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Cancer and Effect on Companies

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Cancer and Effect on Companies

  1. 1. June 18-19, 2009 | Hyatt Regency Chicago Sponsored by
  2. 2. Otis W. Brawley, M.D.Otis W. Brawley, M.D. Chief Medical Officer Executive Vice President American Cancer SocietyAmerican Cancer Society Professor of Hematology, Oncology, Medicine and Epidemiology Emory University
  3. 3. 2009 Estimated US Cancer Deaths* ONS=Other nervous system. Source: American Cancer Society, 2009. Men 292,540 Women 269,800 26% Lung & bronchus 15% Breast 9% Colon & rectum 6% Pancreas 5% Ovary 4% Non-Hodgkin lymphoma 3% Leukemia 3% Uterine corpus 2% Liver & intrahepatic bile duct 2% Brain/ONS 25% All other sites Lung & bronchus 30% Prostate 9% Colon & rectum 9% Pancreas 6% Leukemia 4% Liver & intrahepatic 4% bile duct Esophagus 4% Urinary bladder 3% Non-Hodgkin 3% lymphoma Kidney & renal pelvis 3% All other sites 25%
  4. 4. US Mortality, 2006 *Includes nephrotic syndrome and nephrosis. Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 1. Heart Diseases 631,636 26.0 2. Cancer 559,888 23.1 3. Cerebrovascular diseases 137,119 5.7 4. Chronic lower respiratory diseases 124,583 5.1 5. Accidents (unintentional injuries) 121,599 5.0 6. Diabetes mellitus 72,449 3.0 7. Alzheimer disease 72,432 3.0 8. Influenza & pneumonia 56,326 2.3 9. Nephritis* 45,344 1.9 10. Septicemia 34,234 1.4 Rank Cause of Death No. of deaths % of all deaths
  5. 5. Change in US Death Rates* from 1991 to 2006 * Age-adjusted to 2000 US standard population. Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised. 2006 Mortality Data: US Mortality Data 2006, NCHS, Centers for Disease Control and Prevention, 2009. 17.8 63.3 34.8 313.0 215.1 43.6 180.7 200.2 0 100 200 300 400 Heart diseases Cerebrovascular diseases Influenza & pneumonia Cancer 1991 2006 Rate Per 100,000
  6. 6. Cancer Death Rates* by Sex US 1975-2005 *Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. 0 50 100 150 200 250 300 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 Men Both Sexes Rate Per 100,000 Women
  7. 7. Cancer Death Rates* Among Men, US 1930-2005 *Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. 0 20 40 60 80 100 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 Lung & bronchus Colon & rectum Stomach Rate Per 100,000 Prostate Pancreas LiverLeukemia
  8. 8. Cancer Death Rates* Among Women, US 1930-2005 *Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. 0 20 40 60 80 100 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 Lung & bronchus Colon & rectum Uterus Stomach Breast Ovary Pancreas Rate Per 100,000
  9. 9. 2009 Estimated US Cancer Cases* *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, 2009. Men 766,130 Women 713,220 27% Breast 14% Lung & bronchus 10% Colon & rectum 6% Uterine corpus 4% Non-Hodgkin lymphoma 4% Melanoma of skin 4% Thyroid 3% Kidney & renal pelvis 3% Ovary 3% Pancreas 22% All Other Sites Prostate 25% Lung & bronchus 15% Colon & rectum 10% Urinary bladder 7% Melanoma of skin 5% Non-Hodgkin5% lymphoma Kidney & renal pelvis 5% Leukemia 3% Oral cavity 3% Pancreas 3% All Other Sites 19%
  10. 10. Cancer Incidence Rates* by Sex US 1975-2005 *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008. 0 100 200 300 400 500 600 700 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 Both Sexes Men Women Rate Per 100,000
  11. 11. Cancer Incidence Rates* Among Men, US 1975-2005 0 50 100 150 200 250 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 Prostate Lung & bronchus Colon and rectum Urinary bladder Non-Hodgkin lymphoma Rate Per 100,000 Melanoma of the skin *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.
  12. 12. Cancer Incidence Rates* Among Women, US 1975-2005 *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008. 0 50 100 150 200 250 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 Colon and rectum Rate Per 100,000 Breast Lung & bronchus Uterine Corpus Ovary Non-Hodgkin lymphoma
  13. 13. Cancer Incidence & Death Rates* in Children 0-14 Years, 1975-2005 0 2 4 6 8 10 12 14 16 18 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 Incidence Mortality Rate Per 100,000 *Age-adjusted to the 2000 Standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.
