1. Regional Cancer Report Summary: Burlington, Camden and Gloucester Counties Jean F. Mouch, MD, MPH Hilary Dugger Colbert, MPA Camden County Coordinator Burlington County Coordinator

2. History of the NJCCCP In 2002, the Task Force on Cancer Prevention, Early Detection and Treatment in New Jersey released the New Jersey’s Comprehensive Cancer Control Plan (NJ-CCCP). This plan was put together by work groups made up of a variety of individuals and organizations dedicated to cancer control. The CDC defines Comprehensive Cancer Control as “an integrated and coordinated approach to reduce the incidence, morbidity and mortality of cancer through prevention, early detection, treatment, rehabilitation and palliation.” http://www.state.nj.us/health/ccp/ccc_plan.htm

3. NJCCCP, ACS & NJ CEED Cancer Priority Areas NJCCCPACSCEED 1. BREASTYYY 2. CERVICALYNOY 3. COLORECTALYYY 4. LUNGYYNO 5. MELANOMAYNO 6. ORAL/O-PYNO 7. PROSTATEYYY

4. Cancer Deaths in New Jersey by Race http://cancercontrolplanet.cancer.gov Source: http://cancercontrolplanet.cancer.govhttp://cancercontrolplanet.cancer.gov

5. Source: http://cancercontrolplanet.cancer.gov Burlington County Camden County Gloucester County Total for Region Total Cancer Deaths9181,140540 2598 White782966463 2211 Black12616356 345 Age Adjusted Cancer Death Rate per 100,000* Total217.9226.0217.6NA White213.0226.4214.4NA Black278.0250.8281.4NA Cancer as Cause of Death in 2000 for the Tri-County Region Actual Number and Age-Adjusted Death Rate per 100,000 Population in New Jersey for Region (including Burlington, Camden and Gloucester Counties) by Race Source: Community Health Status Profiles and State Profile http://www.state.nj.us/health/chs/county00.pdf#camhttp://www.state.nj.us/health/chs/county00.pdf#cam *Age adjusted rates are computed per 100,000 based on the 2000 standard population

6. Rates are per 100,000 age adjusted, Census 2000 Source: NJ Cancer Registry, August 2003 Burlington County Camden County Gloucester County New Jersey MaleFemaleMaleFemaleMaleFemaleMaleFemale White 634.5462.8616.3469.0572.9489.7624.2461.7 Black 765.2443.3737.3397.0793.8436.5697.7408.1 All Races 644.0456.9625.3456.4587.4479.6623.7449.4 Hisp-Ethnicity* 562.2547.3517.2364.2795.5**615.5**541.4359.1 * Hispanics may be of any race; therefore, the categories of race and ethnicity are not mutually exclusive. ** The Gloucester County Hispanic incidence rates are high and need to be studied. Cancer Incidence Rates for Tri-County Region and NJ Incidence Rates per 100,000 for All Cancer Sites and All Ages, for 1996-2000 in Tri-County Region and New Jersey by Race, Ethnicity, and Gender

7. Prostate CancerLung CancerColorectal Cancer Incidence Rate Regional / Distant Stage at diagnosis Death Rate Incidence Rate Death Rate Incidence Rate Regional / Distant Stage at diagnosis Death Rate Burlington County Total Men 193.811.9%35.694.675.876.754.3%31.2 White 175.412.2%33.0 94.374.7 76.853.7%30.6 Black 314.811.6%66.3 98.895.2 78.757.7%40.2 Hispanic 276.6 a17.7%*138.9 b*94.0 b88.9%* Camden County Total Men 172.012.3%33.6107.087.581.147.8%30.5 White 162.111.5%30.9 105.586.0 83.348.1%30.8 Black 242.714.6%59.8 123.199.9 75.448.5%33.1 Hispanic 206.213.5% 45.3 a 85.341.4 78.567.6% 30.4 a Gloucester County Total Men 161.113.5%29.4 117.295.3 85.247.1%28.3 White 147.413.1%26.1 117.195.3 88.146.8%28.0 Black 290.916.0%70.3 128.0105.2 60.550.0%* Hispanic 262.416.7%* 82.7* *33.3%* Top 3 Cancers for Men in Tri-County Region by Race/Ethnicity Summary of Men’s Cancer Rates: Incidence, Mortality and Staging for the Three Most Common Cancer Diagnoses in the Tri-County Region (1996-2000)

8. Top 3 Cancers for Women in Tri-County Region by Race/Ethnicity Summary of Women’s Cancer Rates: Incidence, Mortality and Staging for the Three Most Common Cancer Diagnoses in the Tri-County Region (1996-2000) Breast CancerLung CancerColorectal Cancer Incidence Rate %Regional or Distant Stage at diagnosis Death Rate Incidence Rate Death Rate Incidence Rate %Regional or Distant Stage at diagnosis Death Rate Burlington County Total Women141.727.3%29.359.445.253.955.7%21.4 White144.926.5%29.659.945.354.956.1%21.7 Black130.633.8%32.462.149.445.347.7%19.8 Hispanic137.832.3%*52.6*66.938.5%* Camden County Total Women128.029.3%34.660.147.559.952.2%19.7 White131.228.4%34.662.047.759.551.9%20.0 Black118.537.1%38.356.452.564.254.3%18.5 Hispanic89.228.8%a*44.713.771.562.8%13.7 Gloucester County Total Women137.124.6%27.066.248.859.748.2%25.6 White138.124.9%25.267.450.160.347.9%24.6 Black*25.5%*60.940.256.055.6%39.4 Hispanic*30.8%****0.0%*

