Data Speak: Using Data for Innovative Cancer Control Efforts

Population-Based Cancer Survival in Canada and the United States: Comparison by Socioeconomic Position

Authors:

Hannah Weir (Presenter)
Centers for Disease Control and Prevention

Hether Bryant, Canadian Partnership Against Cancer
Rami Rahal, Canadian Partnership Against Cancer

Public Health Statement: Population-based cancer survival provides insight into the effectiveness of cancer control and health care delivery. Results from CONCORD-2 showed that overall 5-year survival in Canada and the United States were comparable and among the highest in the world for patients diagnosed 1995 through 2009. Literature suggests a Canadian-advantage in survival among lower socio-economic (SE) groups and a US-advantage among higher SE groups.

Purpose: CONCORD-2 data from Canada and US are being used to compare population-based survival between the US and Canada by socio-economic position

Methods/Approach: Data for cancer patients diagnosed 2001–2009 were from 34 US statewide registries and 10 Canadian provincial registries. We estimated 5-year net survival for selected cancers by age, gender, calendar year, country and neighborhood-level income quintiles (Canada) and county-level SES index and race (U.S.).

Results: In Canada, the survival difference between highest and lowest income quintiles are: 5.4% for ovarian cancer; 5.1% for female breast cancer; 4.3% for prostate cancer; 2.8% for lung cancer; and <1.0% for cancers of the stomach and cervix, and children with acute lymphoblastic leukemia. This analysis will be updated to include results from the US and a comparison of results between Canada and the U.S.

Conclusions/Implications: Health care delivery differs between Canada and the United States. Exploring the relationship between SE-position and population-based cancer survival may help inform cancer control efforts in both countries.

Life-Course Socioeconomic Status and Breast and Cervical Cancer Screening: Analysis of WHO’s Study on Global Aging and Adult Health (SAGE)

Authors:

Oluwafolakemi Ogunsina (Presenter)
University of Alabama at Birmingham

Tomi Akinyemiju, University of Alabama at Birmingham

Public Health Statement: Socioeconomic differences in cancer screening have been well documented in upper -income countries; however, few studies have examined socioeconomic status (SES) over the life-course in relation to cancer screening in lower-income and middle-income countries.

Purpose: To examine individual, parental and life-course SES differences in age-appropriate breast and cervical cancer screening among women in India, China, Mexico, Russia and South Africa.

Methods/Approach: Data from the WHO’s Study on Global Ageing and Adult Health (SAGE) 2007–2008 were used for survey-weighted multivariable regression analysis. By conducting survey weighted multivariable regression analysis in SAS (v9.4, Cary NC), we examined the association between individual, parental and life-course SES in relation to breast and cervical cancer screening using education-based and employment-based measures of SES. Participants included 22,283 women ages 18–65 years, recruited from India, China, Mexico, Russia and South Africa.

Results: Having a college degree (OR: 4.18, 95% CI: 2.36 to 7.40) increased the odds of breast cancer screening compared with no formal education. Women with higher parental SES were almost 10 times more likely to receive breast cancer screening (OR 9.84; 95% CI 1.75 to 55.5) compared with women with low parental SES. Stable higher life-course SES (OR: 3.07, 95% CI: 1.96 to 4.79) increased breast cancer screening by 3-fold, and increased cervical cancer screening by more than 4-fold (OR: 4.35, 95% CI: 2.94 to 6.45); however, declining life-course SES was associated with reduced breast cancer screening (OR: 0.26, 95% CI: 0.08 to 0.79) compared to low life-course SES.

Conclusions/Implications: Higher individual, parental and life course SES was positively associated with breast and cervical cancer screening, although education-based SES measures were stronger predictors of screening compared with employment-based measures. Improving knowledge of the benefits of cancer screening and integrating cancer screening into routine healthcare practice for low SES women are actionable strategies that may significantly improve screening rates in low-income and middle-income countries.

