1. April 6, 2015

2. o What is cancer? o Cancer statistics o Cancer prevention and early detection o Cancer disparities o Cancer survivorship o Cancer research

3. o Disease in which abnormal cells divide without control and are able to invade other tissues o More than 100 types of cancer o 1,655,540 new cases expected in 2014 o Causes of cancer o Cancer arises from malfunctions in genes that control cell growth and division o External and internal factors impact risk of genetic mutations o External factor could be exposure to radiation o Internal factors would be inherited genetic mutations o BRCA1 and BRCA2 o Inherited mutations among different races/ethnicities like prostate cancer risk in African American men

4. o Approximately 13.7 million Americans with a history of cancer were alive on Jan 1, 2012 o Anyone can develop cancer o Risk increases with age o 77% of all cancers diagnosed in people ≥55 years of age

5. o Lifetime risk o Relative risk

6. o Incident rates o Risk of new cases among population at risk o Important for cancer epidemiology.

12. o Who has cancer right now out of everyone in the population o Includes people who are living with cancer o Incidence and survival impact specific cancer prevalence.

13. MalesFemales Prostate - 2,975,970 (43%)Breast - 3,131,440 (41%) Colon & rectum - 621,430 (9%)Uterine corpus - 624,890 (8%) Melanoma - 516,570 (8%)Colon & rectum - 624,340 (8%) Urinary bladder - 455,520 (7%)Melanoma - 528,860 (7%) Non-Hodgkin lymphoma - 297,820 (4%)Thyroid - 470,020 (6%) Testis - 244,110 (4%)Non-Hodgkin lymphoma - 272,000 (4%) Kidney - 229,790 (3%)Cervix - 244,180 (3%) Lung and bronchus - 196,580 (3%)Lung and bronchus - 233,510 (3%) Oral cavity and pharynx - 194,140 (3%)Ovary - 199,900 (3%) Leukemia - 177,940 (3%)Kidney - 159,280 (2%)

14. o In 2014, about 585,720 Americans are expected to die of cancer o Cancer is second most common cause of cancer death in the US

16. o Can be expressed as numbers o I, II, III, IV o Can be expressed as description of disease spread o Localized, regional, distant o Lower number or more localized = better chances of benefiting from treatment o Tracking the rates of late-stage (distant) cancers is a good way to monitor the impact of cancer screening. o When more cancers are detected in early stages, fewer should be detected in late stages.

18. o 5-year relative survival rate for all cancers diagnosed between 2003 and 2009 is 68% o Was 49% in 1975-1977 o What leads to improvements in cancer survival? o Progress in diagnosing cancers at an earlier stage o Improvements in treatment o Survival varies by cancer type and stage of diagnosis o How is survival measured? o Relative survival – compare survival among cancer patients to people not diagnosed with cancer with same age, race, and sex o Usually examined 5 years after diagnosis o Can look at survival by year at diagnosis o Can look at survival by years since diagnosis

21. o What are non-modifiable risk factors of cancer? o Age o Cancer specific factors o Inherited genetic mutations o BRCA 1 and BRCA2 o What are modifiable risk factors of cancer? o Modifiable risk factors for cancer in general. o Exercise o Diet o Specific examples o Lung cancer and smoking

22. o Finding cancer at an earlier stage when it is easier to treat o Why is early detection important? o Reduces cancer mortality o Can sometimes prevent cancer and decrease cancer incidence o National recommendations are made by US Preventive Services Task Force o Critical review of the literature on each screening test o Consider the evidence for efficacy/effectiveness as well as potential harms of screening o Strict criteria on study designs of evidence that is considered o USPSTF guidelines set precedent for what screening tests are covered by Medicare/private insurance

27. o Other organizations also put out screening guidelines. o Don’t always match with USPSTF o What difficulties could this cause? USPSTFAmerican Cancer Society

28. o What is a cancer health disparity? o Different types of groups can be used to identify/examine cancer health disparities o Socioeconomic status o Geographic region o Race/ethnicity o Gender o Causes of health disparities o Complex interaction of many factors o Social o Cultural o Economic o Environmental o Health care-related

29. o People with lower SES have disproportionately higher cancer death rates than those with higher SES, regardless of demographic factors such as race/ethnicity. o For example, cancer mortality rates for African American and non-Hispanic white men with ≤ high school education is ~ 3 times higher than those with a college degree. o Why might this be? o People with lower SES have increased risk of getting cancer and worse outcomes once diagnosed o But really, why?

30. o What are we really looking at when we compare cancer rates be different racial groups? o Genetic factors? o Social factors? o Behavioral factors? o Reflection of obstacles to receiving healthcare services including cancer prevention, early detection and good quality cancer treatment o Poverty o Percent living below the poverty line o 28% African Americans o 25% Hispanics o 10% non-Hispanic whites o Discrimination o Cultural/inherited factors

31. o Look for differences in o Incidence o Late stage-diagnosis o Mortality o Survival

40. o Definition varies o Survivor from time of diagnosis? o Survivor after completing treatment? o Survivor after surviving 5 years after treatment? o ~ 14.5 million adult or childhood cancer survivors in the US on Jan 1, 2014 o ~ 19 million estimated for 2024

41. o Monitoring after completion of cancer treatment o Late-effects o Long-term effects o Evidence-based guidelines for post-treatment care exist o National Comprehensive Care Network (NCCN) o American Society of Clinical Oncology (ASCO) o Provider responsible for follow-up is not explicitly stated o Specialist vs. primary care follow-up care o Specialist is traditional source of care o Breast cancer: Two RCTs of oncology vs. primary care follow-up showed similar outcomes

42. o Existing research on who breast cancer survivors see for their care post-treatment is limited o Only include early stage breast cancer o Only examined follow-up care until 5 years after treatment completion o Patient populations not representative of US o Use of registry, claims, or medical records data o One study assessed patients’ perception of the provider responsible for their follow-up care 4 years after diagnosis (N=844) o No previous studies have examined the patterns of physician follow-up among a large population of U.S. breast cancer survivors of varying survival time

43. Wiseman, KP (2015)

46. o How would you learn about cancer research priorities?

47. o Building on cancer genomics discoveries o Immunotherapy o Preventing childhood cancers o Developing therapies for RAS-driven cancers o New strategies for cancer prevention