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Diversity and the Burden of Cancer

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Diversity and the Burden of Cancer David C. Momrow, M.P.H. ... Ethnicity (1992-1999) Prostate Cancer National Incidence & Mortality by Race - Ethnicity ... – PowerPoint PPT presentation

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Title: Diversity and the Burden of Cancer


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.
  • Its 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 Factors Most
Common Causes of Death, U.S., 1998
National Vital Statistics Report, 1998481-10,
26
8
Chronic Diseases and Related Risk Factors Actual
Causes of Death, U.S., 1990
McGinnis JM, Foege WH, Actual causes of death in
the United States. JAMA 1993 2702207-12.
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 Cancer National 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 Disease Harlem
vs. SEER U.S. White
Harlem
SEER (US White)
  • Stage I 8.4 38
  • Stage II 20.8 38
  • Stage III 22.8 18
  • Stage IV 39.0 5
  • Unstaged 8.0

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 interventions to 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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