Comprehensive Cancer Control Efforts Research Articles

Addressing the rising colorectal cancer burden in the older adult: examining modifiable risk and protective factors for comprehensive prevention strategies

BackgroundColorectal cancer is one of the most prevalent and deadly cancer types worldwide. Emerging evidence suggests that high body mass index (BMI) is a significant risk factor for colorectal cancer, particularly among the older adult population. This comprehensive analysis aims to explore the complex epidemiological patterns of colorectal cancer, with a focus on the association between high BMI and disease burden in the older adult.MethodsThe study leveraged data from the Global Burden of Disease (GBD) 2021 study to examine the temporal trends, regional disparities, and the interplay of age, period, and cohort factors in shaping the global colorectal cancer landscape. Epidemiological techniques, including age-period-cohort modeling and joinpoint regression analysis, were employed to provide insights into the potential drivers of the evolving disease burden while controlling for relevant confounding factors.ResultsThe analysis revealed significant geographical disparities in the burden of colorectal cancer among the older adult population. Countries like Uruguay, Monaco, Croatia, Hungary, and Poland exhibited higher mortality and disability-adjusted life-year (DALY) rates, while regions like Bangladesh, Nepal, and much of Africa had relatively lower disease burden. These regional differences are likely attributable to variations in healthcare systems, access to screening and early detection programs, as well as differences in lifestyle behaviors and risk factor prevalence.ConclusionThe strong association between high BMI and colorectal cancer risk, particularly in the older adult population and among men, emphasizes the importance of comprehensive obesity management strategies as part of comprehensive cancer control efforts. Targeted interventions, such as community-based weight management programs and enhanced screening initiatives in high-risk regions, could help mitigate the disproportionate burden of colorectal cancer observed in countries like Monaco, Croatia, and Hungary. Ongoing research and multifaceted public health interventions are crucial to address the growing global burden of colorectal cancer and mitigate the disproportionate impact on vulnerable populations. Strengthening healthcare systems, improving access to quality cancer care, and promoting lifestyle modifications to reduce obesity and other modifiable risk factors should be prioritized to effectively combat this pressing public health challenge.

The role of communication in the successful implementation of the Slovenian NCCP

Abstract Issue Cancer remains a significant global public health challenge, necessitating comprehensive strategies for effective control and management. Slovenian National Cancer Control Programme (NCCP) addresses this challenge by prioritizing proactive communication with various stakeholders engaged in cancer care planning, delivery and advocacy. The communication strategy within this programme plays a pivotal role in its successful implementation. Description of the problem Active engagement and collaboration among stakeholders is crucial for achieving the programme’s objectives. NCCP seeks to address this challenge through various communication activities by fostering dialogue, sharing best practices, and facilitating networking opportunities among oncology professionals throughout Slovenia. Additionally, it seeks to strengthen partnerships with sectors beyond health and prioritizes engagement with cancer patient advocacy groups. Results The programme has devised a long-term communication strategy, guiding annual communication plans to engage stakeholders and foster support for its objectives. Notable communication activities in the period 2022-2024 include: organizing annual meetings for different oncology stakeholders including cancer patient associations, hosting impactful professional events, conducting visits to regional cancer hospitals, distributing e-newsletters and managing a NCCP website. Initial outcomes indicate strengthened communication and collaboration among professionals and institutions in the field of oncology nationwide. Engagement with patient advocacy groups has facilitated discussions on topics important to patients. Lessons Effective communication with diverse stakeholders is crucial for comprehensive cancer control. Collaborating across sectors enhances the impact of cancer control initiatives. Enhanced networking fosters innovation and synergy among oncology professionals, positioning Slovenia for greater success in cancer control. Key messages • Slovenia’s NCCP prioritizes proactive communication, fostering collaboration among stakeholders. Annual events, newsletter, and partnerships strengthen awareness and drive comprehensive cancer control. • Long-term communication strategy of Slovenia’s NCCP drives stakeholder engagement, and supports strategic objectives. This proactive approach strengthens comprehensive cancer control efforts.

Understanding geographic variations of indoor radon potential for comprehensive cancer control planning.