  14. 14. Cancer Incidence Rates* in Children 0-14 Years by Sex, 2001-2005 *Per 100,000, age-adjusted to the 2000 US standard population. ONS = Other nervous system Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site Male Female Total All sites 16.1 14.1 15.1 Leukemia 5.4 4.5 5.0 Acute Lymphocytic 4.3 3.6 3.9 Brain/ONS 3.4 3.1 3.2 Soft tissue 1.1 1.0 1.1 Non-Hodgkin lymphoma 1.2 0.6 0.9 Kidney and renal pelvis 0.8 0.8 0.8 Bone and Joint 0.7 0.7 0.7 Hodgkin lymphoma 0.7 0.4 0.5
  15. 15. Cancer Death Rates* in Children 0-14 Years by Sex, US 2001-2005 *Per 100,000, age-adjusted to the 2000 US standard population. ONS = Other nervous system Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site Male Female Total All sites 2.7 2.3 2.5 Leukemia 0.8 0.7 0.8 Acute Lymphocytic 0.4 0.3 0.4 Brain/ONS 0.8 0.7 0.7 Non-Hodgkin lymphoma 0.1 0.1 0.1 Soft tissue 0.1 0.1 0.1 Bone and Joint 0.1 0.1 0.1 Kidney and Renal pelvis 0.1 0.1 0.1
  16. 16. Tobacco Use in the US, 1900-2005 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 1900 1905 1910 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 Year PerCapitaCigaretteConsumption 0 10 20 30 40 50 60 70 80 90 100 Age-AdjustedLungCancerDeathRates* *Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Data, 1960-2005, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. Cigarette consumption: US Department of Agriculture, 1900-2007. Per capita cigarette consumption Male lung cancer death rate Female lung cancer death rate
  17. 17. Current* Cigarette Smoking Prevalence (%) Among High School Students by Sex and Race/Ethnicity - US 1991-2007 *Smoked cigarettes on one or more of the 30 days preceding the survey. Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, 2003, 2005, 2007 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2008. 28 35 31 13 16 27 23 11 19 18 19 27 25 12 14 19 25 23 24 8 15 15 19 32 30 11 14 23 40 37 12 28 33 40 40 17 32 36 28 34 39 38 22 32 18 33 2726 0 10 20 30 40 50 White, non- Hispanic Female White, non- Hispanic Male African American, non- Hispanic Female African American, non- Hispanic Male Hispanic Female Hispanic Male Prevalence(%) 1991 1995 1997 1999 2001 2003 2005 2007
  18. 18. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape (2000, 2003, 2005, 2007), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2004, 2006, 2008. 24.2 24.4 24.1 24.4 23.6 24.3 24.7 0 5 10 15 20 25 30 35 1994 1996 1998 2000 2003 2005 2007 Year Prevalence(%) Trends in Consumption of Five or More Recommended Vegetable and Fruit Servings for Cancer Prevention, Adults 18 and Older, US, 1994-2007
  19. 19. Trends in Prevalence (%) of No Leisure-Time Physical Activity, by Educational Attainment Adults 18 and Older - US 1992-2007 Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for adults 25 and older. Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape (2000, 2002, 2004, 2005, 2006, 2007), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2003, 2005, 2006, 2007, 2008. 0 5 10 15 20 25 30 35 40 45 50 55 60 1992 1994 1996 1998 2000 2002 2003 2004 2005 2006 2007 Year Prevalence(%) Adults with less than a high school education All adults
  20. 20. Trends in Obesity* Prevalence (%) Children and Adolescents, by Age Group US 1971-2006 *Body mass index (BMI) at or above the sex-and age-specific 95th percentile BMI cutoff points from the 2000 sex-specific BMI-for-age CDC Growth Charts. Note: Previous editions of Cancer Statistics used the term “overweight” to describe youth in this BMI category. Source: National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2006: Ogden CL, et al. High Body Mass Index for Age among US Children and Adolescents, 2003-2006. JAMA 2008; 299 (20): 2401-05. 5 4 6 5 7 5 7 11 11 10 16 16 12 17 18 0 5 10 15 20 2 to 5 years 6 to 11 years 12 to 19 years Prevalence(%) NHANES I (1971-74) NHANES II (1976-80) NHANES III (1988-94) NHANES 1999-2002 NHANES 2003-2006
  21. 21. Trends in Obesity* Prevalence (%), By Gender Adults Aged 20 to 74, US, 1960-2006† *Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard population. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003- 2004, 2005-2006: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, 2005-2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007. 13 11 16 15 12 17 15 13 17 23 21 26 31 28 3433 32 3535 34 36 0 5 10 15 20 25 30 35 40 45 Both sexes Men Women Prevalence(%) NHES I (1960-62) NHANES I (1971-74) NHANES II (1976-80) NHANES III (1988-94) NHANES 1999-2002 NHANES 2003-2004 NHANES 2005-2006
