What’s in Your Toolbox? A Potpourri of Research Methods to Address the Cancer Control Continuum

Estimation of Breast Cancer Incident Cases and Medical Care Costs Attributable to Alcohol Consumption Among Insured Women under 45 Years of Age in the United States

Authors:

Donatus (Don) Ekwueme (Presenter)
Centers for Disease Control and Prevention

Benjamin Allaire, RTI International
William Parish, RTI International
Cheryll Thomas, Centers for Disease Control and Prevention
Gery Guy, Centers for Disease Control and Prevention
Temeika Fairley, Centers for Disease Control and Prevention
Justin Trogdon, University of North Carolina at Chapel Hill

Public Health Statement: Over 22,000 new cases of breast cancer are diagnosed among women under the age of 45 years (“younger women”) annually.

Purpose: To estimate the percent of breast cancer cases, total number of incident breast cancer cases, and the total annual medical care costs attributable to alcohol consumption among insured younger women by type of insurance (Medicaid, private, and both groups) and by stage at diagnosis.

Methods/Approach: We used data from the 2012–2013 National Survey on Drug Use and Health, the Centers for Disease Control and Prevention’s National Program of Cancer Registries, the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, and published literature to estimate: 1) the alcohol-attributable fraction of breast cancer cases among younger women aged 18–44 years by type of insurance; 2) the total number of breast cancer incident cases attributable to alcohol consumption by stage at diagnosis and insurance status; and 3) the total annual medical care costs of treating breast cancer incident cases attributable to alcohol consumption. All costs were expressed in 2013 U.S. dollars.

Results: Among younger women enrolled in Medicaid, private insurance, and both groups, we estimated that 8.7%, (95% confidence interval [CI]:7.4–10.0%), 13.8% (95% CI:13.3–14.4%), and 12.3% (95% CI:11.4–13.1%) or 1-in-12, 1-in-7, and 1-in-8 of all breast cancer cases were attributable to alcohol consumption. Across both insurance groups, the largest proportion of estimated attributable incident cases were in localized stage. The estimated total number of breast cancer incident cases attributable to alcohol consumption was 2,212 (95% CI: 2,125–2,303). These breast cancer incident cases accounted for estimated total annual medical care costs of $201.7 million (95% CI: $191.1–$212.2 million).

Conclusions/Implications: Alcohol use in younger women is a modifiable risk factor for breast cancer. We estimate that breast cancer attributable to alcohol has medical care costs in excess of $200 million per year. Thus the findings from this study could be used to support evidence-based interventions to reduce alcohol consumption in younger women.

Preventing Alcohol-Related Cancer: What If Everyone Drank Within the Guidelines?

Authors:

Stephanie Young (Presenter)
Cancer Care Ontario

Norman Giesbrecht, Centre for Addiction and Mental Health
Elisa Candido, Cancer Care Ontario
Julie Klein-Geltink, Cancer Care Ontario

Public Health Statement: Alcohol consumption is a major cause of morbidity and mortality. Guidelines have been developed in many countries to help individuals reduce their alcohol-related harm. In Canada, two sets of guidelines are commonly promoted: the Low-Risk Alcohol Drinking Guidelines (LRADG) and stricter, cancer-specific guidelines developed by the World Canada Research Fund (WCRF) and the American Institute for Cancer Research (AICR).

Purpose: To estimate the proportion and number of cancers diagnosed in Ontario in 2012 attributable to alcohol consumption, and compare with estimates assuming alcohol consumption had not exceeded the levels recommended by 1) the LRADG and 2) the WCRF/AICR guidelines.

Methods/Approach: Population attributable fractions (PAFs) were calculated for six cancer types using drinking prevalence from the 2000/01 Canadian Community Health Survey and relative risks obtained from meta-analyses. Each PAF was multiplied by the number of incident cancers in 2012 to calculate the number of alcohol-attributable cases. The numbers of alcohol-attributable cases assuming consumption had not exceeded the levels recommended by the LRADG or the WCRF/AICR guidelines were also estimated.