Lung cancer is the leading cause of U.S. cancer deaths and radon is the second leading risk factor for lung cancer. By better understanding geologic variations of radon production in states, comprehensive cancer control efforts could be improved. The study purpose was to assess states with the greatest potential for elevated radon and the likelihood of radon-related actions in National Comprehensive Cancer Control Program (NCCCP) awardee cancer plans. Two state-level variables were derived to approximate potential for elevated radon using the Environmental Protection Agency county map and the 2015 U.S. Census. The association between radon potential and inclusion of radon activity within cancer plans was evaluated using logistic regression. Fifty-one percent of cancer plans recognized an association between radon and cancer risk, and included measurable radon activities. Most states with high radon potential included radon activity in cancer plans. Both measures of radon potential were significantly associated with NCCCP cancer plans including radon activity. Geospatial analyses help to prioritize radon-related lung cancer activities. In areas with high potential for radon exposure, increasing knowledge about potential for radon exposure may result in increased radon testing, mitigation, or other radon reducing strategies, and ultimately reduction of lung cancer deaths.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2016.

PurposeThis study presents the 2016 nationwide cancer statistics in Korea, including cancer incidence, survival, prevalence, and mortality.Materials and MethodsCancer incidence data from 1999 to 2016 were obtained from the Korea National Cancer Incidence Database and followed until December 31, 2017. Mortality data from 1983 to 2016 were obtained from Statistics Korea. The prevalence was defined as the number of cancer patients alive on January 1, 2017 among all cancer patients diagnosed since 1999. Crude and age-standardized rates (ASRs) for incidence, mortality, and prevalence and 5-year relative survivals were also calculated.ResultsOverall, 229,180 and 78,194 Koreans were newly diagnosed and died from cancer in 2016, respectively. The ASRs for cancer incidence and mortality in 2016 were 269.0 and 79.8 per 100,000 individuals, respectively. The all-cancer incidence rate increased significantly by 3.6% annually from 1999 to 2011 and started to decrease after 2011 (2011-2016; annual percent change, –3.1%). However, overall cancer mortality has decreased 2.7% annually since 2002. The 5-year relative survival rate for patients diagnosed with cancer between 2012 and 2016 was 70.6%, an improvement from the 41.2% for patients diagnosed between 1993 and 1995.ConclusionThe cancer prevalence in Korea has increased very fast as survival has improved remarkably. The high prevalence of cancer emphasizes the need for comprehensive cancer control efforts in Korea.

Comprehensive cancer control in the U.S.: summarizing twenty years of progress and looking ahead.

In order to celebrate the accomplishments of the Centers for Disease Control and Prevention's (CDC) National Comprehensive Cancer Control Program (NCCCP), the Comprehensive Cancer Control National Partners (CCCNP) developed this Special Issue on Cancer Causes and Control. This, the third Special Issue on Comprehensive Cancer Control (CCC), is a reflection of 20years of building successful partnerships to prevent and control cancer; planning and implementing strategic cancer control; collaborating to address national cancer prevention and control priorities; evaluating efforts; sharing successes; and, in later years, serving as a model for global cancer control planning and implementation. The CDC currently supports cancer control planning and implementation in all 50 states, the District of Columbia, eight tribes or tribal organizations, and seven Pacific Island Jurisdictions and U.S. territories through the NCCCP. CCC is an approach that brings together multi-sector partners to address the cancer burden in a community collectively by leveraging existing resources and identifying and addressing cancer related issues and needs. The Comprehensive Cancer Control National Partnership (CCCNP), a partnership of national organizations, has been committed to supporting comprehensive cancer control efforts since 1999. We summarize the efforts described in this Special Issue. We also describe opportunities and critical elements to continue the momentum for comprehensive cancer control well into the future.

Surveillance for Cancers Associated with Tobacco Use - United States, 2010-2014.

