April 12 2022
Written by: Joan Cahill BNS, OCN, CCRP, Asst. Research Practice Manager (ARPM), Department of Radiation Oncology. Duke Cancer Center
On March 28 1938, Congress under the administration of Franklin D. Roosevelt declared April as the first Cancer Control Month. Since then every April, the President issues a proclamation calling upon healthcare professionals, government agencies, research institutions, the media, and the public to dedicate April to increasing awareness of cancer prevention and early detection through recommended screenings.
The National Cancer Institute (NCI) defines cancer control as “the conduct of basic and applied research in the behavioral, social, and population sciences to create or enhance interventions that independently or in combination with biomedical approaches, reduce cancer risk, incidence, morbidity and mortality, and improve quality of life”.
Simply put, the goal of cancer control is to reduce cancer burden by preventing cancer, diagnosing cancer early and decreasing the impacts of cancer on the individual, the family and the community they live in. The cancer control continuum is complex; there are five basic aims to cancer control programs.
- to improve cancer prevention
- to promote early detection,
- to improve cancer treatment
- to improve the quality of life for people with cancer, and
- to reduce the burden of cancer on patients, families and their communities
One week in cancer control month, April 17-23 is committed to National Minority Cancer Awareness Week. Cancer impacts people of every background and socio-economic status however the National Community Reinvestment Coalition (NCRC) reports that up to 60% of your health is determined by your zip code. The COVID-19 pandemic illustrated these differences between socioeconomic groups when low-income communities and communities of color carried a higher burden of confirmed COVID-19 cases and with poorer health outcomes. This is also true with cancer, early in 2021 the NCI voiced concerns that pandemic related delays in cancer diagnosis and treatment is likely to have serious consequences.
In July 2021 the NCI Cancer Trends Progress reported that 73.5% of women of all races 21-65 years old are current with cervical screening. Looking more closely at the report, 64.2% of women earning <200% of the federal poverty level were screened, indicating ~35% of women living in low-income communities are being missed. With colorectal cancer (CRC) screening, 67% of adults 50-75 years are current with screening, that number drops to 55.4% when economic status is factored in. Compare education levels between socio-economic groups and the same pattern is seen; people living in lower socio-economic communities are not attending cancer screenings for many reasons; no or poor insurance, co-pays, transportation, childcare and jobs that do not provide paid sick time all contribute to health disparities.
Prevention:
Cancer Moonshot launched in 2016 aims to make serious advances in cancer prevention, diagnosis, and treatment. Cancer Moonshot programs are paid through $1.8 billion in federal funding over 7 years. A Cancer Moonshot funded program is Accelerating Colorectal Cancer Screening through Implementation Science in Appalachia (ACCSIS). The goal is to increase screening and follow-up for colorectal cancer (CRC) in central Appalachia, a medically underserved region identified as a “hotspot” for colorectal cancer mortality. Community-based outreach programs like ACCSIS, influence behavior on preventing tobacco use initiation, tobacco cessation, improving diet and nutrition programs, promoting physical activity and weight control. Additionally, HPV vaccination is recommended starting at ages 11 or 12 years to prevent known HPV associated cancers (head and neck, cervix, vulva and penis). Check locally, HPV vaccines may be provided free of charge to the uninsured and minorities.
The U.S. Preventive Services Task Force (USPSTF) recommends the following cancer detection screenings (abbreviated here):
- women 50 to 74 years complete a mammogram every 2 years
- women 21-65 years cervical cancer screening every 3-5 years
- adults 45 years and older complete a screening colonoscopy once every 10 years
- adults 50-80 years with a 20 pack-year smoking history or more and who currently smoke or have quit within the past 15 years complete a LDCT scan annually (revised March 2021 based on the National Lung Screening Trial)
- men 55 to 69 years, recommends clinicians provide information about the potential benefits and harms of PSA-based screening for prostate cancer
As a healthcare professional you may be asked for information during April, the National Foundation for Cancer Research has a free Cancer Prevention and Early Detection Kit. The kit includes information on screenings for breast, lung, cervical and colorectal cancer as well as tips for healthy living, NFCR also provides a downloadable guide to cancer screenings for men and women.
Great strides have been made in cancer control, a lot more work must be done particularly in health equity and reaching underserved populations.
This April, take every opportunity to educate yourself, colleagues, loved ones, friends and your community about cancer control recommendations and programs available where you live. As we emerge from the pandemic, let’s repurpose the “we are in this together” mantra for April 2022 and onwards in cancer control.
Citations:
1 National Cancer Institute Division of Cancer Control & Population Sciences
https://cancercontrol.cancer.gov/about-dccps/about-division/cancer-control-framework-and-synthesis-rationale
2 American Cancer Society: What is Cancer Control? Sandy McDowell August 2 2018 https://www.cancer.org/latest-news/what-is-cancer-control.html 2/2
3 National Institute of Health: https://cancercontrol.cancer.gov/about-dccps/about-cc/cancer-control-continuum (The Cancer Control Continuum: Adapted from David B. Abrams, Brown University School of Medicine)
4 National Minority Cancer Awareness Week and CDC's national cancer prevention and control efforts is available at http://www.cdc.gov/cancer
5 Emily Orminski June 30 2021 Your Zipcode is more important than your genetic code: https://www.ncrc.org/your-zip-code-is-more-important-than-your-geneticcode/#:~:text=Up%20to%2060%25%20of%20your,centers%20are%20present%2C%20among%20oth
6 S. Agarwala PhD December 29 2021:Cancer and COVID-19: the impact of missed screenings in vulnerable communities https://www.uchicagomedicine.org/forefront/cancer-articles/cancer-and-covid-19-the-impact-of-missed-screenings-in-vulnerable-communities
7National Cancer Institute: For Cancer Screening, COVID-19 Pandemic Creates Obstacles, Opportunities was originally published by the National Cancer Institute: https://www.cancer.gov/news-events/cancer-currents-blog/2021/cancer-screening-decreases-coronavirus-pandemic
8Cancer Trends Progress Report: National Cancer institute, NIH, DHHS, Bethesda MD, July 2021, https://progressreport.caner.gov
9 https://www.nfcr.org/wp-content/uploads/2020/12/Cancer-Screening-Guidelines.pdf