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Cancer in Brooklyn:. A brief look at who gets cancer, who survives and what we can do to make this better. The American Cancer Society 17 Eastern Parkway, 5 th Floor Brooklyn, NY 11238 Hope, progress, answers… and determined to save lives. Brooklyn!.

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Cancer in brooklyn

Cancer in Brooklyn:

A brief look at who gets cancer,

who survives

and what we can do to make this better

The American Cancer Society

17 Eastern Parkway, 5th Floor

Brooklyn, NY 11238

Hope, progress, answers… and determined to save lives


Brooklyn
Brooklyn!

  • Largest borough: 2.6 million residents

  • 23% of us have no health insurance

    - 105,000 eligible but not enrolled

  • 53% of us are female

    • Average age: 36.5

  • 47% of us are male

    • Average age: 32.7 years

  • (Estimated US Census data for 2008)


Understanding cancer in brooklyn

10,258 people diagnosed every year

About 200 people a week

 Over half from four cancers:

Prostate cancer (14.6%)

Breast cancer (13.8%)

Colon cancer (12.4%)

Lung cancer (11.1%)

Understanding cancer in Brooklyn

(54.5%)


Understanding cancer in brooklyn1

4,100 people die every year from cancer

 Just over half from four cancers:

Lung cancer (22.4%)

Colon cancer (12.2%)

Breast cancer ( 9.9%)

Prostate cancer ( 6.1%)

Understanding cancer in Brooklyn

(50.7%)


Understanding cancer in brooklyn2

Most common

cancers:

Prostate cancer

Breast cancer

Colon cancer

Lung cancer

Most common causes of cancer death:

Lung cancer

Colon cancer

Breast cancer

Prostate cancer

Understanding cancer in Brooklyn

This data is true for all white, black and Latino residents of Brooklyn.


Understanding cancer in brooklyn3

Biggest risk factors for getting cancer?

#1 Getting older

#2 Smoking

#3 Caucasian/white background

#4 Lack of physical exercise, obesity

Understanding cancer in Brooklyn

  • The highest rates of cancer are in neighborhoods with a high percentage of older white residents and high smoking rates.

  • E.g., Bay Ridge & Bensonhurst

  • E.g., East Asian communities


Understanding cancer in brooklyn4

In Brooklyn, our overall cancer burden is lower because:

- We are younger (32-36 average age)

Many of us do not smoke, especially recent immigrants

Between 1991 to 2005 – cancer rates actually decreased in Brooklyn!

This is true of all four major cancers, prostate, breast, colon and lung, in all population groups.

Understanding cancer in Brooklyn


Understanding cancer in brooklyn5

It is really good great that smoking rates are falling, esp. among our youth.

Note: Young Americans of African descent are at risk for starting to smoke in their 20’s

However, by 2020, the #1 cause of cancer in the US will be obesity.

And researchers worry that cancer rates may start going up again because we are eating too much and not exercising enough.

Understanding cancer in Brooklyn


Understanding cancer in brooklyn6

Biggest risk factors for dying of cancer? among our youth.

Lack of health insurance

DOUBLES your chance of dying from cancer

Late stage of detection

Once cancer has already spread, it’s much harder to successfully treat

Smoking

Hard to find cancers, increases chance of cancer coming back

African descent, black

Understanding cancer in Brooklyn


Understanding cancer in brooklyn7

In the country with the highest screening rates in the world,

people of African descent have the highest cancer mortality rates in the world.

Understanding cancer in Brooklyn


Looking at cancer disparities in brooklyn
Looking at cancer disparities in Brooklyn world,

  • In Brooklyn:

  • Men of African descent have 3 times (300%) the chance of dying from prostate cancer as their white neighbors

  • Women of African descent have a 22% greater chance of dying from breast cancer

  • In colon cancer, the rate is quite similar, and whites have a 7% higher chance of dying of lung cancer.


Understanding cancer disparities in brooklyn
Understanding cancer disparities in Brooklyn world,

  • In Brooklyn:

  • Women of African descent have higher rates of cervical cancer and cervical cancer death, and

  • Higher rates of uterine cancer and uterine cancer death than white women.