Problem/ConditionTobacco use is the leading preventable cause of cancer, contributing to at least 12 types of cancer, including acute myeloid leukemia (AML) and cancers of the oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; and cervix. This report provides a comprehensive assessment of recent tobacco-associated cancer incidence for each cancer type by sex, age, race/ethnicity, metropolitan county classification, tumor characteristics, U.S. census region, and state. These data are important for initiation, monitoring, and evaluation of tobacco prevention and control measures.Period Covered2010–2014.Description of SystemCancer incidence data from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2010–2014 and trends in annual age-adjusted incidence rates for 2010–2014. These cancer incidence data cover approximately 99% of the U.S. population. This report provides age-adjusted cancer incidence rates for each of the 12 cancer types known to be causally associated with tobacco use, including liver and colorectal cancer, which were deemed to be causally associated with tobacco use by the U.S. Surgeon General in 2014. Findings are reported by demographic and geographic characteristics, percentage distributions for tumor characteristics, and trends in cancer incidence by sex.ResultsDuring 2010–2014, approximately 3.3 million new tobacco-associated cancer cases were reported in the United States, approximately 667,000 per year. Age-adjusted incidence rates ranged from 4.2 AML cases per 100,000 persons to 61.3 lung cancer cases per 100,000 persons. By cancer type, incidence rates were higher among men than women (excluding cervical cancer), higher among non-Hispanics than Hispanics (for all cancers except stomach, liver, kidney, and cervical), higher among persons in nonmetropolitan counties than those in metropolitan counties (for all cancers except stomach, liver, pancreatic, and AML), and lower in the West than in other U.S. census regions (all except stomach, liver, bladder, and AML). Compared with other racial/ethnic groups, certain cancer rates were highest among whites (oral cavity and pharyngeal, esophageal, bladder, and AML), blacks (colon and rectal, pancreatic, laryngeal, lung and bronchial, cervical, and kidney), and Asians/Pacific Islanders (stomach and liver). During 2010–2014, the rate of all tobacco-associated cancers combined decreased 1.2% per year, influenced largely by decreases in cancers of the larynx (3.0%), lung (2.2%), colon and rectum (2.1%), and bladder (1.3%).InterpretationAlthough tobacco-associated cancer incidence decreased overall during 2010–2014, the incidence remains high in several states and subgroups, including among men, whites, blacks, non-Hispanics, and persons in nonmetropolitan counties. These disproportionately high rates of tobacco-related cancer incidence reflect overall demographic patterns of cancer incidence in the United States and also reflect patterns of tobacco use.Public Health ActionTobacco-associated cancer incidence can be reduced through prevention and control of tobacco use and comprehensive cancer-control efforts focused on reducing cancer risk, detecting cancer early, and better assisting communities disproportionately affected by cancer. Ongoing surveillance to monitor cancer incidence can identify populations with a high incidence of tobacco-associated cancers and evaluate the effectiveness of tobacco control programs and policies. Implementation research can be conducted to achieve wider adoption of existing evidence-based cancer prevention and screening programs and tobacco control measures, especially to reach groups with the largest disparities in cancer rates.

Policy Report: Introducing an Effective National Cancer Control Plan in the Maldives

Background and context: There is no National Cancer Control Plan (NCCP) in the Maldives. The Health Plan has identified cancer as an area with a need for development of separate policy, strategy paper while it is also reflected in the Multi-Stakeholder Action Plan for NCDs. Aim: The main aim of the project is to produce a policy report to guide the development of an effective National Cancer Control Plan (NCCP) in the Maldives. The objectives are to estimate the total period prevalence of cancer in the Maldives (2013-2014); to understand the views of key stakeholders; and synthesize this to develop a policy report and applying the “Cancer Control, Knowledge into Action: WHO Guide for Effective Programmes - in Low and Middle Income Countries”, to the Maldives context to identify priority components in light of the prevalence estimates and views of the key stakeholders. Strategy/Tactics: The policy report will bring together the findings from secondary analysis of quantitative data, analysis of key informant in-depth interviews from stakeholders, using the framework analysis method for qualitative data analysis and applying the “WHO Guide for Effective Programmes - in Low and Middle Income Countries”, to the Maldives context and identify priority components in light of the prevalence estimates and views of the key stakeholders. Outcomes: Among a population of 344,023 people, the estimated total period prevalence for all cancers in the period of 2013-2014 in Maldives is 0.92% (920 cases per 100,000 population). The estimated prevalence is 0.84% for males and 1.01% for females. Oral cancers (including lip, tongue, gum, mouth, and palate) is the most common cancer, followed by eye, breast (with carcinoma in situ), sinuses, skin (melanoma and skin cancers and carcinoma in situ). How common eye cancers and sinus cancers could be reflected as an anomaly in the data as these are uncommon when regional prevalences are compared or is an area where further research is warranted. Thyroid, prostate, lymphomas, leukemias and lung cancers are among the top 10 cancers. The key informant interviews, revealed that there are very limited services available for cancer prevention, diagnosis, treatment and care. What was learned: It is evident that there is a substantial amount of work to be done with regard to cancer control in the Maldives. The high prevalence of cancer and the views of the respondents from the study emphasizes the need for developing a National Cancer Control Plan (NCCP) as an initial step toward comprehensive cancer control efforts in the Maldives. A comprehensive cancer prevention strategy with early detection-early diagnosis and screening should be a priority component for the NCCP, with improvement of diagnosis and treatment services and establishment of a comprehensive palliative and psychosocial care program across the cancer care continuum. This policy report will provide guidance to development of an NCCP with priorities identified.

Vital Signs: Disparities in Tobacco-Related Cancer Incidence and Mortality - United States, 2004-2013.

Tobacco use causes at least 12 types of cancer and is the leading preventable cause of cancer. Data from the United States Cancer Statistics dataset for 2004-2013 were used to assess incidence and death rates and trends for cancers that can be caused by tobacco use (tobacco-related cancers: oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; cervix; and acute myeloid leukemia) by sex, age, race, ethnicity, state, county-level poverty and educational attainment, and cancer site. Each year during 2009-2013, on average, 660,000 persons in the United States received a diagnosis of a tobacco-related cancer, and 343,000 persons died from these cancers. Tobacco-related cancer incidence and death rates were higher among men than women; highest among black men and women; higher in counties with low proportion of college graduates or high level of poverty; lowest in the West; and differed two-fold among states. During 2004-2013, incidence of tobacco-related cancer decreased 1.3% per year and mortality decreased 1.6% per year, with decreases observed across most groups, but not at the same rate. Tobacco-related cancer declined during 2004-2013. However, the burden remains high, and disparities persist among certain groups with higher rates or slower declines in rates. The burden of tobacco-related cancers can be reduced through efforts to prevent and control tobacco use and other comprehensive cancer control efforts focused on reducing cancer risk, detecting cancer early, improving cancer treatments, helping more persons survive cancer, improving cancer survivors' quality of life, and better assisting communities disproportionately impacted by cancer.

Spatial Heterogeneity in Cancer Control Planning and Cancer Screening Behavior

Each state is autonomous in its comprehensive cancer control (CCC) program, and considerable heterogeneity exists in the program plans, but researchers often focus on the concept of nationally representative data and pool observations across states using regression analysis to come up with average effects when interpreting results. Due to considerable state autonomy and heterogeneity in various dimensions—including culture, politics, historical precedent, regulatory environment, and CCC efforts—it is important to examine states separately and to use geographic analysis to translate findings in place and time. We used 100 percent population data for Medicare-insured persons aged sixty-five or older and examined predictors of breast cancer (BC) and colorectal cancer (CRC) screening from 2001 to 2005. Examining BC and CRC screening behavior separately in each state, we performed 100 multilevel regressions. We summarize the state-specific findings of racial disparities in screening for either cancer in a single bivariate map of the fifty states, producing a separate map for African American and for Hispanic disparities in each state relative to whites. The maps serve to spatially translate the voluminous regression findings regarding statistically significant disparities between whites and minorities in cancer screening within states. Qualitative comparisons can be made of the states’ disparity environments or for a state against a national benchmark using the bivariate maps. We find that African Americans in Michigan and Hispanics in New Jersey are significantly more likely than whites to utilize CRC screening and that Hispanics in six states are significantly and persistently more likely to utilize mammography than whites. We stress the importance of spatial translation research for informing and evaluating CCC activities within states and over time.

Progress in addressing disparities through comprehensive cancer control

Cancer-related disparities are the significant differences in cancer incidence, cancer prevalence, cancer death, cancer survivorship, and burden of cancer or related health conditions that exist disproportionately in certain populations compared with the general population with respect to variables like race, ethnicity, and geography. The emergence of comprehensive cancer control efforts provides a framework to address the unequal disease burden felt by these groups. This article illustrates four distinct programs uniquely designed to fit at-risk populations. Specific examples are given that demonstrate a significant impact on the full range of the cancer care continuum. Although measureable progress has been made to improve prevention, detection, and treatment of cancer throughout the United States, many populations remain underserved, impeding our ability to achieve national healthcare goals. Here, we reemphasize the need to sustain this progress through use of partnerships, technology, and policy.

