Transcript MinorityCancerAwareness-032712 - Texas Department of State

Legislative Update
March 28, 2012
“Cancer’s Impact on Minorities
in Texas”
David Lakey, M.D.
Commissioner
Texas Department of State Health Services
Life Expectancy in Texas
Total and by Race
Life Expectancy in Years
(1989 – 2009)
2
10 Leading Causes
of Death in Texas (2009)
Rank
Cause
# of Deaths
% of All Deaths
1
Heart Diseases
38,008
23.3%
2
Malignant Neoplasms
35,531
21.8%
3
Accidents
9,310
5.7%
4
Cerebrovascular Diseases
9,118
5.6%
5
Chronic Lower Respiratory Diseases
8,624
5.3%
6
Alzheimer's Disease
5,062
3.1%
7
Diabetes Mellitus
4,866
3.0%
8
Nephritis, Nephrotic Syndrome, Nephrosis
3,688
2.3%
9
Influenza And Pneumonia
3,380
2.1%
10
Septicemia
3,085
1.9%
Deaths from all causes
162,792
Ten leading causes account for
75.3%
3
Actual Causes of Death
Shaped by Behavior
Tobacco
Overweight/Obesity
Alcohol
Auto Accidents
Drugs
Suicide
DWI
Homicide
Sexual Behavior
0
5000
10000
15000
20000
Chronic Disease in Texas 2007, DSHS
25000
30000
4
Cancer Facts
• In 2012, more than 110,000 Texans will
likely be diagnosed with cancer.
• Over 39,000 Texans will die from cancer.
• The total annual cost associated with
cancer in the state is estimated to be $28
billion.
– This includes medical care, as well as indirect
costs due to lost productivity from illness and
premature death.
5
Cancer in Texas
• Lung cancer remains the leading cause of cancer deaths,
killing an average of 9,641 Texans (2005 – 2009).
• Breast cancer is the most common cancer among Texas
women.
– Only 70% of women age 40+ have a mammogram in the past 2 years.
• Cervical cancer is one of the most preventable and
detectable through regular screening.
– Only 76% of women 18+ were screened in the past 3 years.
• In Texas, colorectal cancer is the 3rd most common
cancer in men & women & the 2nd leading cause of death.
– Only 53% of Texans age 50+ have had colorectal screenings.
– The CDC says 60% of colorectal cancers could be prevented through
screening.
6
Focus on Four
Cancer Disparities
•
•
•
•
Lung Cancer
Breast Cancer
Cervical Cancer
Colorectal Cancer
7
Lung Cancer Incidence Rate
by Sex & Race/Ethnicity Texas 2005-2009
140
116*
120
100
90
80
60
59
53
Males
Females
49
40
40
25
28
20
0
Non-Hispanic White
Black
Hispanic
Asian/Pacific Islander
*Rate is statistically significantly higher than the rate of Non-Hispanic Whites.
Rates are average annual rates per 100,000, age-adjusted to the 2000 U.S. Standard Population.
8
Lung Cancer Mortality Rate
by Sex & Race/Ethnicity Texas 2005-2009
100
93*
90
80
70
69
60
50
43
40
Males
Females
39
35
30
30
19
20
15
10
0
Non-Hispanic White
Black
Hispanic
Asian/Pacific Islander
*Rate is statistically significantly higher than the rate of Non-Hispanic Whites.
Rates are average annual rates per 100,000, age-adjusted to the 2000 U.S. Standard Population.
9
Lung Cancer Disparities
• Cigarette smoking is the number one risk factor
for lung cancer, causing about 90% of all U.S.
lung cancers.
• Lung cancer was diagnosed in black males at a
rate almost 1/3 greater than that of white males.
• As with lung cancer incidence, black men also
have higher mortality rates, at a rate 1/3 greater
than non-Hispanic white men.
• Among Texas women, white women were
diagnosed with and died from lung cancer at rates
higher than other race/ethnic groups in Texas.
10
Adult Smokers
Race and Ethnicity
11
Female Breast Cancer
Incidence Rates by Race/Ethnicity
Texas 2005-2009
140
124
120
119
93
100
80
63
60
40
20
0
Non-Hispanic White
Black
Hispanic
Asian/Pacific Islander
Rates are average annual rates per 100,000, age-adjusted to the 2000 U.S. Standard Population.