  • Like colon cancer, these two cancers are generally considered to be either almost fully preventable or fully treatable.


How do we understand cancer disparities
How do we understand cancer disparities? world,

  • Cancer is often – increasingly – successfully treated or even cured if the cancer is found early and quality treatment is available. Key words:

    • Found early

    • Quality treatment

    • Cure

  • These are difficult for people without health insurance. That’s why lack of health insurance is so serious for anyone with cancer.


How do we understand cancer disparities1
How do we understand cancer disparities? world,

  • In Brooklyn, breast cancer disparities are largely from:

  • - lack of health insurance and

  • - lower rates of regular screening among

  • elderly women and women of color.

  • Mammograms find breast cancers 2 years before clinical breast exams, and 3-6 years before self-exam. They are the single best way to avoid dying from breast cancer.


How do we understand cancer disparities2
How do we understand cancer disparities? world,

For example, from 2002-2006, in New York City, 60% of breast cancer cases were found early.

In Brooklyn, breast cancer was found early in:

- 59.2% of whites,

- 55.2% of Latinas,

- 50.1 % of black women

NYS DOH phone surveys confirm that unlike in the rest of the United States, in Brooklyn fewer women of African descent are getting regular mammograms than white women!


How do we understand cancer disparities3
How do we understand cancer disparities? world,

  • Brooklyn has some of the lowest rates of mammography among women over 65 in the country.

  • Medicare reports these numbers every year, and we average about 39%.

  • Half of all breast cancer deaths in Brooklyn are among older women on Medicare. The lowest rates are among elderly black women.

  • Many of these cancer deaths are preventable.


How do we understand cancer disparities4
How do we understand cancer disparities? world,

  • PAUSE -

  • Lack of health insurance?

  • Difficulty getting a mammogram?

  • Please note that I have not brought up:

    • - Family history

    • - Genetics

  • Sometimes, genetics has a lot to do with cancer survival – but with most cancers, most of the time – very little.


How do we understand cancer disparities5
How do we understand cancer disparities? world,

  • Prostate cancer

  • Men of African descent have 3 times the chance of dying from prostate cancer as white men in Brooklyn.

  • Let’s look at stage of detection. In Brooklyn (2002-2006), early stage prostate cancer was found in:

    • - Whites 86.2%

    • - Blacks 87.6%

    • - Latinos 84.6%


How do we understand cancer disparities6
How do we understand cancer disparities? world,

  • Prostate cancer disparities are believed to be complex (but much research is on-going):

    • Longer time to follow-up after screening

    • Suboptimal treatment

    • Possibly: genetics

    • Possibly: compounded by other health problems

    • Absolutely: not understood entirely.


How do we understand cancer disparities7
How do we understand cancer disparities? world,

- Real differences in access to respectful regular primary care

- Real differences in receipt of timely care

- Real differences in receipt of high-quality cancer care

A recent comprehensive review found … substantial differences in receipt of optimal treatment, including definitive primary therapy, adjuvant therapy, conservative surgery, and follow-up after potentially curative treatment.

Shavers VI, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. JNCI 94(5): 334-357, 2002


What can we do
What can we do? world,

First – I think it’s really important to

Let people know that there are real differences in survival right now –

But there is NOTHING inevitable or biological about racial differences in cancer survival.

How do we know this?


Age-adjusted rate per 100,000 world,

Overall cancer mortality,

by race and ethnicity

300

Black

250

200

White

2010 Target

Hispanic

150

Asian

American Indian

100

0

1970

1950

1960

1980

2000

2003

1990

Note: Data are age adjusted to the 2000 standard population. American Indian includes Alaska Native. Asian includes Pacific Islander. Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.

SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

Obj. 3-1


What can we do about cancer disparities
What can we do about cancer disparities? world,

Organize!

In 1987, only 15% of American women got mammograms. By 1990, this had jumped to 40% or so. Most of these women were white.

