Cancer Care in Low-Resource Areas

CANCER PREVENTION AND
EARLY DETECTION

WORKSHOP SUMMARY

Erin Balogh, Margie Patlak, and Sharyl J. Nass, Rapporteurs

National Cancer Policy Forum

Board on Health Care Services

Institute of Medicine

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This project was supported by Contract No. HHSN261200900003C and Contract No. HHSN2632012000741 (Task Order No. HHSN26300052) between the National Academy of Sciences and the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, EMD Serono, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-39101-6
International Standard Book Number-10: 0-309-39101-6
Digital Object Identifier: 10.17226/21892

Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2016 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Cancer control in low-resource areas: Cancer prevention and early detection: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/21892.

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WORKSHOP PLANNING COMMITTEE¹

GRETA MASSETTI (Co-Chair), Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

KATHLEEN SCHEMELER (Co-Chair), Associate Professor, Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center

LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center

AFSAN BHADELIA, Visiting Scientist, Department of Global Health and Population, Harvard School of Public Health

DEJANA BRAITHWAITE, Associate Professor in Residence, Department of Epidemiology & Biostatistics, University of California, San Francisco, School of Medicine

WENDY DEMARK-WAHNEFRIED, Professor and Webb Endowed Chair of Nutrition Sciences, Associate Director, Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center

LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor, Department of Veterans Affairs, Cancer Program Director, Albany Stratton Veterans Affairs Medical Center

SAMIR KHLEIF, Director, Georgia Cancer Center at Augusta University

FELICIA KNAUL, Professor, Department of Public Health Sciences, University of Miami; Senior Economist, Mexican Health Foundation; Founding President, Tomatelo a Pecho, A.C.; Honorary Research Professor of Medical Sciences, National Institute of Public Health, Mexico

DANIEL MASYS, Affiliate Professor, Biomedical and Health Informatics, Department of Medical Education and Biomedical Informatics, University of Washington School of Medicine

TASHA MOSES, Vice President, Strategic Management Services, LLC

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

HEATHER WHITE, Technical Adviser, Noncommunicable Diseases, Sexual, Reproductive Health and Tuberculosis Department, Population Services International

Project Staff

SHARYL J. NASS, Director, National Cancer Policy Forum

ERIN BALOGH, Senior Program Officer

PATRICK ROSS, Research Assistant

CYNDI TRANG, Senior Program Assistant

NATIONAL CANCER POLICY FORUM¹

MICHAEL CALIGIURI (Chair), Chief Executive Officer, James Cancer Hospital and Solove Research Institute; Director, Ohio State University Comprehensive Cancer Center

PATRICIA A. GANZ (Vice Chair), Distinguished Professor, University of California, Los Angeles, Fielding School of Public Health; Director, Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center

AMY P. ABERNETHY, Chief Medical Officer and Senior Vice President for Oncology, Flatiron Health; Professor, Division of Medical Oncology, Duke University School of Medicine; Director, Center for Learning Health Care, Duke Clinical Research Institute

LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center

KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute

MONICA BERTAGNOLLI, Richard and Wilson, MD Professor of Surgery, Harvard University Medical School; Associate Surgeon, Dana-Farber Cancer Institute; Alliance for Clinical Trials in Oncology, Brigham and Women’s Hospital

OTIS BRAWLEY, Chief Medical Officer, American Cancer Society

CARLTON BROWN, Director of Professional Services, Oregon Nurses Association

ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network

GREGORY CURT, Executive Director, External Scientific and Clinical Relations, U.S. Medical Affairs, AstraZeneca

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

WILLIAM S. DALTON, Chief Executive Officer, M2Gen Personalized Medicine Institute, H. Lee Moffitt Cancer Center; Chair, American Association for Cancer Research Science Policy & Legislative Affairs Committee

WENDY DEMARK-WAHNEFRIED, Professor and Webb Endowed Chair of Nutrition Sciences, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center

JAMES DOROSHOW, Deputy Director for Clinical and Translational Research, National Cancer Institute

JOHN FRIEND II, Senior Vice President, Helsinn Therapeutics

LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor, Department of Veterans Affairs, Cancer Program Director, Albany Stratton Veterans Affairs Medical Center

LINDA HOUSE, President, Cancer Support Community

HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center

SAMIR N. KHLEIF, Director, Georgia Cancer Center at Augusta University

RONALD M. KLINE, Medical Officer, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services

LEE M. KRUG, Disease Area Head, Immuno-Oncology, Bristol-Myers Squibb

RICHARD A. LARSON, Hematology/Oncology Director, Hematologic Malignancies Clinical Research Program, University of Chicago

MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine, Director, University of Chicago Comprehensive Cancer Center

GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

DANIEL R. MASYS, Affiliate Professor, Biomedical and Health Informatics, Department of Medical Education and Biomedical Informatics, University of Washington School of Medicine

MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer

LOYCE PACE, Health Policy Director, LIVESTRONG Foundation

RICHARD PAZDUR, Director, Office of Oncology and Hematology Products, Food and Drug Administration

STEVEN PIANTADOSI, Phase One Foundation Endowed Chair and Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center

JENNIFER A. PIETENPOL, Director, Vanderbilt-Ingraham Cancer Center, Benjamin F. Byrd, Jr., Professor of Oncology, Professor of Biochemistry, Vanderbilt University

MACE L. ROTHENBERG, Chief Medical Officer & Senior Vice President, Clinical Development & Medical Affairs, Pfizer Oncology, Pfizer Inc.

