against the disease.
Former Vice President
Joe Biden led the
Biden needed to look
no further than his
home state, Delaware,
for an example of what
an effective colorectal
cancer screening initiative looks like. In 2001, then-Governor
Ruth Ann Minner established a task force to determine how
to combat high rates of cancer and cancer mortality in the
state. Two years later, a newly formed Delaware Cancer
Consortium—with appointed volunteers from private industry and government—devised a statewide colorectal cancer
screening and treatment program.
“We knew we couldn’t solve all the problems at once. So we
asked, ‘Can we pick a couple of problems to solve and show that
we can get things done so we can move on to new projects?’ ”
says Stephen Grubbs, an oncologist who served on the consortium and worked at Christiana Care’s Helen F. Graham Cancer
Center and Research Institute in Newark, Delaware.
The program offered provider reimbursement for colorectal
cancer screening and treatment for those who met income
eligibility requirements. The state also rolled out a campaign
to publicize screenings, and it hired nurse navigators to help
guide patients to screening services. The campaign also
provided outreach at churches and community centers to
raise awareness among African-Americans, who had lower
screening rates than whites.
The results were dramatic: In 2001, before the program started,
48 percent of blacks over 50 and 57 percent of the total population
over that age had received colorectal cancer screening. (For adults
at normal risk, 50 is the recommended age to begin screening.) In
2009, as a result of the program, screening in the state had jumped
to 74 percent for both blacks and whites over 50. In addition,
deaths linked to colorectal cancer had declined, especially among
African-Americans. In 2001, the colorectal cancer mortality rate
for blacks in Delaware was 31. 2 per 100,000. By 2009, that number
had dropped to 18 per 100,000, which was almost as low as the
rate among whites. (Rates among whites declined from 19. 5 to 16. 9
deaths per 100,000 from 2001 to 2009.)
“I challenge anybody to show me anywhere in medicine on
a statewide level that they eliminated a health care disparity,
but that’s what we did,” says Grubbs, who is now the director of
clinical affairs at the American Society of Clinical Oncology.
A COMPREHENSIVE PLAN
Cancer control planning falls on the shoulders of each state (as
well as the District of Columbia, tribes and tribal organizations,
territories and Pacific Island Jurisdictions), says Nikki Hayes,
who leads the National Comprehensive Cancer Control program
at the U.S. Centers for Disease Control and Prevention (CDC), the
federal agency that funds state cancer control efforts.
Tobacco control efforts have had successes and setbacks:
Jan. 11, 1964: The U.S. Surgeon General releases Smoking and
Health, which reviews more than 7,000 studies and conclusively
links smoking to lung cancer.
1965: Smoking incidence among adults is 42. 4 percent.
All cigarette packages are required to carry a health warning.
1967: Television and radio are required to donate free air time
for anti-smoking commercials to balance cigarette advertising.
1970: The federal government imposes a ban on cigarette
advertising on television and radio to take effect in 1971.
1975: The Minnesota Clean Indoor Air Act becomes the
first statewide law to require separate smoking areas in
1986: The Surgeon General’s report acknowledges the harmful
effects of secondhand smoke.
1987: Lung cancer surpasses breast cancer as the leading
cancer-related cause of death among U.S. women.
1994: California issues a statewide ban on smoking in restaurants,
offices, stores and other large workplaces. It is the first of its kind
in the U.S.
1997: Smoking incidence is 24. 7 percent among U.S. adults.
1998: Forty-six states sign the Master Settlement Agreement
with tobacco companies, under which the companies agree
to pay billions in annual payments to go toward efforts to
discourage youth smoking and promote public health.
2014: The average state tax for cigarettes is $1.69 a pack, with
New York topping the list at $4.35. E-cigarettes become the most
commonly used tobacco product among U.S. middle school and
high school students.
2015: The U.S. adult smoking rate is 15. 1 percent.
2016: Twenty-eight states and the District of Columbia have
prohibited smoking in workplaces, restaurants and bars. States
collect $25.8 billion from the Master Settlement Agreement and
taxes associated with tobacco products, though only 1. 8 percent
is spent on smoking prevention or cessation, according to the
Campaign for Tobacco-Free Kids.
THE EBB AND FLOW OF TOBACCO CONTROL