1. CDC’s Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Coordinating Center for Health Promotion Centers for Disease Control and Prevention Atlanta, Georgia

2. CDC-DCPC Mission The Division of Cancer Prevention and Control reduces the burden of cancer in the United States through cancer prevention and reduction of risk for cancer, through early detection of cancer, through better treatment, and by improving the quality of life for cancer survivors.

3. CDC-DCPC Background  Lead authority for all cancer matters within CDC  Priority topics (funding): Cancer registries Comprehensive cancer control Survivorship and end-of-life Colorectal, prostate, breast, cervical, ovarian, skin, hematologic, and gynecologic cancers

4. DCPC Focus: Public Health Action  Cancer surveillance  Education for health care providers and the public  Screening and early detection  Risk reduction  Access to care  Survivorship and end of life care  Reduction in health disparities  Comprehensive cancer control  Genomics  Dissemination science for cancer

5. National Breast and Cervical Cancer Early Detection Program  Provides breast and cervical cancer screening & diagnosis to poor, uninsured women  Screening support in all 50 states, the District of Columbia, 4 US territories, and 13 American Indian/Alaska Native organizations  Services include Clinical breast examination Mammograms Pap tests Diagnostic testing for women with abnormal results Surgical consultation Referrals to treatment

6. Interagency Agreement with IHS  Through an agreement in place for over 15 years, CDC provides direct technical assistance and consultation to the tribes and tribal organizations funded through the National Breast & Cervical Cancer Early Detection Program (NBCCEDP) and the National Comprehensive Cancer Control Program (NCCCP). Ongoing program activities include the following: 1.Facilitate and enhance collaborative relationships and partnerships. 2.Monitor the progress of all states in developing plans that specifically address outreach to AI/AN women for breast and cervical cancer screening.

7. Interagency Agreement with IHS Ongoing program activities continued… 3.Identify a national organization or organizations (i.e. the National Indian Health Board) with which DCPC can establish collaborative relations to address cancer-related outreach, service delivery, and policy issues. 4.Participate in annual conferences, meetings and workshops with Indian organizations and AI/AN people. 5.Coordinate efforts with state cancer registries, IHS, and tribal data systems to build infrastructure needed for surveillance and evaluation of the impact of cancer prevention and control initiatives.

8. Cancer Occurrence in AI/AN populations  Annual Report to the Nation on the Status of Cancer, 1975- 2004, Featuring Cancer in American Indians and Alaska Natives, JNCI (forthcoming)  Special monograph (12 manuscripts) supplement in Cancer (2008)  Applied research with the Indian Health Service and local partners to address disparities in CRC mortality among Alaska Natives

9. Record Linkage between NPCR Program Registries and IHS Administrative Records Graph with smaller scale for lower 20 NPCR Program registries

10. 10 The National Comprehensive Cancer Control Program Sharon Sharpe, Assistant Chief Comprehensive Cancer Control Branch

12. CCCB Mission Statement COMPREHENSIVE CANCER CONTROL: CCCB Mission Statement To provide unsurpassed programmatic, scientific, and financial support to States, Tribes, Tribal Organizations, and US Territories to advance the principles of comprehensive cancer control to reduce the cancer burden.To provide unsurpassed programmatic, scientific, and financial support to States, Tribes, Tribal Organizations, and US Territories to advance the principles of comprehensive cancer control to reduce the cancer burden.

13. Definition COMPREHENSIVE CANCER CONTROL: Definition Comprehensive Cancer Control is a collaborative process through which a community pools resources to reduce the burden of cancer that results in Risk reduction Risk reduction Early detection Early detection Better treatment Better treatment Enhanced survivorship Enhanced survivorship

14. AI/AN CCC Workgroup for the National Partners COMPREHENSIVE CANCER CONTROL: AI/AN CCC Workgroup for the National Partners Formulated in early 2006 Comprised of seven members all of American Indian or Alaska Native heritage. Major emphasis was on participating in the National Partner Leadership Institute Initiatives to establish ongoing positive communication and collaborative processes, between Tribes, States, and Urban Health Centers/Clinics for CCC programming. The workgroup created a workplan/action plan for long term inclusion of the AI/AN constituency in the National CCC arena. A representative from the AI/AN Workgroup will participate in the National Partner’s planning process to develop a five year CCC action plan.

15. 2000 NCCCP Status of Cancer Plans

16. CA ID NM TX OK NE SD ND MN WI IL OH KY VA NC GA AL MS LA MI PA NY CT MA VT NH ME TN SC OR NV MT WY CO UT IA MO AR KS IN WV FL NJ Updating or Creating New Plan Current Plan OR Northwest Portland Area Indian Health Board South Puget Intertribal Planning Agency Cherokee Nation Fond Du Lac Reservation Aberdeen Area Tribal Chairmen’s Health Board AK Alaska Native Tribal Health Consortium HI National Comprehensive Cancer Control Program Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Coordinating Center for Health Promotion January 2008 MD DE RI DC WA AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS PUERTO RICO REPUBLIC OF THE MARSHALL ISLANDS REPUBLIC OF PALAU U.S. VIRGIN ISLANDS AZ Tohono O’Odham Nation 2008 NCCCP Status of Cancer Plans

17. Scope of National Comprehensive Cancer Control Program COMPREHENSIVE CANCER CONTROL: Scope of National Comprehensive Cancer Control Program As of October 2006As of October 2006 –54 CCC plans completed and being put into action –64 CCC programs funded –50-600 members in each coalition

18. Planning Component:  The “Planning” component of this initiative supports the development of model comprehensive state cancer control plans and descriptive evaluation of comprehensive cancer control planning. Comprehensive Cancer Control Planning Component

19. Implementation Component:  The “Implementation” component is designed to provide startup and operational support to states/tribes/tribal organizations and territories with existing, up to date comprehensive cancer control plans CDC CCC Program Components Implementation Component

20. CDC Comprehensive Cancer Control Program Operationalizing CCC involves: A systematic data- and science-based planning processA systematic data- and science-based planning process A broad-based and active coalition of stakeholders collaborating in meaningful waysA broad-based and active coalition of stakeholders collaborating in meaningful ways A public health, “whole person” approach to service deliveryA public health, “whole person” approach to service delivery A strong focus on infrastructure developmentA strong focus on infrastructure development A long-term view of costs and benefits.A long-term view of costs and benefits.

