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

• 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

The only reason we exist is to reduce the burden of cancer on the American people.

Distribution ofCancer by Site

Incidence

Mortality

27% Prostate16% Lung & Bronchus12% Colorectal

55%

29% Lung & Bronchus12% Prostate11% Colorectal52%

Incidence

29% Breast13% Colorectal 12% Lung & Bronchus 54%

Mortality

22% Lung & Bronchus 18% Breast12% Colorectal52%

New York

NYS Cancer Registry, 2001

Over 50% of New Cases and Deaths from Cancer Occur in 4 Sites

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 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

Diversity is…

Secondary Dimension

Primary Dimension

Chronic Diseases and Related Risk FactorsMost Common Causes of Death, U.S., 1998*

0 10 20 30 40 50

Chronic liver disease/cirrhosis

Nephritis and nephrosis

Suicide

Diabetes mellitus

Pneumonia and influenza

Unintentional injuries

Chronic obstructive pulmonary disease

All Cancers

Health disease and stroke

* National Vital Statistics Report, 1998;48:1-10, 26

Chronic Diseases and Related Risk FactorsActual Causes of Death, U.S., 1990

0 5 10 15 20

I llicit drug use

Motor vehicles

Sexual behavior

Firearms

Pollutants and toxins

Infectious agents

Alcohol

Poor diet/ lack of exercise

Tobacco

McGinnis JM, Foege WH, Actual causes of death in the United States. JAMA 1993; 270:2207-12.

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 65 Years

White Males 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.

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

0

100

200

300

400

500

600 IncidenceMortality

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

0102030405060708090

IncidenceMortality

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

0

50

100

150

200

250

300

IncidenceMortality

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

0

20

40

60

80

100

120

140

WhiteAfrican American

HispanicAsian/Pacific Islander

Amer. Indian/Alaska Native

IncidenceMortality

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

0

10

20

30

40

50

60

70IncidenceMortality

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)

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

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.

Disease always occurs within a context of human circumstances

Colorectal Carcinoma 5-Year Relative Survival Rate (%)

0

10

20

30

40

50

60

70

1974-76 1977-79 1980-82 1983-85 1986-92

Black HarlemUS WhiteUS Black

Freeman, Cancer, May 1, 2002

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 No person in America with cancer should go untreated.go untreated.

No person in America should be bankrupted No person in America should be bankrupted by a diagnosis of cancerby a diagnosis of cancer

CultureCulture

Social InjusticeSocial Injustice

CAUSES OF HEALTH CAUSES OF HEALTH DISPARITIESDISPARITIES

Low Economic Low Economic Status/PovertyStatus/Poverty

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