachieve the global treatment expenditurestandard.

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The project represented a major contribution to the global public health community

raising awareness and focusing attention on the rapidly growing tidal wave ofcancers and their impact in the developing world

LIVESTRONG Global Cancer Summit;Press conference; August 24, 2009.http://www.livestrong.com/lance-armstrong/blog/summit-press-briefing/

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The global burden of cancersome facts:

Cancer is the second leading cause of death anddisabilityin the world.

More people die from cancer every year around the world,than from AIDS, tuberculosis and malaria, combined.

Cancer deaths occur with 6 time the frequency of traffic

fatalities and 42 times the frequency of deaths from war. More than 50% of new cancer cases and two-thirds of

cancer deaths occur in the developing world.

The overall risk of developing cancer duringyourlifetime is risingfrom 1:3 to 1:2.

Cancer is not just a health tragedy. It is a financial and

economic nightmare for individuals and communities7


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AmericasUS$17,221m

Global economic burden of cancer in 2009= US$286bn

Africa US$76mOceania

US$461m

EuropeUS$ 8,742m

Asia US$1,928m

AmericasUS$154bn

EuropeUS$ 83bn

AfricaUS$849m

AsiaUS$44bn

Oceania

US$4bn

*Includes medical costs, non-medical costs and lost income (productivity).

Big Numberscancer costs real money

Total costs* of new cancer cases worldwide, 2009

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The project attracted a lot of attention and helped focus resources fortackling cancer in the most impoverished countries around the world

5% of global resources for cancer arespent in the developing world (p.9)

160,000+ search results (Google).

Breakaway: The global burden of cancer 906,000+ search results (Google).

Cited in formation of Global Task Force onExpanded Access to Cancer Care and

Control in Developing Countries (GTF.CCC) Expansion of cancer care and control in

countries of low and middle income: a call toaction (Lancet; August 2010;http://www.lancet.com/journals/lancet/article/PIIS0140-6736%2810%2961152-X/fulltext?version=printerFriendly).

GTF.CCC (http://isites.harvard.edu/icb/icb.do?keyword=k69586&pageid=icb.page334798)

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That got me thinking

Whats happening on the cancer front at home?...

...So I started to investigate

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What I discovered came as a surprise

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Sadly, changesand actionabroad do not equate tochange at home

Cancer

Remains the second leading cause ofdeath in the United States.

Accounts for nearly one-fourth of USdeaths annually.

Deaths increase each year, as thepopulation ages.

Change in US Death Rates*, 1991 to 2006

17.8

63.3

34.8

313.0

215.1

43.6

180.7200.2

0

100

200

300

400

Heart diseases Cerebrovascular

diseases

Influenza &

pneumonia

Cancer

Rate Per 100,000

*Age adjusted to 2000 US standard population.

Sources: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

0

50,000

100,000

150,000

200,000

250,000

300,000

1930 1940 1950 1960 1970 1980 1990 2000

Number of US Cancer Deaths, 1930-2006

Men

Women

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Down36%

Down31%

Down49%

Down16%


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The war on cancerbegan over forty years ago, when PresidentRichard Nixon signed into law the National Cancer Act

While cancer death ratesremain singularly stubborn.

US Cancer Death Rates* by Sex,1975-2005

Rate Per 100,000

0

50

100

150

200

250

300

1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005

Women

Both Sexes

Men

After adjusting for the size and age of thepopulation, deaths from heart disease andstroke*, have dropped significantly since

the 1950s

*Age adjusted to 2000 US standard population.Sources: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

President Nixon signingthe National Cancer Act,December 23, 1971.

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Since the National Cancer Act became law (1971), the

federal government has spent over $105bn on the effortBut

Cancerremains the second leading cause of death in the United States.

Cancercauses as many deaths each year as the next five causes of deathcombined:

US Mortality, 2007

Rank Cause of Death No. of Deaths % of all deaths1. Heart Diseases 616,067 25.4

2. Cancer 562,875 23.2

3. Cerebrovascular diseases 135,952 5.64. Chronic lower respiratory

diseases 127,924 5.35. Accidents/unintentional injuries 123,706 5.16. Alzheimer disease 74,632 3.17. Diabetes mellitus 71,382 2.9

As it is around the world, cancerin the US is a financial and economic nightmareas well as a health tragedy:

$143bn = cost* of new cancer cases in the United States, 2009

*Includes medical costs, non-medical costs and lost income (productivity).