Using CDC’s Science Impact Framework to Evaluate the Impact of Hereditary Breast and Ovarian Cancer Public Health Activities

Authors:

Ridgely Green (Presenter)
Centers for Disease Control and Prevention

Mary Ari, Centers for Disease Control and Prevention
Nancy Habarta, Centers for Disease Control and Prevention
Tempest Hill, Centers for Disease Control and Prevention
Katherine Kolor, Centers for Disease Control and Prevention
Scott Bowen, Centers for Disease Control and Prevention
W Dotson, Centers for Disease Control and Prevention
Juan Rodriguez, Centers for Disease Control and Prevention
Muin Khoury, Centers for Disease Control and Prevention

Public Health Statement: About 3% of breast cancers (about 6,000 women/year) and 10% of ovarian cancers (about 2,000 women/year) result from inherited BRCA1 and BRCA2 mutations.

Purpose: We documented the influence of the United States Prevention Task Force (USPSTF) BRCA testing recommendation and its implementation by public health programs.

Methods/Approach: We used CDC’s science impact framework (SIF), which considers five spheres of influence that emphasize contribution to long-term impact.

Results: Disseminating Science: USPSTF published evidence-based recommendations in 2005 and 2013 on use of family health history to identify women at risk for BRCA mutations (B rating).
Creating Awareness: >470 publications cited the USPSTF recommendations.
Catalyzing Action: CDC-funded state HBOC activities started in 2008. The Affordable Care Act requires non-grandfathered health plans to cover without cost sharing the USPSTF BRCA testing recommendation, due to its “B” rating. The Centers for Medicare and Medicaid Services Local Coverage Determination on BRCA1 and BRCA2 Genetic Testing allows regional coverage of BRCA genetic counseling and testing for some individuals with personal histories of BRCA-related cancers.
Effecting Change: Seven national and international recommendations on identification of women at risk for BRCA mutations cite the USPSTF recommendation. The USPSTF recommendation formed the basis for the Healthy People 2020 genomics objective on HBOC.
Shaping the Future: The National Academy of Medicine’s Roundtable on Genomics and Precision Health formed the Genomics and Population Health Action Collaborative, focusing on state HBOC activities and their interface with healthcare systems.

Conclusions/Implications: The SIF can help trace how genomics implementation impacts public health over time.

Utilizing Population-Based Surveys Data for Women at Risk for Hereditary Breast and Ovarian Cancer in Michigan

Author:

Debra Duquette (Presenter)
MDHHS

Public Health Statement: Evidence-based guidelines recommend that women with a significant family history of breast (BC) and/or ovarian cancer (OC) be referred for genetic counseling with possible genetic testing. For women identified with hereditary breast and ovarian cancer (HBOC), increased surveillance with appropriate HBOC management can reduce cancer risks.

Purpose: State and national objectives seek to increase the percentage of women with appropriate family history of BC or OC that are offered genetic counseling. Analyses of MI Michigan Pregnancy Risk Assessment and Monitoring System (PRAMS) and Michigan Behavioral Risk Factors Survey (MiBRFS) data serve as metrics to evaluate achievements.

Methods/Approach: Results from the 2015 MiBRFS were used to establish weighted estimates of significant personal and/or family history of BC and OC and genetic counseling among adult women. MI PRAMS analysis included survey-weighted responses from mothers of 2012–2014 live births about family history of BC before age 50 and OC.

Results: The prevalence of genetic counseling among the 1.4% of adult women with a significant personal history was 39%, and 10–16% among the 10–22% of women with significant family history of BC and/or OC. Similarly, 8.5–10% of new MI mothers reported a family history of early-onset BC or OC. More black women reported family history of early-onset BC than white women, but fewer reported a family history of OC.

Conclusions/Implications: In addition to the first-ever report of significant personal cancer history, these results show that MI has met state and national objectives for genetic counseling for HBOC. Michigan’s PRAMS is the first to analyze family BC/OC history. These population-based surveys will be utilized for ongoing surveillance in 2018.