Federal, state and local governments mobilized, American Cancer Society and other cancer organizations mobilized,

But most important of all, communities mobilized.

By 2000, black women had the highest rates of regular mammography in the US.


Age-adjusted rate per 100,000 world,

Female breast cancer mortality,

by race and ethnicity

45

40

White

35

30

Black

25

2010 Target

Hispanic

20

15

Asian

10

American Indian

5

0

2000

1995

2003

1970

1950

1960

1980

1990

Note: Data are age adjusted to the 2000 standard population. American Indian includes Alaska Native. Asian includes Pacific Islander. Persons of Hispanic origin may be any race. Only one race category could be recorded. Recording more than one race was not an option.

SOURCE: National Vital Statistics System--Mortality, NCHS, CDC.

Obj. 3-3


What can we do about cancer disparities1
What can we do about cancer disparities? world,

Organize!

Support free screening programs

  • From 2003 - today, we have been able to offer free, high quality colon screening for uninsured New Yorkers in all five boroughs.

  • Community groups, the city DOHMH, NYC HHC and ACS formed a strong coalition to promote colon screening for everyone over 50

  • By 2008, racial disparities in who receives colon screening in New York City had all but disappeared!


What do we do about cancer disparities
What do we do about cancer disparities? world,

Organize!

But from the facts!

Cancer is:

  • NOT inevitable – there are proven steps we as individuals and as communities can start doing today to lower the burden of cancer in Brooklyn


What do we do about cancer disparities1
What do we do about cancer disparities? world,

Organize! But from the facts!

  • MOST of the time, cancer is NOT a death sentence. In the US, 70% of cancer patients do not die from cancer.

    In Brooklyn, 60% of cancer patients do not die from their cancer – but let’s make it 70% or better!


What can we do about cancer disparities2
What can we do about cancer disparities? world,

Organize!

But from the facts!

3. Timely, quality treatment matters.

In 3 months, cancer can spread. If everyone with a positive mammogram or prostate test started high quality treatment within a month of their test, we could save a whole lot of lives in Brooklyn!


What can we do about cancer disparities3
What can we do about cancer disparities? world,

Organize!

But from the facts!

4. Pap smears, mammograms and regular care save lives. Our elders need support, information and love to get cancer checkups and early treatment for uterine cancer. If we help them, we can save lives!


What can we do about cancer disparities4
What can we do about cancer disparities? world,

One of the most powerful roles that community groups and individuals can play is to publicly support screening and anti-smoking efforts,

and get the truth out – cancer does not need to be killing so many of us. Support second opinions, support peoples’ choices to go for quality (and sometimes aggressive) treatment, support the cancer patients in your community!


What can we do about cancer disparities5
What can we do about cancer disparities? world,

One of the most powerful roles that community groups can do is learn about cancer, and -

get the truth out – cancer does not need to be killing so many of us.

Support second opinions, support peoples’ choices to go for quality (and sometimes aggressive) treatment, support the cancer patients in your communities!


What can we do about cancer disparities6
What can we do about cancer disparities? world,

ACS programs in Brooklyn:

16 trained volunteer and patient Navigators in local hospitals

Free breast, cervical, colon and prostate screening, follow-up tests and access to Medicaid for uninsured cancer patients

Speakers bureau

Relay for Life & Making Strides: joyous occasions to celebrate survivors and families

Advocacy for a new health care system and better laws to protect patients


The American Cancer Society is that nation’s largest voluntary health organization.

  • Since 1913, we have worked in multiple ways on many fronts – to eliminate cancer.

  • In 2000, we committed to work for the following goals to be achieved in the US by 2015:

    • Decrease the incidence of cancer by 25%

    • Decrease cancer mortality by 50%

    • Significantly improve the quality of life of cancer patients and their families

    • End cancer disparities.


Thank you
Thank you! voluntary health organization.

Please call anytime – we’re here to help:

1-800-ACS-2345

www.cancer.org

Sally Cooper

American Cancer Society

17 Eastern Parkway, 5th Floor

Brooklyn 11239

718-622-2492, x5121 or 800-ACS-2345


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