22.0%533,596

Source: US Mortality Data, National Center for Health Statistics,Centers for Disease Control and Prevention, 2010.

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And its not getting better quickly

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Its worse for some groups than for othersUS Cancer Death Rates* by Race and Ethnicity, 2002-2006

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Its particularly bad for African American menUS Cancer Death Rates* by Sex and Race, 1975-2006

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Cancer death rates are much higher for African American men than for white men.

Death rates for African American women are worse than for white women.


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Cancer Sites in Men for Which African American Death Rates*Exceed White Death Rates*, 2002-2006

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Cancer Sites in Women for Which African American Death Rates*Exceed White Death Rates*, 2002-2006

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New cancer rates (incidence) are also worse for African Americansespecially menthan for other groups

US Cancer Incidence Rates* by Race and Ethnicity, 2001-2006Rate Per 100,000

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The outlook for new cancer cases (incidence) is not particularlygoodespecially in African American men

US Cancer Incidence Rates* by Sex and Race, 1975-2006Rate Per 100,000

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According to the Presidents Cancer Panel 2009-2010 Annual Report:

Between 2010 and 2030, cancer incidence among minorities is expected to nearly double.

By comparison, cancer incidence in non-Hispanic whites is expected to grow by 31 percent.


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If you are African American and contract cancer, thats a problemCancer Survival*(%) by Race, 1999-2005

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A serious problem

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Cancer: 5-Year Relative Survival by Year of Diagnosis,Race and Sex (All Sites, All Ages)

Percent

White men

African American men

White women

African American women

Cancer sites include invasive cases only.5-year survival estimates calculated using monthly intervals.Survival source: National Cancer Institute, SurveillanceEpidemiology and End Results (SEER).

African American men

African American women

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African American men and women fare worse than whitemen and women, even after diagnosis, year after year.


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The bad news is that you have a large chance of developing cancer if youre a man

Lifetime Probability of Developing Cancer (Men), 2004-2006*

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For men and women,the overall risk ofdeveloping cancerduring ones lifetime

is increasing.


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or a womanLifetime Probability of Developing Cancer (Women), 2004-2006*

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For men and women,the overall risk ofdeveloping cancerduring ones lifetime

is increasing.


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As bad as it seems, there is alot that can be done to fight

cancer

Community and individual actions

matter26


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3 important cancer controlactions:1. Prevention

1. Detection

1. Treatment

Halfof the annual cancer deaths in the

United States are preventable (AmericanCancer Society).

Several activities that you control, matter: Dont smoketobacco control

Eat right, lose weight and get active

Follow cancer screening guidelines27


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Community and individual

actions matter

And were not

doingenough

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Each year, smoking causes about 443,000 premature deaths, including171,000 cancer deaths

49,000 deaths among nonsmokers (from secondhand smoke exposure)

Tobacco Use in the United States, 1900-2006

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Tobacco use remains the single largest

preventable cause of premature death inthe United States

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Update:

January 11, 2014 marked the 50th anniversary of the first Surgeon GeneralsReport on Smoking and Health.

Over 20 million Americans have diedbecause of smoking since the firstreport, in 1964.

At current rates, 5.6 million Americans alive today & younger than 18, willdie prematurely from smoking-related diseases.

Smoking causes one out of three cancer deaths, 87 percent of lungcancer deaths, 32 percent of coronary heart disease deaths and 79 percent

of chronic obstructive pulmonary disease (COPD) in the United States.Womens disease risks from smoking have risen over the past 50 yearsnow = mens risks for lung cancer, cardiovascular disease and COPD (withmore women dying from COPD than men)!

Economic costs attributable to smoking and exposure to tobaccosmoke now approach $300 billion annually!!


