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Diversity and the Burden of Cancer

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.

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Diversity and the Burden of Cancer

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  1. 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

  2. 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. A Few Simple Ideas to Make PowerPoint Easy

  3. New York Over 50% of New Cases and Deaths from Cancer Occur in 4 Sites Distribution of Cancer by Site Incidence Incidence 27% Prostate 16% Lung & Bronchus 12% Colorectal 55% 29% Breast 13% Colorectal 12% Lung & Bronchus 54% Mortality Mortality 29% Lung & Bronchus 12% Prostate 11% Colorectal 52% 22% Lung & Bronchus 18% Breast 12% Colorectal 52% NYS Cancer Registry, 2001

  4. Defining Diversity “Diversity refers to any mixture of items characterized by differences and similarities.”

  5. Population of Eastern Division by Race/Ethnicity Black or African American 15.9 13.6 Hispanic or Latino 15.1 13.3 Asian 5.5 5.7 Total 36.5 32.6 U.S. Census Bureau, Census 2000

  6. Diversity is… Secondary Dimension Primary Dimension

  7. Chronic Diseases and Related Risk FactorsMost Common Causes of Death, U.S., 1998* * National Vital Statistics Report, 1998;48:1-10, 26

  8. Chronic Diseases and Related Risk FactorsActual Causes of Death, U.S., 1990 McGinnis JM, Foege WH, Actual causes of death in the United States. JAMA 1993; 270:2207-12.

  9. U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority Groups— A Report of the Surgeon General, 1998.

  10. Life Expectancy Black Males 65 Years White Males 73 Years Black Females 73 Years White Females 78 Years

  11. 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.

  12. National Incidence & Mortality - All cancers by Race - Ethnicity (1992-1999) *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

  13. Lung and Bronchus CancerNational Incidence & Mortality by Race - Ethnicity (1992-1999)

  14. Prostate Cancer National Incidence & Mortality by Race - Ethnicity (1992-1999)

  15. Female Breast Cancer National Incidence & Mortality by Race - Ethnicity (1992-1999)

  16. Colon & Rectum Cancer National Incidence & Mortality by Race - Ethnicity (1992-1999) *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

  17. Colorectal Carcinoma by Stage of DiseaseHarlem vs. SEER U.S. White Stage I 8.4% 38% Stage II 20.8% 38% Stage III 22.8% 18% Stage IV 39.0% 5% Unstaged 8.0% Harlem SEER (US White)

  18. 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

  19. 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.

  20. Colorectal Carcinoma 5-Year Relative Survival Rate (%) Freeman, Cancer, May 1, 2002

  21. 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

  22. Obesity, Diet, and Physical Exercise Need more research on how these factors impact health disparities Develop effective interventionsto encourage lifestyle changes that impact health disparities

  23. 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.

  24. 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

  25. CAUSES OF HEALTH DISPARITIES Culture Low Economic Status/Poverty Social Injustice Freeman, Cancer Epidemiology Biomarkers & Prevention, April 2003

  26. 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

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