RICHARD SCHILSKY, Chief Medical Officer, American Society of Clinical Oncology

DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute

YA-CHEN TINA SHIH, Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center

ELLEN V. SIGAL, Chair and Founder, Friends of Cancer Research

RALPH WEICHSELBAUM, Daniel K. Ludwig Professor and Chair, Department of Radiation Oncology, Director, Ludwig Center for Metastasis Research, The University of Chicago Medical Center

GEORGE J. WEINER, President, Association of American Cancer Institutes, C.E. Block Chair of Cancer Research, Professor of Internal Medicine, Director, Holden Comprehensive Cancer Center, University of Iowa

RICHARD WOODMAN, Senior Vice President, Head North America Oncology Clinical Development & Medical Affairs, Novartis Pharmaceuticals Corporation

WENDY WOODWARD, Associate Professor and the Section Chief of Clinical Breast Radiation, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center

National Cancer Policy Forum Staff

SHARYL J. NASS, Forum Director and Director, Board on Health Care Services

ERIN BALOGH, Senior Program Officer

PATRICK ROSS, Research Assistant

CYNDI TRANG, Senior Program Assistant

PATRICK BURKE, Financial Associate

Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this report was overseen by VIVIAN W. PINN. She was responsible for making certain that an

independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the rapporteurs and the institution.

Acknowledgments

Support from the many annual sponsors of the National Cancer Policy Forum is crucial to the work of the Forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Non-federal sponsors include the American Association for Cancer Research, American Cancer Society, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, EMD Serono, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc.

The Forum wishes to express its gratitude to the expert speakers whose presentations helped examine the issues of cancer prevention and early detection in low-resource areas. The Forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.

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Contents

ACRONYMS AND ABBREVIATIONS

INTRODUCTION

CANCER TRENDS

Rapidly Rising Cancer Burden

Differences in Cancer Burdens Among Low- and High-Resource Countries

Differences in Cancer Burdens in the United States

Causes of Cancer Disparities

Potential Impact of Prevention

SOCIOCULTURAL CHALLENGES IN LOW-RESOURCE AREAS

Lack of Education, Cancer Myths, and Stigma

Religious Beliefs and Outlook

Language Barriers and Lack of Trust

The Built Environment and Geographic Challenges

Challenges in Obtaining a Healthy Diet

Challenges in Providing Women’s Health Care

CANCER PREVENTION EFFORTS IN LOW-RESOURCE AREAS

Behavior Modification Programs

Tobacco Prevention and Cessation

Smoke-Free Environments

Graphic Warning Labels

Countering Tobacco Industry Efforts

Smoking Cessation Programs

Physical Activity

Multilevel Programs for Health Promotion, Cancer Prevention, and Early Detection

Cancer Vaccines

Early Detection and Screening for Cancer

Cervical Cancer

Breast Cancer

Colorectal Cancer

Lung Cancer

Experimental Approaches

LESSONS LEARNED

Advocacy

Program Planning and Implementation

Comprehensive Plan

Cultural Sensitivity

Integration and Synergy

Monitoring

Funding

Infrastructure

Education

Communication

RESEARCH

WRAP-UP

REFERENCES

APPENDIX A: Statement of Task

APPENDIX B: Workshop Agenda

Boxes, Figures, and Tables

BOXES

1 Suggestions Made by Individual Workshop Participants

2 Anti-Tobacco Efforts in Guam and the Philippines

3 Cervical Cancer Vaccine Program in Botswana

4 Overview of the Cancer Prevention and Control Activities at the Centers for Disease Control and Prevention

5 Cervical Cancer Prevention and Treatment in Zambia

6 African Research Group for Oncology

FIGURES

1 The cancer survival gap for various cancers

2 Age-adjusted annual death rates from cancer in the United States, 2012

3A Smoking prevalence among adult men aged 15 and older, 2013

3B Estimate of current adult smokers in the United States by quartile ranking

4 Cervical cancer death rates by state economic areas (SEAs), 2008-2012

5 Death and disability due to noncommunicable disease outnumber those due to infectious disease

6 Age-adjusted county-level estimates of leisure-time physical inactivity among adults aged ≥ 20 years in 2011

7 Estimated cumulative tobacco deaths from 1950 to 2050 with different intervention strategies

8 The affordability of cervical cancer programs, total and per capita, in African countries

9 The availability of pathologists is limited in many parts of Africa

10 Global status of cancer registration and vital registration

TABLES

1 Physical Activity Recommendations for Cancer Prevention

2 The Breast Health Global Initiative Guidelines for International Breast Health and Cancer Control–Early Detection

Acronyms and Abbreviations