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Tobacco use increases the risk of cancers of the:

lungmouthnasal cavities

larynxpharynx

esophagusstomachcolorectum

liver

pancreaskidney

bladdercervixovary

myeloid leukemia

Smoking also causes diabetes mellitus; rheumatoid arthritis; increased riskfor tuberculosis; ectopic pregnancy; cleft lip and cleft palate in babies born

to smokers; age-related macular degeneration and much more

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Each year, smoking causes over 171,000 cancer deaths. Smokerstoday are at greater risk of developing lung cancer than in 1964

Annual Number of US Cancer Deaths Attributable to Smoking, 2000-2004

Male Female

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over 171,000 cancer deaths from smoking nationwide

Cigarette Smoking Among Adults (18+) in Southeastern Pennsylvania(Percentage of adults by county who smoke every day or some days)

Source: 2008 Southeastern Pennsylvania Household Health Survey, Community Health Data Base, Public Health ManagementCorporation; Centers for Disease Control and Prevention; American Lung Association; Campaign for Tobacco-Free Kids.

15.7%

14.5%

17.1%

19.2%

27.3%

About 20,000 Pennsylvanians die each year, as a result of smoking.

Almost 6,400 Pennsylvanians die each year from lung cancer.

In Pennsylvania, economic costs of smoking are estimated at $9.4 bn.

This includes $5.2 bn in health costs and $4.2 bn in lost productivity.

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42 million adults plus 3 million middle & high schoolstudents smoke.

If you dont smoke, you dont have to quit!Smokers and Quitters, 1985-2009

AFRICANAMERICAN

Source: Centers for Disease Control and Prevention; 2009 Youth Risk Behavior Surveillance System Survey Data;Commonwealth of Pennsylvania; American Lung Association; Campaign for Tobacco-Free Kids.

In Philadelphia, among high school students who smoked cigarettes, 38% did not try to quit duringthe prior twelve months.

Funding for tobacco prevention and cessation in Pennsylvania declined from $50.5 million (02-03)to $14.2 million (12-13)nearly 72%.

This is just 9.1% of the CDC recommended spending.

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Obesity now creates

more preventableillness and disease

than tobacco.

Current trends suggest itwill become the single

largest preventable causeof deaths in the future 35

Axis of Evil


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Each year, poor nutrition, obesity and physical inactivity causeabout 188,000 cancer deaths

Obesity is worse for African Americans than for other groups

Obesity in US Adolescents (12-19 years), by Gender, Race/Ethnicityt 1976-2008

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*BMI>=85th percentile for age and gender.Source: 2008 Southeastern Pennsylvania Household Health Survey, Community Health Data Base, Public Health ManagementCorporation; Giridhar Mallya, MD, MSHP; Philadelphia Department of Public Health.

Citywide average (6-17 years) = 46.9%

188,000 cancer deaths from poor nutrition, obesity and physical inactivitynationwide

Philadelphia: Children (6-17 years) who are Overweight* or Obese* (%), 2008

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Each year, poor nutrition, obesity and physical inactivity causeabout 188,000 cancer deaths

Its no better for African Americans adults

Obesity* in US Adults (20-74 years), by Gender, Race/Ethnicityt, 1976-2008

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Poor nutrition is also about access

Food deserts are areas that lack access to affordablefoods thatmake up the full range of a healthy diet.*

*Centers for Disease Control and Prevention

Philadelphia has the second lowest number ofsupermarkets in the United States, per capita.

In this map of Philadelphia, blue areas representareas of greatest need, with low supermarketsales, low income, and high rates of death due todiet-related diseases.

Orange dots represent stores that have beenopened under the Pennsylvania Fresh FoodFinancing Initiative (PFFFI).

Yellow dots represent stores financed by thePFFFI program and under construction at the timeof mapping.

Source: Access to Affordable and Nutritious FoodMeasuring andUnderstanding Food Deserts and Their Consequences: Report to Congress;US Department of Agriculture, Economic Research Service; June 2009(http://www.ers.usda.gov/publications/ap/ap036/)Figure provided courtesy of Robert Wood Johnson Foundation and The FoodTrust (http://www.rwjf.org/files/newsroom/profiles/foodtrust/)

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*BMI>=85th percentile for age and gender.Source: 2008 Southeastern Pennsylvania Household Health Survey, Community Health DataBase, Public Health Management Corporation; Giridhar Mallya, MD, MSHP; PhiladelphiaDepartment of Public Health; Centers for Disease Control and Prevention 2009 Youth RiskBehavior Surveillance System Survey Data.

Food deserts are not only short on the right resourcesThey are often full of the wrong resources

Philadelphia: Children (6-17 years) who areOverweight* or Obese* (%), 2008

Citywide average 46.9%

Philadelphias food desert

Blue areasrepresentareas ofgreatestneed, withlow

supermarketsales, lowincome, andhigh rates ofdeath due todiet-relateddiseases.