  22. 22. Mammogram Prevalence (%), by Educational Attainment and Health Insurance Status Women 40 and Older, US, 1991-2006 *A mammogram within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data Tape (2000, 2002, 2004, 2006), National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007. 0 10 20 30 40 50 60 70 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2002 2004 2006 Year Prevalence(%) Women with less than a high school education Women with no health insurance All women 40 and older
  23. 23. Disparities in Health • The concept that some populations (however defined) do worse than others • Populations can be defined or categorized by race, culture, area of geographic origin, socioeconomic status
  24. 24. Disparities in Health • The concept that some populations (however defined) do worse than others • The measure can be incidence, mortality, survival, quality of life
  25. 25. All Sites – Cancer Mortality Rates 1973-2004 By Race, Males and Females 100 150 200 250 300 '75 '78 '81 '84 '87 '90 '93 '96 '99 '02 Year Rate Incidence and mortality rates per 100,000 and age-adjusted to 2000 US standard population SEER Cancer Statistics Review 1975-2004. African American Caucasian AI/AN Hispanic API
  26. 26. Disparities in Health • We need to approach this issue logically and rationally • We must focus on what we can change and not on what we cannot change • We must define social and logistical issues versus scientific issues.
  27. 27. My Concern • “Equal treatment yields equal outcome among equal patients” • There is not equal treatment • There is not enough concern about nor emphasis on the fact that there is not equal treatment
  28. 28. How can we provide adequate, high-quality care (to include preventive care) to a population that has so often not received it?
  29. 29. 0 5 10 15 20 25 30 35 40 45 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 Year Rateper100,000 African Americans Whites Hispanic/Latina American Indian/Alaska Native Asian American/Pacific Islander American Cancer Society, Surveillance Research, 2007 2004 Female Breast Cancer Death Rates by Race and Ethnicity, US, 1975-2004
  30. 30. Adjusted Breast Cancer Survival by Stages and Insurance Status, among Patients Diagnosed in 1999-2000 and Reported to the NCDB
  31. 31. Breast Cancer • It is estimated that 57,000 breast cancer deaths were averted between 1990 and 2005 due to screening, early detection, and aggressive treatment. • Breast cancer screening rates have actually gone down during the period 2000 to 2005
  32. 32. Breast Cancer Imagine a world in which… • Mammography rates were greater than 80% • All women with an abnormal screen got it evaluated • All women with breast cancer got optimal therapy
  33. 33. Screening Guidelines for the Early Detection of Colorectal Cancer and Adenomas, American Cancer Society 2008 • Beginning at age 50, men and women should follow one of the following examination schedules:  A flexible sigmoidoscopy (FSIG) every five years  A colonoscopy every ten years  A double-contrast barium enema every five years  A Computerized Tomographic (CT) colonography every five years  A guaiac-based fecal occult blood test (FOBT) or a fecal immunochemical test (FIT) every year  A stool DNA test (interval uncertain)  Tests that detect adenomatous polyps and cancer  Tests that primarily detect cancer People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule
  34. 34. 20 16 8 21 16 9 18 12 22 16 9 19 14 9 16 12 8 24 0 5 10 15 20 25 30 Total Less than a high school education No health insurance Prevalence(%) 1997 1999 2001 2002 2004 2006 Trends in Recent* Fecal Occult Blood Test Prevalence (%) by Educational Attainment and Health Insurance Status Adults 50 Years and Older, US 1997-2006 *A fecal occult blood test within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007.
  35. 35. 44 37 22 44 36 21 45 36 21 50 41 22 56 43 25 0 10 20 30 40 50 60 Total Less than a high school education No health insurance Prevalence(%) 1999 2001 2002 2004 2006 Trends in Recent* Flexible Sigmoidoscopy or Colonoscopy Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US 1997-2006 *A flexible sigmoidoscopy or colonoscopy within the past ten years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007.
