Cancer Control

	See Also: • Cancer Prevention and Control At A Glance 2004 • Prevention Effectiveness • Cancer Prevention and Control Web Site

Comprehensive Cancer Control (CCC)

The National Comprehensive Cancer Control Program is an integrated, coordinated approach to reducing the impact of cancer that includes monitoring, policy, research, education, programs, services, and evaluation. With 2002 funding of $5.5 million, CDC's National Program provides support and technical assistance to plan and implement comprehensive cancer control activities and programs in 19 states and one tribal organization. Health agencies use this funding to establish broad-based cancer coalitions, provide epidemiological support, and develop and implement a comprehensive cancer control plan. In addition, $3.4 million in supplemental funding has been given to support colorectal, prostate, and skin cancer activities within CCC programs.

Comprehensive cancer control is based on the following principles:

1. Scientific data and research are used systematically to identify priorities and inform decision-making.
2. The full scope of cancer care, ranging from primary prevention to early detection and treatment to end-of-life issues, is addressed.
3. Many stakeholders are engaged in cancer prevention and control, including not only the medical and public health communities but also voluntary agencies, insurers, businesses, survivors, government, academia, and advocates.
4. All cancer-related programs and activities are coordinated, thereby creating integrated activities and fostering leadership.
5. The activities of many disciplines are integrated. Appropriate disciplines include administration, basic and applied research, evaluation, health education, program development, public policy, surveillance, clinical services, and health communications.

CCC programs across the country are making significant progress in coordinating and integrating cancer prevention and control. Examples include the following:

Enhancing Infrastructure in Georgia
The Georgia Cancer Coalition, a public-private partnership, was created by Governor Roy Barnes in 2000. With support from tobacco settlement funds, federal grants, and private organizations, the coalition has funded nine rural cancer education and screening projects to develop partnerships to educate citizens and increase cancer screening in rural counties that have breast, cervical, colorectal, or prostate cancer mortality rates above the state average. The Coalition also funded eight projects to improve availability of mammography services for women living in counties that have no mammography facilities.

Assessing the Cancer Burden in Iowa
In 2001, legislation enacted in Iowa mandated the development of the CCC Study Committee. On the basis of the cancer data in Healthy Iowans 2010, the CCC Study Committee used the building blocks model to develop the following priorities:

1. Assess the number of new cases and prevalence of cancer in Iowa.
2. Evaluate the effectiveness of current cancer control efforts in terms of prevention, early detection, treatment, rehabilitation, and quality of life.
3. Identify additional resources for breast and cervical cancer treatment.
4. Evaluate the availability of cancer-related resources and their effectiveness.
5. Focus on prostate, bladder, colorectal, skin, lung, oral cavity and pharynx, breast, and cervical cancers.

The findings of the CCC Study Committee were documented in the CCC Report. The Report identifies priorities for cancer prevention and control in Iowa and serves as the basis for Iowa’s comprehensive cancer prevention and control plan.

Utilizing Data and Research in the Northwest Tribal Population
By linking the records of the Northwest Tribal Registry and the state cancer registries, the Northwest Portland Area Indian Health Board documented an underestimation of cancer incidence among its tribal members (153.5 per 100,000 population prior to linking compared with 267.5 per 100,000 after linking). This work underscores the importance of using high-quality data to assess the cancer burden and eliminate health disparities.

Addressing the Cancer Burden in North Carolina
To address a priority area within the North Carolina CCC plan, the North Carolina Comprehensive Cancer Unit designed a pilot project to conduct colorectal cancer screening in 10 local health departments that service 15 counties throughout the state. The objective of this pilot project was to determine the feasibility of conducting colorectal cancer screening in local health departments. A total of 1,478 participants were counseled and offered fecal occult blood test kits; 706 (48%) completed and returned these kits. Ten precancerous polyps were found and four cancers were diagnosed. An evaluation of this project found local health departments could be useful in raising public awareness about the importance of early detection, as well as encouraging participation in screening programs. North Carolina plans to expand its colorectal cancer screening program as resources become available.