Source: Access to Affordable and Nutritious FoodMeasuring andUnderstanding Food Deserts and Their Consequences: Report to Congress;US Department of Agriculture, Economic Research Service; June 2009(http://www.ers.usda.gov/publications/ap/ap036/)Figure provided courtesy of Robert Wood Johnson Foundation and The FoodTrust (http://www.rwjf.org/files/newsroom/profiles/foodtrust/)

Too few supermarkets (healthy choices) = poor food selection = overweight and obesity

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*BMI>=85th percentile for age and gender.Source: 2008 Southeastern Pennsylvania Household Health Survey, Community Health Data Base, Public Health Management Corporation;Giridhar Mallya, MD, MSHP; Philadelphia Department of Public Health;Centers for Disease Control and Prevention 2009 Youth Risk Behavior Surveillance System Survey Data.

And the wrong resources lead to poor choices

And poor outcomes

Citywide average 46.9%

Philadelphia: Children (6-17 years) whoare Overweight* or Obese* (%), 2008

Nearly 25% of children and 30% of adults get oneor fewer servings of fruits and vegetables per day.

Over 80% of high school students report getting lessthan 100% of the recommended daily servings offruit and vegetables.

Nearly 25% of adults consume fast food/take-outat least 3 times per week.

30% of African American adults consume fast food/take-out at least 3 times per week.

1 in 3 high school students drink soda daily.

School children buy, on average, 360 nutrient-poorcalories from corner stores for just over $1 per visit:

Chips, candy and sugar sweetened beverages.

Since 2000, over 24,000 Philadelphians have died of diseases caused by poor diet and physical inactivity.

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Poor choicespoor outcomes188,000 cancer deaths in the UnitedStates from poor nutrition, obesity and physical inactivity every year

In Philadelphia, one-fourth of children do not get 30 minutes ofsustained physical activity even once a week.

Nearly half of the adults report exercising less than 3 times perweek.

Over half of Philadelphians report that they never use City parks

or recreation facilities.

Over half of the high school students report watching television 3or more hours per day.

Over one-third of high school students report playing video gamesor using computers for other than school work at least 3 hours perday.

Source: 2008 Southeastern Pennsylvania Household Health Survey, Community Health Data Base, Public Health ManagementCorporation; Giridhar Mallya, MD, MSHP; Philadelphia Department of Public Health;Centers for Disease Control and Prevention 2009 Youth Risk Behavior Surveillance System Survey Data.

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What you do matters Dont smoketobacco control

Where you live matters, too

Detection Follow cancer screening guidelines

Treatment

Detection and treatment are both easier with healthinsurance coverage

A lot can be done to fight cancer

=

School children buy, on average, 360 nutrient-poor calories from corner storesfor just over $1 per visit: chips, candy and sugar sweetened beverages.

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Percentage of Adults (18-64) Without Health Insurance,Southeastern Pennsylvania

Source: 2008 Southeastern Pennsylvania Household Health Survey, Community Health Data Base, Public HealthManagement Corporation

In Philadelphia, 16% of adults are withoutpublic or private health insurance.

In Bucks and Delaware Counties, morethan 7% of adults are without healthinsurance.

In Chester County, 6% of adults

have no health insurance.

In Montgomery County,about 5% of adults haveno health insurance.

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Where you live matters too


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Source: 2008 Southeastern Pennsylvania Household Health Survey, Community Health Data Base, Public Health ManagementCorporation


Percentage of Adults (18-64) Without Health Insurance, Philadelphia

In Philadelphia, 16% of adults are withoutpublic or private health insurance.

In Upper North Philadelphia, morethan one quarter (26%) of adults have

no health insurance.In South Philadelphia, 21% of adults

have no health insurance.

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Source: Cancer Prevention & Early Detection Facts & Figures 2010; American Cancer Society.

Breast cancer: In Pennsylvania, the rate of mammography and/orclinical breast exam is nearly 50% lower among women 40 and olderwith no usual source of medical care and/or no health insurance.

Nationwide, it is also 50% lower.

Cervical cancer: In Pennsylvania, the rate of Pap test is nearly one-

third lower among women 40 and older with no usual source ofmedical care and/or no health insurance. Nationwide, it is nearly one-quarter lower than in Pennsylvania.