9. Incidence Rates in Tri-County Region In most categories, the incidence rates for all 3 counties in the region exceed those of the state of NJ In some instances, such as cancer incidence in white males in Camden and Gloucester counties, the rate is lower than the state Higher rates for Hispanics in Gloucester County needs further study

10. Top Cancers in the Region Prostate is highest incidence cancer in the region followed by breast cancer in women, lung then colorectal cancer These 4 cancers represent 55.3% of all new cancer cases for women and 57.4% of all new cancer cases for men

11. Lung Cancer in New Jersey Lung and Bronchus cancers kill more people than the top three cancers of Prostate, Breast and Colorectal Cancers 87% of Lung and Bronchus Cancers are attributed to smoking Over 60% of Lung and Bronchus Cancers are detected in late stages of the disease In NJ, annual health care expenditures directly caused by tobacco use = $2.6 billion

12. Further cost savings… 1,000 kids kept from smoking: Decline of $12 million in future health care costs 1,000 adults prompted to quit: Decline of $8 million in further health care costs Under the age of 18, each year 20,100 young people in NJ begin to smoke Good News: Since 1999 with the Tobacco Control Program, 42% decrease in smoking among middle school students

13. Behavioral Risk Factor Surveillance Survey for 2003 at a Tri-County Regional Level with 1.2 Million population Looks at 5 issues of lifestyle and other behaviors Gender, race and age group data available at the regional level for adults, >18 years of age:  Fruit and vegetable intake of 5 or more servings daily – 26%  BMI Classification of Overweight (obese) – 21%  No leisure time physical activity – 26%  Not meeting moderate physical activity – 52%  Current smoking – 21%  Binge drinking within past 30 days – 18%

14. BRFSS – Cancer Screening Behaviors for 1.2 million population Tri-County Regional data is available for:  Mammograms within past 2 years (females 40 yrs +) = 70.8%  Pap Smear within past 2 years by age (females 18 yrs +) = 84%  Pap Smear within past 3 years by age (females 18 yrs +) = 87.7%  BST within past year or sigmoidoscopy ever for adults 50+ yrs old = 60.1% The question is raised: “Can we reach the Healthy New Jersey 2010 Targets for Cancer Screening?” e.g. Mammogram in past two years to reach 85% All women >40 e.g. Pap Smear within past 2 years to reach 90% All women >18

15. Survivorship – Living with Cancer U.S. study on those living with cancer since the SEER-CA-registry began 25 years ago 9.6 million men and women As of January 2000 – 5.3 million women and 4.2 million men

16. Estimated # of Persons Alive in U.S. with invasive cancer cases only http://seer.cancer.gov/faststats/html/inc_all.html

17. Discussion, Analysis, and Recommendations to form a common Tri-County Regional Approach  For County and Local Priorities  For Statewide Priorities  For Evidence-based Interventions

18. Recommendations for Tri-County Region and Local Priorities Concentrate on the top 4 Cancers – Prostate, Breast in women, Lung and Colorectal Cancers Follow the NJ-CCCP strategies for the Tri-County Region as far as possible Two principles of implementation: (1) all general awareness, education, and screening strategies reach out to adults who are >18, and all health care providers (2) primary prevention strategies provided for all school age children and youth

19. …continuing County and Local Priorities General Awareness and Education for NJCCCP via County Cancer Coalitions; support of ACS activities; provide presentations to major health care provider groups; work with the county health departments on their Community Health Improvement Plans Research Study on Primary Care Providers and Cancer Prevention, Screening, and Treatment Continue to strengthen coalition work for Cancer Plan at local levels e.g. directory of providers and other services e.g. support groups

20. http://www.state.nj.us/health/ccp/index.html Click on the map to locate cancer resources in a particular county.

21. Support the choice of Evidenced- based Interventions to address Tri-County Regional cancer problems Prevention of Cancer (1) Physical Activity / Weight Management (2) Smoking Cessation Programs –adult and youth (3) “Never start smoking” programs for children and youth (4) Fruits and Vegetables Cancer Screening programs e.g CEED (1) Minority groups - Black, Hispanic, and other minorities e.g. Vietnamese or Korean in largest municipalities in the Counties (2) Poverty areas – focus on the municipalities with >10% poverty rates in the Tri-County Region (3) Use the NCIS medically underserved populations information for programs, media, and outreach strategies

22. The Three Counties’ Cancer Coalitions focus on common media and events:  Multi-media campaigns with South Jersey County Cancer Coalitions that have proven themselves via research tested materials i.e. evidenced based campaigns  Websites for the three Counties and their Cancer Coalitions for greater collaboration  CEED be part of an event / education project to promote CEED program with primary care providers Promote and educate providers for Tri County CEED programs Phone Numbers Burlington County (609) 267-1950 ext.42881 Camden County Toll Free (888) VIRTUA-3 (Virtua Camden) (856) 968-7308 (Cooper Hospital) Gloucester County (856) 686-5036

23. Slogan for Healthy New Jersey 2010 100% ACCESS + 0% DISPARITIES

24. Resources for creating a county based Cancer Control Plan: http://cancercontrolplanet.cancer.gov National Cancer Institute http://www.state.nj.us/health/ccp NJ Office for Cancer Control and Prevention for copy of the NJCCCP http://seer.cancer.gov/faststats/html/inc_all.html US study on Prevalence of Cancer, 2000 Surveillance, Epidemiology and End Results Program covers 26% of the US Population. NJ CA Registry is part of the SEER database.