Results: 1,207 new cases of cancer diagnosed in Ontario during 2012 were attributable to alcohol consumption, representing approximately 1.6% of all new cancer cases. If no Ontario adults had exceeded the LRADG, an estimated 286 fewer cancer cases would have been diagnosed in 2012. An estimated 434 fewer cancer cases would have been diagnosed if no Ontario adults had exceeded the WCRF/AICR guidelines.

Conclusions/Implications: Strategies to reduce alcohol consumption in the population to the levels recommended by drinking guidelines may reduce the cancer burden in Ontario.

Healthlinks: Reaching Employees of Small, Low-Wage Worksites with Evidence-Based Interventions

Authors:

Peggy Hannon (Presenter)
University of Washington

Jeffrey Harris, University of Washington
Kristen Hammerback, University of Washington
Marlana Kohn, University of Washington
Amanda Parrish, University of Washington
K Gary Chan, University of Washington
christian helfrich, University of Washington

Public Health Statement: Small worksites (<200 employees) are less likely to have wellness programs than larger worksites, even though many of their employees receive low wages and are at high risk for unhealthy behaviors such as physical inactivity and tobacco use. We developed HealthLinks to disseminate evidence-based wellness interventions (EBIs) to small worksites in low-wage industries.

Purpose: We conducted a three-arm, site-randomized trial to test whether HealthLinks increased EBI implementation at small worksites, and whether forming a wellness committee at the worksite facilitated EBI implementation. EBIs were from the Guide to Community Preventive Services.

Methods/Approach: We recruited 78 worksites and retained 72 through the 15-month follow-up. We randomly assigned worksites to one of three arms: HealthLinks (n=26), HealthLinks plus wellness committee (n=25), or delayed control (n=21). At baseline and 15 months, we assessed worksites’ implementation of EBIs on a 0–100% scale, and surveyed employees about worksite support of their health.

Results: Baseline scores were equivalent across the HealthLinks (17%), HealthLinks plus wellness committee (19%), and control arms (20%). Follow-up scores increased significantly in both intervention arms (to 49% and 48%, respectively), but not in the control arm (23%). At follow-up, employees of intervention worksites perceived more worksite support for their health than employees of control worksites.

Conclusions/Implications: Small worksites that received HealthLinks went from having fewer than 20% of EBIs in place to having nearly 50% EBI implementation Their employees reported higher levels of support for their health. Formation of an onsite wellness committee neither helped nor harmed EBI implementation efforts.

Racial Differences in Survival of Pediatric Patients with Brain and Central Nervous System Cancer—United States, 2001–2012

Authors:

David Siegel (Presenter)
Centers for Disease Control and Prevention

Simple Singh, Centers for Disease Control and Prevention
Jun Li, Centers for Disease Control and Prevention

Public Health Statement: Brain and central nervous system (CNS) cancer is the leading cause of cancer death among children and adolescents. Despite improvements in survival during the past 40 years, some data suggest a racial disparity for survival.

Purpose: Our study describes survival by race by using national data to better understand the effects of demographic and clinical factors.

Methods/Approach: Data from the National Program of Cancer Registries were used to evaluate relative survival (RS) (cancer survival in the absence of other causes of death) among individuals aged 0–19 years diagnosed with brain and CNS cancer during 2001–2012. Data were from 29 states and covered 66% of the U.S. population. Overall and specific to black and white races, RS was stratified by sex, age, cancer stage, anatomic site, histology, U.S. Census region, and county economic status.

Results: We identified 16,675 primary brain and CNS cancer cases, with a 5-year RS of 75.5% (95% confidence interval [CI]: 75.0–76.5). White patients had a significantly higher 5-year RS (76.5%; 95% CI: 75.7–77.3) than black patients (70.8%; 95% CI: 68.6–72.9). The racial difference remained significant at 1 and 3-year RS, for both sexes, among children and adolescents, and in the South Census region. Cancer stage, primary anatomic site, histology, and economic status also affected racial differences for survival.

Conclusions/Implications: This study highlights brain and CNS cancer survival differences between black and white patients. Future investigation of access to care, socioeconomic status, and host genetic factors may explain why race is a marker for survival and could help guide public health planning.