21. PotentialGains from Declining Mortality COMPREHENSIVE CANCER CONTROL: Potential Gains from Declining Mortality From 1970 to 2000, gains in life expectancy added $3.2 trillion per year to national wealthFrom 1970 to 2000, gains in life expectancy added $3.2 trillion per year to national wealth –½ gains due to progress against heart disease Modest progress against major diseases extremely valuableModest progress against major diseases extremely valuable –Prospectively, 1% reduction in mortality from cancer worth nearly $500 billion to current and future Americans –Cure for cancer worth about $50 trillion Source: Murphy KM, Topel RH. The Value of Health and Longevity; Jouranl of Politcal Economy, 2006, (114); 871-903

22. Tohono O’Odham Nation Agreement # U55-CCU000840 Vicky D’Alfonso, Program Consultant Comprehensive Cancer Control Branch Management Office

23. Tohono O’Odham Nation Agreement # U55-CCU000840 Through FOA #DP07-703, Tohono O’Odham Nation was selected for funding as a planning program to begin their development of a Comprehensive Cancer Prevention & Control Plan. The Tohono O’Odham Nation will use this plan to reduce the cancer burden for its tribal members, as well as enhance the quality of life of cancer victims and their families.

24. Tohono O’Odham Nation Agreement # U55-CCU000840 The program is in its first year of funding - $120,484. The project period is 6/30/2007 – 6/29/2008. Multiple partners will join together as a Cancer Planning Committee (CPC) to pursue a collaborative planning process. The CPC will consist of the following partners: – Tohono O’Odham Department of Health & Human Services (TODHHS), –Tucson Area Indian Health Service, –Arizona Comprehensive Cancer Control Program, –Tribal leaders, community members, cancer survivors, and cancer co-survivors, –Southwest American Indian Collaborative Network/Inter Tribal Council of Arizona, –Arizona Cancer Center, and – University of Arizona Mel and Enid Zuckerman College of Public Health.

25. The first CPC meeting was held January 8, 2008. The CPC has set up (3) sub-committees who will be working on setting goals. The next CPC meeting is scheduled for January 30, 2008. Program Director: Christina Andrews CCC Project Coordinators: Jane Latane’ & Teresa Wall NCCCB Assistant Branch Chief: Sharon Sharpe NCCCP Program Consultant: Vicky D’Alfonso Tohono O’Odham Nation Agreement # U55-CCU000840

26. The age-adjusted incidence rates for the Tohono O’odham Reservation for a five- year period between 1996-2000 show five types of cancers (brain, cervical, leukemia, multiple myeloma, prostate) are higher than the incidence rate for the State of Arizona. Recent strategic planning during 2005 has identified new health concerns for capacity building and cancer is one of these. Tohono O’Odham Nation Agreement # U55-CCU000840

27. Based on the successful experience addressing other public health issues, a good planning and assessment process is needed as the foundation for comprehensive cancer services. TODHHS participated in the Arizona Department of Health Services Comprehensive Cancer Control Plan process in 2005 and has continued to participate in implementation activities. Tohono O’Odham Nation Agreement # U55-CCU000840

28. This planning grant will fulfill the following six goals: (1) Coordination - Foster coordination and integration among cancer programs that serve Tohono O’odham tribal members in the form of a Cancer Planning Committee (CPC) in order to develop a comprehensive plan for cancer prevention and control. (2) Prevention - Plan to increase the capacity to provide broad community education and outreach for those cancers with known means of prevention through lifestyle change. (3) Early Detection - Plan how to maximize community acceptance and timely utilization of available cancer screening to increase the likelihood of early diagnosis and treatment. Tohono O’Odham Nation Agreement # CCU000840

29. Goals continued: (4) Diagnosis & Treatment - Plan how to increase access to appropriate & effective diagnosis and treatment services. (5) End of Life Care - Plan how to improve the quality of life for tribal members whose live are shortened by cancer. (6) Survivorship - Plan how to improve support available to cancer survivors and their family members as co-survivors. Tohono O’Odham Nation Agreement # U55-CCU000840

30. We’re not there yet… We’re not there yet… In Ensuring Quality Cancer Care, the National Cancer Policy Board of the Institute of Medicine identified a gap between practice and the quality care that could be provided to cancer patients, and estimated that by 2015, if proven methods to change risky behaviors and increase screening were implemented in communities, the nation would see a 19% decline in the rate at which new cancer cases occur and a 29% decline in the rate of cancer deaths. CDC Comprehensive Cancer Control Program

31. National Comprehensive Cancer Control Program For more information, please contact: Vicky D’Alfonso, Program Consultant, DCPC/CCCB Phone: (770) 488-4243 Email: VCD3@cdc.govVCD3@cdc.gov Annie Fair, Tribal Liaison, DCPC Phone: (602) 263-1200, ext. 1351 Email: ggv3@cdc.govggv3@cdc.gov Phoenix Indian Medical Center 4212 N. 16th Street Phoenix, AZ 85016