Building Partnerships for Cancer Control in Colorado
Colorado has enlisted the help of a large and varied group of partners both internal and external to the state health department to launch a public education campaign called Sun Smart Tips. The goal of this campaign is to educate national park visitors about the need to protect themselves from the damaging rays of the sun and how best to prevent skin cancer. This campaign resulted from a unique partnership between national park officials and the state health department. Together, Colorado’s Comprehensive Cancer Prevention and Control Program, the Mesa Verde National Park, and the park concessioner are educating Colorado residents and visitors from all over the world about the easy steps they can take to protect themselves from the damaging effects of sun exposure.

 
Preventing Breast and Cervical Cancer

Breast cancer is the second most common cancer among American women (after skin cancer) and the second most common cause of cancer-related death (after lung cancer). According to the American Cancer Society, 203,500 new cases of invasive breast cancer will be diagnosed in 2002, and 40,000 women will die of this disease. 

The incidence of invasive cervical cancer decreased significantly during the last 40 years, in large part because of early detection. Even so, the American Cancer Society estimates that 13,000 new cases will be diagnosed in 2002, and 4,100 women will die of the disease.

Many deaths—which occur disproportionately among low-income women and women from racial and ethnic minority groups—could be avoided by increasing cancer screening rates for all women at risk. Both mammograms and Papanicolaou (Pap) tests are underused by women who are members of some racial and ethnic minority groups, have less than a high school education, are older than 40, or live below the poverty level.

Costs

According to the National Institutes of Health, in 2002 the overall annual costs for cancer were $170 billion: over $60 billion for direct medical costs, $110 billion in lost productivity. No information is available on the medical or overall costs associated specifically with breast or cervical cancer.

 
CDC Goals

• To strengthen the capacity to conduct cancer prevention programs in all 50 states, U.S. territories, the District of Columbia, and Native American/Alaska Native organizations.
• To provide lifesaving screening for low-income women through CDC’s National Breast and Cervical Cancer Early Detection Program.

Effectiveness of Screening 

Mammography is the best way of detecting breast cancer in its earliest, most treatable stage—by about 1 to 3 years before a woman would notice a lump. Timely mammography for women older than age 40 could prevent 15%–30% of all deaths from breast cancer. When breast cancer is diagnosed at a local stage, 97% of women are still alive 5 years later. The 5-year survival rate decreases to 21% when the disease is diagnosed after spreading to other sites. 

Pap tests detect not only cervical cancer but also precancerous lesions. Detecting and treating such lesions can prevent cervical cancer—and thus prevent virtually all deaths from this disease.

Examples of CDC Activities 

• In 2001, CDC funded cancer prevention activities in all 50 states, 6 U.S. territories, the District of Columbia, and 14 American Indian or Alaska Native organizations.
• CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) screens underserved women for breast and cervical cancer. The NBCCEDP provides clinical breast examinations, mammograms, pelvic examinations, and Pap tests. The NBCCEDP also funds postscreening diagnostic services, such as surgical consultation and biopsy. Now in its 11th year, the NBCCEDP has provided more than 3 million examinations to more than 1.3 million women and diagnosed more than 10,649 breast cancers, 45,154 precancerous cervical lesions, and 700 cases of cervical cancer. 
• With $170.5 million in funding in 2001, CDC increased education and outreach programs for women and for health care providers, improved quality assurance measures for screening programs, and improved underserved women’s access to screening and follow-up services.

Examples of State Activities 

Missouri: In collaboration with the Missouri Department of Social Services, the Missouri Breast and Cervical Cancer Control Program hired women who are moving from welfare to work as outreach coordinators to inform women about free breast and cervical cancer screening. To date, these coordinators have referred about 3,400 women for screening, and 12 coordinators have been given full-time employment. 

Nevada: Along with Race for the Cure, the Nevada Breast and Cervical Cancer Early Detection Program partnered with Chevron, the Susan G. Komen Foundation, and Mobile-Ray Imaging to offer free mammograms at a local Chevron station. The program provided breast health education, follow-up after an abnormal screening result, and additional mammograms for those who qualified. As a result, hundreds of women were educated about breast and cervical health, and more than 200 underserved women were given a free mammogram.

