Examining Cancer Health Disparities: Public Health Responses to a Persistent Trend

Examination of Cancer Outcomes in American Samoa

Authors:

Elizabeth Van Dyne (Presenter)
Centers for Disease Control and Prevention

Virginia Senkomago, CDC
Lee Buenconsejo-Lum, University of Hawaii
Mona Saraiya, Centers for Disease Control and Prevention

Public Health Statement: A state of health emergency due to the epidemic of non-communicable diseases has been declared in the 6 U.S. Pacific Island jurisdictions. American Samoa, a territory of 55,519 people, lacks capacity to process Pap tests for cervical cancer and on-island treatment (chemotherapy and radiation therapy) for patients diagnosed with cancer. There are insufficient data on cause of cancer-related deaths, which are necessary for prioritizing and implementing cancer control activities.

Purpose: As cancer-related mortality in the US Pacific Island jurisdictions is unknown, this project aims to determine cause of deaths due to cancer in American Samoa, and the 5 other U.S. Pacific Island jurisdictions for the cancer surveillance system.

Methods/Approach: We examined vital status (alive/dead) of the 192 cancer cases diagnosed in American Samoa from 2007–2014 reported through the Pacific Regional Central Cancer Registry. We coded cause of death from clinical information using the International Classification of Diseases, Tenth Revision. Data were analyzed using SEER*Stat software.

Results: Of the 192 cases diagnosed, 66 died from June 2007 to May 2014 (case fatality rate: 34%, n=66); cancer was the predominant cause of death (94%, n=62). The most common cancer-related causes of death were female breast cancer (n=13), lung cancer (n=6), gastric cancer (n=6), cervical cancer (n=4), and ovarian cancer (n=4). The median time from diagnosis to death was 4 months. A majority of deaths occurred among those with late-stage cancer at time of diagnosis. Of those who died, 15% (n=10) had some form of palliative care documented in the registry.

Conclusions/Implications: This mortality data can help with the prioritization and implementation of evidence-based interventions that could reduce cancer-related deaths through early detection and improve quality of life through palliative care.

Cervical Cancer Screening in the National Breast and Cervical Cancer Early Detection Program in Four U.S.-Affiliated Pacific Islands Between 2007 and 2015

Authors:

Virginia Senkomago (Presenter)
Centers for Disease Control and Prevention/ORISE

Janet Royalty, Centers for Disease Control and Prevention
Jacqueline Miller, Centers for Disease Control and Prevention
Lee Buenconsejo-Lum, University of Hawaii
Vicki Benard, Centers for Disease Control and Prevention
Mona Saraiya, Centers for Disease Control and Prevention

Public Health Statement: Cervical cancer incidence in the US-Affiliated Pacific Islands (USAPIs) is double that of the US mainland. American Samoa, Commonwealth of Northern Mariana Islands (CNMI), Guam and the Republic of Palau receive funding from CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to implement cervical cancer screening to low-income, uninsured or under insured women.

Purpose: To examine cervical cancer screening, diagnostic tests and follow-up condcuted for women served in the NBCCEDPs in four US-Affiliated Islands between 2007 and 2015.

Methods/Approach: The USAPI grantees report data on screening and follow-up activities to the CDC. We examined cervical cancer screening and follow-up data from the NBCCEDP programs in the four USAPIs from 2007-2015. We summarized screening done by Papanicolaou (Pap) and high-risk Human Papillomavirus (HPV) tests, follow-up and diagnostic tests provided, and histology results observed.

Results: A total of 22,249 Pap tests were conducted in 14,206 women in the four USAPIs programs from 2007- 2015. The overall percentages of abnormal Pap results (low-grade squamous intraepithelial lesions or worse) was 2.4 % for first program screens and 1.8% for subsequent program screens. Histology results showed a high proportion of cervical intraepithelial neoplasia grade 2 or worse (57%) among these women. Roughly one-third (32%) of Pap test results warranting follow-up had no data recorded on diagnostic tests or follow-up done.

Conclusions/Implications: This is the first report of cervical cancer screening and outcomes of women served in the USAPI through the NBCCEDP with similar results for abnormal Pap tests, but higher proportion of pre-cancers and cancers, when compared to national NBCCEDP data. The USAPI face significant challenges in implementing cervical cancer screening, particularly in providing and recording data on diagnostic tests and follow-up. The screening programs in the USAPI should further examine specific barriers to follow-up of women with abnormal Pap results and possible solutions to address them.

Working with State-Funded Health Centers to Address Cancer Health Disparities in Indiana

Author:

Keylee Wright (Presenter)
Indiana State Department of Health

Public Health Statement: The National Cancer Institute defines “cancer health disparities” as adverse differences in cancer incidence, prevalence, mortality, and survivorship, and burden of cancer or related health conditions that exist among specific population groups. These population groups may be characterized by age, education, geographic location, income, race, ethnicity, etc.

Purpose: Indiana’s 40 state-funded health centers provide care to 500,000 people. Their catchment populations encompass communities with significant populations over 65, those living at or below the poverty line, rural and urban areas, Medicaid (50%) and uninsured (20%), and potentially low literacy due to low educational attainment and language barriers.

Methods/Approach: The Indiana State Department of Health Cancer Sections helped to staff the Indiana Primary Care Learning Collaborative (INPCLC), a multi-cohort initiative that supports state-funded health centers in implementing the Chronic Care Model and Model for Improvement focused in the areas of diabetes, smoking cessation, obesity, and cancer prevention and control. The cancer sections provided technical assistance to participating health centers to increase breast, cervical, and colorectal cancer screening rates, and human papillomavirus (HPV) vaccination series initiation.

Results: For the three INPCLC cohorts, screening rates for colorectal cancer increased 29 percent; breast cancer increased 12 percent; and cervical cancer increased 8 percent. The percentage of adolescents who received a recommendation for the HPV vaccine by their 13^th birthday increased 11 percent.

Conclusions/Implications: Peer learning experiences, multiple learning modalities, regular measurement of progress, and on-site practice coaching increases cancer screening rates in a community health center setting.

Addressing Breast Cancer Mortality Disparities in Milwaukee

Authors:

Sarah Mroz (Presenter)
University of Wisconsin – Carbone Cancer Center

Noelle LoConte, University of Wisconsin – Carbone Cancer Center

Public Health Statement: Specific Milwaukee areas have been identified as “hot spots” where women are nearly twice as likely to die from breast cancer than women in surrounding neighborhoods.

Purpose: The Wisconsin Breast Cancer Task Force (WBCTF) is collaborating with numerous partners on a project called Sister Pact to address these disparities. The Sister Pact campaign, piloted in Memphis in 2015, encourages women to address their breast health by: talking to friends and family to make a commitment – a Sister Pact – to take action, visiting a resource directory to access local resources, and by getting a mammogram.

Methods/Approach: The Sister Pact media campaign features local women and is being combined with ongoing awareness events. Focus groups were conducted to test the messages and images and the media materials were adapted to be locally appropriate. A pre campaign survey of women in the target area was conducted to measure breast cancer screening behavior and understanding and a post campaign survey will conducted during the summer of 2017.

Results: We expect the Milwaukee campaign to have outcomes similar to the Memphis project, which showed that over 90% of women intended to take action, almost 80% had already made a Sister Pact, visited the directory, or gotten screened six months after the campaign launch, and 20% had received a mammogram.

Conclusions/Implications: The Milwaukee Sister Pact program is an intensely collaborative effort that has the potential to increase breast cancer screening and reduce breast cancer mortality disparities.