12
Female Breast Cancer
Mortality Rates by Race/Ethnicity
Texas 2005-2009
40
34*
35
30
25
22
20
17
15
9
10
5
0
Non-Hispanic White
Black
Hispanic
Asian/Pacific Islander
*Rate is statistically significantly higher than the rate of Non-Hispanic Whites.
Rates are average annual rates per 100,000, age-adjusted to the 2000 U.S. Standard Population.
13
Breast Cancer Disparities
• Even though black women were diagnosed at a lower
rate than white women:
– Black women died from breast cancer at a rate 50% higher than
whites
• Possible Explanations:
– Lack of health care coverage,
– Less access to mammography, and
– Potentially unequal access to improvements in cancer treatment.
• Research shows that black women are more likely to
develop aggressive breast tumors at a younger age.
– These aggressive tumors are associated with poorer survival.
14
Cervical Cancer Incidence Rate
by Race/Ethnicity Texas 2005-2009
*
14
13
12
10*
10
8
8
6
5
4
2
0
Non-Hispanic White
Black
Hispanic
Asian/Pacific Islander
*Rate is statistically significantly higher than the rate of Non-Hispanic Whites.
Rates are average annual rates per 100,000, age-adjusted to the 2000 U.S. Standard Population.
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Cervical Cancer Mortality Rate
by Race/Ethnicity Texas 2005-2009
4.5
4.0*
4.0
3.9*
3.5
3.0
2.5
2.4
1.9
2.0
1.5
1.0
0.5
0.0
Non-Hispanic White
Black
Hispanic
Asian/Pacific Islander
*Rate is statistically significantly higher than the rate of Non-Hispanic Whites.
Rates are average annual rates per 100,000, age-adjusted to the 2000 U.S. Standard Population.
16
Cervical Cancer Disparities
• While black women had lower cervical cancer
incidence rates than Hispanic women
– They had a slightly higher cervical cancer mortality rate
than Hispanic women.
• The higher rates in Hispanics and blacks are
attributed to lack of:
– Screening due to unequal access to medical care, and
– Cultural and economic barriers to screening.
• The National Immunization Survey-Teen, 2010
estimates that 47.5% of Texans, ages 13-17, received
more than one dose of the HPV vaccine.
– The national number is 48.7%
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Colorectal Cancer Incidence Rates
by Sex and Race/Ethnicity
Texas 2005-2009
80
71*
70
60
52
51*
50
40
50
37
32
30
29
26
20
Males
Females
10
0
Non-Hispanic White
Black
Hispanic
Asian/Pacific Islander
*Rate is statistically significantly higher than the rate of Non-Hispanic Whites.
Rates are average annual rates per 100,000, age-adjusted to the 2000 U.S. Standard Population.
18
Colorectal Cancer Mortality Rates
by Sex and Race/Ethnicity
Texas 2005-2009
40
35
30
25
20
15
10
5
0
34*
22*
20
17
13
10
11
8
Non-Hispanic White
Black
Hispanic
Males
Females
Asian/Pacific Islander
*Rate is statistically significantly higher than the rate of Non-Hispanic Whites.
Rates are average annual rates per 100,000, age-adjusted to the 2000 U.S. Standard Population.
19
Colorectal Cancer Disparities
• Diagnosed in both black males and females at a rate more
than 1/3 greater than that of whites.
• Evidence suggests that biological and genetic predisposition
may contribute, as well as behavioral factors, such as low-fiber
high-fat diets.
• Black Texas men and women died from colorectal cancer
2/3 more often than whites.
• Most colorectal cancer deaths can be prevented through
routine screening and early diagnosis.
• Blacks are less likely to complete colorectal cancer screening,
resulting in later stage diagnosis.
• Lack of access to screening services and health care coverage
may contribute to higher mortality rates.
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Reducing Disparities
• Prevention and early detection are the best
protection.
• Higher screening rates are associated with higher
education levels, availability and use of health care,
and length of U.S. residence.
21
Recommended Screenings
• The U.S. Preventive Services Task Force
(USPSTF) recommended screenings:
– Breast Cancer: Women aged 50-74 be screened by
mammography every 2 years
– Cervical Cancer: Women aged 21-65 be screened by Pap
smear every 3 years
– Colorectal Cancer: regular screening of both men and
women aged 50-75 by testing or colonoscopy
• Breast, cervical and colorectal cancer screening
are now covered in:
– Medicare, and
– In newly offered private insurance plans.
22
Texas Cancer Registry (TCR)
• The TCR collects information, such as types of cancers and locations within
the body, extent of cancer, first course treatment, length of survival, and
patient characteristics.
• Over 248,000 cancer reports were received in 2009 from over 500 reporters.
• Meets the National Program of Central Cancer Registries, CDC high quality
data standards and is Gold Certified by the North American Association of
Central Cancer Registries.
• It is the 4th largest cancer registry in the United States and is recognized by
the CDC as 1 of only 10 Comparative Effectiveness Research Specialized
Registries in the nation.
• The TCR assists local, state, national public health officials and policy
makers in measuring the Texas cancer burden, comprehensive cancer
control efforts, health disparities, progress in prevention, diagnosis,
treatment, and survivorship.
http://www.dshs.state.tx.us/tcr/default.shtm
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Texas Breast & Cervical Cancer
Control Program (BCCS)
• The BCCS goal is to reduce mortality from breast cancer and
cervical cancer in Texas.
• BCCS offers clinical breast examinations, mammograms, pelvic
examinations, and Pap tests at no or low-cost to eligible women
throughout Texas.
 Since 1991, the BCCS program has screened 288,434 women for
breast or cervical cancer.
 Of the 35,911 women seen during the 2010-2011 program year, 14,601
screenings were provided with a total of 325 breast cancers detected.
 Of 16,295 cervical screenings were provided through BCCS contractors,
5,488 precancerous conditions & 53 invasive cervical cancers detected
• Access to the state Medicaid program is available for treatment if
breast or cervical cancer are diagnosed.
http://www.dshs.state.tx.us/bcccs/default.shtm
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The Texas Comprehensive
Cancer Control Program
• Texas Comprehensive Cancer Control Program
(CCCP)
– Engages in activities that include minority and underserved populations’
cancer issues.
– CCCP stakeholders work to reach minorities & the underserved.
– A Del Rio cancer coalition (CCCP provides technical assistance)
conducts a minority awareness campaign along the border.
– The Cancer Alliance of Texas (CAT), includes organizations focused on
disadvantaged populations.
– CAT membership includes the American Cancer Society,
LIVESTRONG, UT MD Anderson Cancer Center, and Susan G. Komen
that focus on health disparities, underserved populations, access to
clinical trials, and environmental approach initiatives.
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Smoke Free Ordinances,
Texas
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Tobacco Funding
•
Tobacco prevention/cessation funding reduced 44%
•
However, DSHS is actively working toward
mitigating this reduction
– DSHS has received a $3M grant over 3 years from the Cancer
Prevention Research Institute of Texas (CPRIT)
– DSHS will continue to provide Texas Quitline telephone
counseling services and Nicotine Replacement Therapy to
priority populations at high risk for tobacco addiction
o This includes the uninsured, treatment for addictions to alcohol or
drugs, and individuals referred to the Quitline by their clinician
o DSHS estimates grants funds will provide services to ~7000 callers
annually, of whom 70% will receive counseling and 30% will receive
NRT
http://www.dshs.state.tx.us/tobacco/
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What Helps Smokers Quit?
• Texas Quitline 1-877-YES QUIT
• Comprehensive Community Coalition
Intensive Interventions supported by:
– Mass Media Campaign in 15 of 254 Texas Counties
– Resulted in 8 times more calls to the Quitline than in
counties with no interventions.
• Medicaid Funding for Quitline and Rx Benefit
for Cessation Medication
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Conclusion
• Health disparities in cancer incidence and
mortality can be reduced by 2 key
strategies:
– Prevention
• Smoking cessation
• Healthy diets
• Regular exercise
– Early detection
• Increased awareness about the need for screenings
• Improved access to recommended screenings
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Thank You!