Ohio: In collaboration with the Medical College of Ohio at Toledo, Ohio’s breast and cervical cancer program produced Cultural Competence in Breast Cancer Care, a CD-ROM for health care professionals. The CD-ROM includes discussions on cultural perspectives on breast care, provider-client communication, and follow-up after an abnormal clinical breast examination.

 
Preventing Other Forms of Cancer
Colorectal, Ovarian, Prostate, Skin

Colorectal Cancer

Colorectal cancer—cancer of the colon or rectum—is the second leading cause of cancer-related death among men and women in the United States. The American Cancer Society estimates that nearly 56,600 Americans will die of colorectal cancer in 2002. 

Ovarian Cancer

Among women, ovarian cancer is the seventh most common cancer and the fifth leading cause of cancer-related death. 

The American Cancer Society estimates that, in 2002 in the United States, 13,900 women will die of this disease. More whites than blacks get this disease; there is little information about how this disease affects other races. 

Prostate Cancer

Among men in the United States, prostate cancer is the second most commonly diagnosed form of cancer and second most common cause of cancer-related death. The American Cancer Society estimates that 30,200 men will die of the disease in 2002. Blacks get prostate cancer more than any other racial or ethnic group. The death rate for blacks is twice as high as that for whites. 

Skin Cancer

In the United States, more than 1 million cases of highly curable skin cancer occur annually. The most serious form of skin cancer is melanoma, which occurs 10 times more often among whites than among blacks. Melanoma causes more than 75% of all deaths from skin cancer. If treated early, this disease can usually be cured. Untreated melanoma can spread to other organs, usually the lungs and liver. 

Although death rates from basal cell and squamous cell carcinomas are low, they can cause considerable disfigurement and damage if left untreated. 

CDC Goals

• To increase the number of adults aged 50 or older who are screened for colorectal cancer from 35% to 50%. 
• To research the symptoms of ovarian cancer in order to be able to diagnose the disease during its early stages.
• To contribute significantly to the Healthy People 2010 goal of reducing death rate due to prostate cancer from 32.0 to 28.8 per 100,000 men. 
• To increase to the number of adults and children who regularly use at least one protective measure against skin cancer.

Examples of CDC Activities 

Colorectal Cancer 

• In partnership with the Centers for Medicare and Medicaid Services, formerly HCFA, CDC created Screen for Life, a multimedia campaign to promote colorectal cancer screening for men and women aged 50 or older. Screen for Life materials can be ordered or downloaded from the Internet at www.cdc.gov/cancer/screenforlife. 
• CDC developed A Call to Action, a Web-based training program to raise primary care providers’ awareness and knowledge about prevention and early detection of colorectal cancer. 
• CDC supports a variety of epidemiological and behavioral research projects to reduce the incidence of colorectal cancer.

Ovarian Cancer 

CDC conducts research or collaborates in research on a variety of issues. For example 

• The factors that distinguish women at stages 1 and 2 from women at stages 3 and 4 of ovarian cancer.
• Ovarian cancer incidence by race.
• The factors that distinguish women with borderline ovarian tumors from women with ovarian cancer. 

Prostate Cancer

• Six questions on prostate cancer screening were added to the core questionnaire of the 2001 Behavioral Risk Factor Surveillance System. Answers to these questions are helping determine what proportion of men aged 40 or older were screened for prostate cancer and whether there is an association between race, age, family history of prostate cancer and whether a man gets screened for prostate cancer.
• By collecting prostate cancer data through the National Program of Cancer Registries—especially data on stage of diagnosis, quality of care, and race and ethnicity—CDC and the states can design more effective public health programs to combat the disease. For example

Skin Cancer

• CDC conducted epidemiologic research to determine national trends in sun protection behavior and attitudes about sun exposure. The findings are being used to target and evaluate skin cancer prevention programs.
• CDC’s national Choose Your Cover media campaign helps states increase people’s awareness about skin cancer and its causes as well as influence social norms regarding sun protection and tanned skin.

 
Related Information

One or more documents on this Web page is available in Portable Document Format (PDF). You will need Acrobat Reader (a free application) to view and print these documents.

• The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives
• Cancer Registries: The Foundation for Cancer Prevention and Control
• Exemplary State Programs — Cancer (148K–PDF)

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This page last reviewed August 10, 2004

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion