Fulfilling the Potential of Cancer Prevention and Early Detection (2003) / Chapter Skim
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11. Findings, Policy Implications, and Recommendations
11. Findings, Policy Implications, and Recommendations
Pages 400-437
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From page 400... ...
cancer death rates is a result of cancer prevention and early detection, but more progress is possible by simply implementing known interventions. A 19 percent decline in the rate at which new cancer cases occur and a 29 percent decline in the rate of cancer deaths could potentially be achieved by 2015 if efforts to help people change their behaviors that put them at risk were stepped up and if behavioral change were sustained.
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From page 401... ...
4. What steps can be taken to overcome barriers to using effective interventions and to improve what we know about cancer prevention and early detection?
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From page 402... ...
Although an association between cancer and physical activity is established, the mechanisms whereby physical activity reduce risk of cancer are not fully known. Diet There is clear and convincing evidence that a diet rich in plant foods and moderate in animal products lowers the risk of cardiovascular disease, diabetes, and other important outcomes, but evidence linking specific aspects of the diet to cancer risk is inconsistent.
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From page 403... ...
Use of Cancer Screening A core consensus has emerged about the appropriateness of some methods of cancer screening. There is essentially universal agreement across organizations that all adults age 50 and older should be screened for colorectal cancer, that all women should receive mammograms every 1 to 2 years beginning at least by age 50, and that cervical cancer screening should occur regularly in all sexually active women with a cervix.
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From page 404... ...
SOURCE: US DHHS and Office of Disease Prevention and Health Promotion, 2000.
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From page 405... ...
The major barriers that most people face when trying to increase physical activity are lack of time, lack of access to convenient facilities, and lack of safe environments in which to be active (US DHHS and Office of Disease Prevention and Health Promotion, 2000~. More than 1 in 10 children and more than half of adults in the United States are overweight or obese, representing sharp increases in rates of obesity over the last three decades (US DHHS and Office of Disease Prevention and Health Promotion, 2000~.
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From page 406... ...
Insurance status, age, socioeconomic status, race, ethnicity, and education account for marked disparities in the access of Americans to cancer screening tests. Rates of screening of women for breast and cervical cancer are relatively high.
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From page 407... ...
7~. Tobacco Use Certain states such as California and Massachusetts have implemented comprehensive tobacco control programs and have achieved some important milestones: sharp reductions in smoking and declines in rates of chronic
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Preventive Services Task Force, the Agency for Healthcare Research and Quality) (Hopkins et al., 2001a; Wasserman, 2001 )
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From page 409... ...
Optimizing the delivery of effective cancer screening services and reducing inappropriate testing lie in changing the behaviors of · systems of care, to make cancer screening services available to eligible populations; · health care providers, to perform cancer screening as recommended, on time, and with skill when they encounter patients eligible for screening; and · individuals, to obtain recommended screening tests and pursue follow-up.
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From page 410... ...
WHAT STEPS CAN BE TAKEN TO OVERCOME BARRIERS TO USING EFFECTIVE INTERVENTIONS AND TO IMPROVE WHAT WE KNOW ABOUT CANCER PREVENTION AND EARLY DETECTION? The Board recommends that the following steps be taken to increase the rate of adoption, the reach, and the impacts of evidence-based cancer prevention and early detection interventions.
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From page 411... ...
. California and Massachusetts, two states with large-scale and sustained tobacco control programs, fund the program using excise tax revenues and Tobacco Master Settlement Agreement funds.
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· States should impose tobacco-licensing requirements for merchants selling tobacco products, as recommended in the 2000 report of the Surgeon General (U.S. Department of Health and Human Services and Office of Disease Prevention and Health Promotion, 2000~.
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A comprehensive set of recommendations, the Recommendations for Public Health Action on Weight Control and Physical Activity to Promote Cancer Prevention, has been proposed by the International Agency for Research on Cancer (IARC) , an agency within the World Health Organization (2002)
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4. Enable state education and health departments to work together to help schools implement quality, daily physical education and other physical activity programs: · with a full-time state coordinator for school physical activity programs, · as part of a coordinated school health program, and · with support from relevant governmental and nongovernmental .
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From page 417... ...
CDC has issued guidelines for school health programs to promote lifelong healthy eating, including four attributes of effective school-based nutrition education programs (http://www.cdc.gov/ nccUphp/dashlnutguide .htm)
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From page 418... ...
CDC's Office of Smoking and Health, for example, provides technical assistance to states and monitors progress in reaching tobacco-related goals outlined in Healthy People 2010 (US DHHS and Office of Disease Prevention and Health Promotion, 2000~. Other programs at CDC address other risk factors, for example, the Division of Nutrition and Physical Activity promotes healthy diet, weight control, and physical activity, and the Division of Cancer Prevention and Control oversees the National Breast and Cervical Cancer Early Detection Program that operates in all states to provide screening and follow-up services to underserved women.
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From page 419... ...
Approximately half of them, for example, have cancer registries that achieve the standards of completeness, timeliness, and coverage to provide accurate cancer incidence data for planning and evaluation. All states monitor the prevalence of cancer-related risk factors such as smoking, and all states have in place CDC-funded breast and cervical cancer screening programs targeted to low-income and underserved women.
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From page 420... ...
, and use of preventive health services (e.g., screening and smoking cessation programs) ; · collaborate with school systems to develop cancer prevention-related educational curricula and programs; · collaborate with public and private organizations to provide incent~ves for physical activity, healthy eating, and participation in weight loss programs (e.g., reduced fees for fitness clubs, on-site weight control groups, employer nonautomotive commuting programs)
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From page 421... ...
States have mandated coverage for some cancer prevention and early detection interventions. As of 1998, for example, 43 states and the District of Columbia mandated coverage of cancer screening tests.
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From page 422... ...
Evidence was not sufficient to include a recommendation regarding mandated reimbursement for interventions to increase physical activity, improve diet, and reduce obesity as a general cancer prevention strategy, though optional offerings by insurers should be encouraged. There are many opportunities for employers, business coalitions, and other large purchasers of health insurance to exert influence to encourage the use of cancer prevention and early detection services.
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. These programs increase the use of cancer prevention and early detection services among medically underserved populations.
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rely on a patchwork of public and private programs for primary care (IOM, 20003~. Community and Migrant Health Centers and Title X family planning clinics are vital sources of primary health care and are important providers of cancer prevention and early detection services (see Chapter 9~.
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From page 425... ...
These programs do not always reflect best practices in cancer prevention and early detection. The Medicare program, for example, does not cover any costs for smoking cessation treatment, and two-thirds of state Medicaid programs cover such treatments (Schauffler et al., 2001a)
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From page 426... ...
Health care providers who completed their training 10 or more years ago are unlikely to have been trained in cancer prevention and control. In the early 1990s, for example, relatively few meclical schools offered any training in smoking cessation.
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From page 427... ...
Clinicians want to provide good care and need to know the effects of their actions and be in a position to respond to incentives (Center for the Advancement of Health, 2001~. There are many opportunities to monitor performance and assist providers in improving their practices: · CMS could examine provider performance regarding adherence to recommended cancer prevention and early detection recommendations.
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From page 428... ...
The aging of the nation's population will sharply increase the demand for certain cancer prevention services such as screening. There may be an inadequate supply of personnel to meet these demands.
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From page 429... ...
Screening for prostate cancer by prostate-specific antigen testing, for example, for which there is comparatively little evidence of effectiveness, is more commonly used than colorectal cancer screening, for which there is strong evidence of effectiveness. More recently, low-dose computed tomography scanning has been promoted as a screening test for lung cancer among high-risk individuals, with the scientific community divided on the merits of its effectiveness.
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From page 430... ...
and monitor the impacts of diffusion and dissemination efforts on the health promotion and cancer control objectives of Healthy People 2010 (US DHHS and Office of Disease Prevention and Health Promotion, 2000~; · collaboratively promote adoption of evidence-based cancer control interventions by local, state, and national service organizations; and · focus on eliminating cancer-related health disparities among medically underserved populations with cancer. Recommendation 10: Public and private organizations (e.g., the National Cancer Institute, the American Cancer Society)
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From page 431... ...
The public's thirst for quick medical "miracles" and simple impatience also pose significant barriers to progress in cancer prevention and early detection. It can take many years to reap the benefits of behavioral change like smoking cessation and the rewards of many other interventions can take time to be realized.
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From page 432... ...
Likewise, support for cancer prevention may lag behind that for other interventions because many people do not acknowledge the difficulty of initiating behavioral change and the need for supportive systems to help individuals maintain healthy behavioral change. Recognizing that society is in the midst of a communications revolution, NCI (2001)
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From page 433... ...
Personal barriers can include cultural differences, language barriers, not knowing what to clo or when to seek care, or concerns about confidentiality or discrimination (US DHHS and Office of Disease Prevention and Health Promotion, 2000~. In a nation of increasing diversity, interventions to improve cancer prevention and early detection must accommoclate different languages, cultural values, and beliefs.
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From page 434... ...
IDENTIFYING RESEARCH PRIORITIES The Board has prioritized research to encourage healthy behaviors among children and their families, underserved populations, and the public at large through multicomponent interventions. In its review of the evidence regarding the effectiveness of cancer prevention and early detection, the Board identified specific research priorities in the major areas covered in
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From page 435... ...
· Assess the Tobacco Master Settlement Agreement, in particular, industry adherence to its provisions and the success of these provisions in reducing youth smoking rates. · Evaluate the effectiveness of channels for the delivery of smoking cessation services (e.g., workplaces, the Internet, families, health care providers, and peers)
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From page 436... ...
Cancer Screening · Develop useful methods for implementing shared decision making as applied to cancer screening. Given the growing number of cancer screening tests for which shared decision making is recommended, there is a growing need to answer questions surrounding the appropriateness, feasibility, and proper methods of this form of counseling.
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From page 437... ...
Essential too are investments in basic research in both cancer biology and behavioral health that can lead to the development of improved methods for cancer prevention and control (IOM, 2001a)
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