Colorectal cancer: In Pennsylvania, the rate of endoscopy is nearly50% lower among adults 50 and older with no usual source of medicalcare and/or no health insurance. Nationwide, it is nearly 75% lowerthan in Pennsylvania.

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Conclusion: Key Takeaways

Cancer is a worldwide problem.The growing tidal wave of new cancer cases (and theirimpact) has attracted attention from the global publichealth community.

Cancer remains a bigproblem in the United States. It is worse for the African American community than

almost every other ethnic group.

Individuals Individuals can do a lot to preventcancer and reduce cancer risk...BUTThere remains a large need for public

government and community groupintervention:$$$Policy / law

EducationNOW is the time to act!!! 47


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These people have declared war on

cancer around the world Paul Farmer, MD; Founding Director, Partners in Health; Harvard Medical School Julio Frenk, MD; Dean, Harvard School of Public Health Felicia M. Knaul, PhD; Director, Harvard Global Equity Initiative Lawrence N. Schulman, MD; Chief Medical Officer and Senior Vice President, Dana-Farber Cancer Institute Sir George Alleyne, MD; Director Emeritus, Pan American Health Organization Lance Armstrong; 7-time champion, Tour de France; Founder and Chairman, LIVESTRONG / Lance Armstrong Foundation

Prof. Rifat Atun; Director, Strategy, Performance & Evaluation, Global Fund to Fight AIDS, Tuberculosis and Malaria Douglas Blayney, MD; Medical Director, Stanford Cancer Center; Immediate Past President, American Society of ClinicalOncology

Lincoln Chen, MD; President, China Medical Board Prof. Sir Richard Feachem; Executive Director, UCSF Global Health Sciences; Professor of Global Health, University of

California, San Francisco and University of California, Berkeley Mary Gospodarowicz, MD; Professor, University of Toronto, Princess Margaret Hospital; President-elect, Union for

International Cancer Control (UICC) Julie Gralow, MD; Seattle Cancer Care Alliance; Fred Hutchinson Cancer Research Center, University of Washington

Sanjay Gupta, MD; Chief Medical Correspondent, CNN Ana Langer, MD; Coordinator of the Deans Special Initiative in Women and Health, Harvard School of Public Health Julian Lob-levyt, MD; Chief Executive Officer, Global Alliance for Vaccine and Immunization (GAVI) Claire Neale, MPH; Senior Director for Mission, LIVESTRONG / Lance Armstrong Foundation Anthony Mbewu, MD; former Executive Director, Global Forum for Health Research; past President, Medical Research

Council of South Africa HRH Princess Dina Mired; Director General, King Hussein Cancer Foundation; Honorary Co-President, Harvard Global Task

Force for Expanded Access to Cancer Control and Care in the Developing World

Peter Piot, MD; Director, London School of Hygiene & Tropical Medicine; founding Executive Director, UNAIDS K. Srinath Reddy, MD; President, Public Health Foundation of India Prof. Jeffrey Sachs, PhD; Director, Earth Institute, Columbia University Mahmoud Sarhan, MD; Chief Executive Officer and Director General, King Hussein Cancer Center John R. Seffrin, PhD; Chief Executive Officer, American Cancer Society

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Focus on tackling cancer in the most impoverished countriesaround the world

5% of global resources for cancer are spent in the developingworld (p.9)

160,000+ search results (Google).

Breakaway: The global burden of cancer 906,000+ search results (Google).

Global Task Force on Expanded Access to Cancer Care and

Control in Developing Countries (GTF.CCC) Expansion of cancer care and control in countries of low and middle

income: a call to action (Lancet; August 2010).

GTF.CCC

While at home

The American Lung Association gavePennsylvania an F for tobacco prevention

control and for cessation efforts in 2013.

The Pennsylvania Auditor General reports that $1.34 billion was

diverted from uses originally intended by the Tobacco

Settlement Act of 2001. More than 41,000 residents lost state-subsidized health insurance

coverage, as a result.

racial disparities in cancer outcomes 220,000 search results (Google).

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What are we going to

do about it at home?


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Dont give up on cancer

Richard M. Stein

[email protected]


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Dont giveuponca

ncer

Stein.richard@

ymail.com

Tel:856-283-01

83

don't give up on cancer (march 2014)

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