  36. 36. U.S. Colorectal Cancer Mortality 1975-2005 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Rateper100,000 Blalck Male WhiteMale Black Female White Female
  37. 37. Adjusted Colorectal Cancer Survival by Stages and Insurance Status, among Patients Diagnosed in 1999- 2000 and Reported to the NCDB
  38. 38. Colorectal Cancer • It is estimated that 77,000 colorectal cancer deaths were averted between 1990 and 2005 due to screening, early detection, and aggressive treatment. • Colorectal cancer screening rates have actually gone down during the period 2000 to 2005
  39. 39. Colorectal Cancer Imagine a world in which… • Colorectal screening rates were greater than 80% • All men and women with an abnormal screen got it evaluated • All with colorectal cancer got optimal therapy
  40. 40. Sunburn* Prevalence (%) in the Past Year, Adults 18 and Older, US, 2004 46.4 36.3 22.5 24.0 18.4 5.7 5.8 26.3 0 5 10 15 20 25 30 35 40 45 50 Male Female Age-AdjustedPrevalence(%) White non- Hispanic Other Hispanic Black non- Hispanic *Reddening of any part of the skin for more than 12 hours. Note: The overall prevalence of sunburn among adult males is 46.4% and among females is 36.3%. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape , 2004. National Center for Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2005. Sunburn* Prevalence (%) in the Past Year, Adults 18 and Older, US 2004
  41. 41. Ultraviolet Radiation Exposure Behaviors* Prevalence (%), Adults 18 and Older, US, 2005 30 33 12 10 30 14 19 26 13 11 37 11 40 12 10 24 17 40 0 5 10 15 20 25 30 35 40 45 Apply sunscreen Seek the shade Wear a hat Wear long- sleeved shirt Wear long pants Used indoor tanning device† Prevalence(%) Total Male Female *Proportion of respondents reporting always or often practicing the particular sun protection behavior on any warm sunny day. †Used an indoor tanning device, including a sunbed, sunlamp, or tanning booth at least once, in the past 12 months. Source: National Health Interview Survey Public Use Data File 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
  42. 42. Cancer Survival and Deprivation in Scotland 5yr survival Affluent Deprived Breast 58% 48% Colon 40% 34% Lymphoma 58% 42% Prostate 45% 36% Bladder 70% 58% Melanoma 84% 69%
  43. 43. Survival Rates RMS Titanic Concept of Dr. Lisa Newman First Class 60% Second Class 43% Third Class 20%
  44. 44. How can we provide adequate, high-quality care (to include preventive care) to a population that has so often not received it?
  45. 45. Higher Per Capita Spending in the U.S. Does Not Translate into Longer Life Expectancy The Cost of a Long Life Life Expectancy – Per Capita Spending 2006 CIA FACTBOOK AverageLifeEx PerCapitaSp 74 75 76 77 78 79 80 81 82 J a p a n S a n M a rin o M o n a c o S w itz e rla n d A u s tra lia S w e d e nIc e la n d A n d o rra C a n a d aF ra n c e Ita lyA u s triaS p a inN o rw a y S in g a p o re Is ra e l L u x e m b o u rg N e w Z e a la n d N e th e rla n d s G e rm a n yG re e c e M a lta B e lg iu mF in la n d U n ite d K in g d o m D e n m a rk U n ite d S ta te s C u b aC y p ru sIre la n d P o rtu g a l 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 United States
  46. 46. The Economics of Healthcare • Healthcare is 17% of the nation’s Gross Domestic Product and growing • The country with the second greatest is Israel with 9.5% of its GDP devoted to healthcare • The U.S. spends more on healthcare than it spends on food and clothing
  47. 47. The Economics of Healthcare • The average Medicare costs per beneficiary nationwide in 2006 was $8,304 • New York City $9,564 • Honolulu $5,311 • Miami $16,351 • San Francisco $8,331 NY Times June 11, 2009
  48. 48. Disparities in Health • Some consume too much (unnecessary care given) • Some consume too little (necessary care not given) • We could decrease the waste and improve overall health!!
  49. 49. Disparities in Health There are dramatic geographical differences in use of a number of expensive screening technologies and therapies without evidence of difference in outcomes. •Prostate cancer screening and overtreatment •Lung cancer screening •Third and fourth-time chemotherapy of metastatic disease •Intensity Modulated Radiation Therapy in some cancers •Overuse of radiologic imaging
  50. 50. Faith-based versus Evidence-based Medicine • We in medicine have a tendency to adopt things before fully accessing their benefit or harm. • We also criticize those who question the benefit and some even praise/worship advocates with a monetary interest. • Bone marrow transplant for breast cancer • Lung cancer screening with chest X-ray • Neuroblastoma screening with urine VMA • The Halsted Mastectomy • Postmenopausal hormone replacement • Prostate cancer screening
  51. 51. Disparities in Health • A call for the use of “Evidence-Based Care” That is: The rational use of medicine not the rationing of medicine
  52. 52. We know WHAT to do, We just need to DO it!!
  53. 53. Sponsored by

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