The CCC National Partnership: an example of organizations collaborating on comprehensive cancer control

The landscape of cancer control has changed throughout the past 12years and continues to change even more so as health reform is implemented in the United States. With the advent of health reform, coalitions, such as comprehensive cancer control (CCC) coalitions, are more important than ever if the intended benefits of reform are to be realized. Comprehensive cancer control (CCC) coalitions in state, tribe, territory, and Pacific Island Jurisdictions are "engines of change" and form a network that can facilitate important cancer control progress throughout this country. Since the onset of CCC efforts, the vitality of this network of coalitions and their sustainability has been the primary focus of a group of national organizations, now known as the Comprehensive Cancer Control National Partnership (CCCNP). The CCCNP is national organizations who come together voluntarily to develop strategies and resources that support implementation of CCC coalition plans across the nation.

Heterogeneity in mammography use across the nation: separating evidence of disparities from the disproportionate effects of geography

BackgroundMammography is essential for early detection of breast cancer and both reduced morbidity and increased survival among breast cancer victims. Utilization is lower than national guidelines, and evidence of a recent decline in mammography use has sparked concern. We demonstrate that regression models estimated over pooled samples of heterogeneous states may provide misleading information regarding predictors of health care utilization and that comprehensive cancer control efforts should focus on understanding these differences and underlying causal factors. Our study population includes all women over age 64 with breast cancer in the Surveillance Epidemiology and End Results (SEER) cancer registries, linked to a nationally representative 5% reference sample of Medicare-eligible women located in 11 states that span all census regions and are heterogeneous in racial and ethnic mix. Combining women with and without cancer in the sample allows assessment of previous cancer diagnosis on propensity to use mammography. Our conceptual model recognizes the interplay between individual, social, cultural, and physical environments along the pathways to health care utilization, while delineating local and more distant levels of influence among contextual variables. In regression modeling, we assess individual-level effects, direct effects of contextual factors, and interaction effects between individual and contextual factors.ResultsPooling all women across states leads to quite different conclusions than state-specific models. Commuter intensity, community acculturation, and community elderly impoverishment have significant direct impacts on mammography use which vary across states. Minorities living in isolated enclaves with others of the same race/ethnicity may be either advantaged or disadvantaged, depending upon the place studied.ConclusionCareful analysis of place-specific context is essential for understanding differences across communities stemming from different causal factors. Optimal policy interventions to change behavior (improve screening rates) will be as heterogeneous as local community characteristics, so no "one size fits all" policy can improve population health. Probability modeling with correction for clustering of individuals within multilevel contexts can reveal important differences from place to place and identify key factors to inform targeting of specific communities for further study.

The Evaluation of Comprehensive Cancer Control Efforts: Useful Techniques and Unique Requirements

This article discusses evaluation of comprehensive cancer control efforts as developed in the United States by involved partners at all levels -- community, regional, state, tribal, territorial, and national. Evaluation of comprehensive cancer control can concern the evaluation of a program, a plan or activities from a plan. In its development, it is grounded in both theory and practice, and the results are used in program development and implementation to document activities, inform decision making, and demonstrate accountability. Various types of evaluation have been shown to be important. Challenges to evaluating comprehensive cancer control include incorporating and working with a broad group of stakeholders; developing an agreed upon plan and evaluation, ensuring the necessary infrastructure for overseeing, facilitating, and disseminating results of evaluations; conceptualizing and communicating desired changes; and potentially implementing (and evaluating) programs at the community, regional, tribal, territorial, state, or national level. Using the CDC Framework for Evaluation, selected examples of state program evaluations are presented. These examples show the use of both process and outcome evaluations to illustrate programmatic improvement and the accomplishment of proposed objectives. As evaluation of comprehensive cancer control continues to be developed and results communicated, our ability to evaluate comprehensive cancer control programs increases and the growth of comprehensive cancer control efforts are encouraged.