Cancer in Brooklyn:

1
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
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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)

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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)

(54.5)
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Understanding cancer in Brooklyn

• ? 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)

(50.7)
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Understanding cancer in Brooklyn

• 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

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

• Biggest risk factors for getting cancer?
• 1 Getting older
• 2 Smoking
• 3 Caucasian/white background
• 4 Lack of physical exercise, obesity

• 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

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Understanding cancer in Brooklyn

• 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.

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Understanding cancer in Brooklyn

• 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 20s
• 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.

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Understanding cancer in Brooklyn

• Biggest risk factors for dying of cancer?
• Lack of health insurance
• DOUBLES your chance of dying from cancer
• Late stage of detection
• Once cancer has already spread, its much harder
  to successfully treat
• Smoking
• Hard to find cancers, increases chance of cancer
  coming back
• African descent, black

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Understanding cancer in Brooklyn

• In the country with the highest screening rates
  in the world,
• people of African descent have the highest cancer
  mortality rates in the world.

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Looking at cancer disparities in Brooklyn

• 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.

12
Understanding cancer disparities in Brooklyn

• 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.

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How do we understand cancer disparities?

• 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. Thats why lack of health insurance
  is so serious for anyone with cancer.

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How do we understand cancer disparities?

• 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.

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How do we understand cancer disparities?
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!
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How do we understand cancer disparities?

• 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.

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How do we understand cancer disparities?

• 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.

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How do we understand cancer disparities?

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

Lets 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
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How do we understand cancer disparities?

• 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.

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How do we understand cancer disparities?

• - 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

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What can we do?

• First I think its 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?

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Age-adjusted rate per 100,000
Overall cancer mortality, by race and ethnicity
300

Black
250
200
White
2010 Target
Hispanic
150
Asian
American Indian
100
0
1970
1960
1950
1980
2003
2000
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
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What can we do about cancer disparities?

• 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.

24
Age-adjusted rate per 100,000
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
2003
2000
1995
1970
1960
1950
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
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What can we do about cancer disparities?

• 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!

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What do we do about cancer disparities?

• 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

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What do we do about cancer disparities?

• 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 lets make it 70 or
  better!

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What can we do about cancer disparities?

• 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!

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What can we do about cancer disparities?

• 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!

30
What can we do about cancer disparities?

• 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!

31
What can we do about cancer disparities?

• 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!

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What can we do about cancer disparities?

• 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

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• The American Cancer Society is that nations
  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.

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Thank you!

• Please call anytime were 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