C. Brooke Steele

Surveillance for Health Behaviors of American Indians and Alaska Natives—Findings From the Behavioral Risk Factor Surveillance System, 2000-2006

The authors compared estimates for cancer risk factors, use of cancer screening tests, health status indicators, and access to care for American Indians and Alaska Natives (AI/ANs) and non‐Hispanic whites (NHWs) in the US and for AI/ANs in 6 Indian Health Service regions.

Mammography Adherence: A Qualitative Study

BACKGROUND Regular mammography accounts for half of the recent declines in breast cancer mortality. Mammography use declined significantly in 2008. Given the success of regular breast cancer screening, understanding why mammography use decreased is important. We undertook a focus group study to explore reasons women who were previously adherent with regular mammography no longer were screened. METHODS We conducted 20 focus groups with white non-Hispanic, black non-Hispanic, Hispanic, Japanese American, and American Indian/Alaska Native women, and segmented the groups by age, race/ethnicity, and health insurance status. A conceptual framework, based on existing research, informed the development of the focus group guide. Discussion topics included previous mammography experiences, perceptions of personal breast cancer risk, barriers to mammography, and risks and benefits associated with undergoing mammography. Atlas.ti was used to facilitate data analysis. RESULTS All focus groups (n=128 women) were completed in 2009 in five cities across the United States. Half of the groups were held with white non-Hispanic women and the remainder with other racial/ethnic groups. Major barriers to routine mammography included (1) concerns about test efficacy, (2) personal concerns about the procedure, (3) access to screening services, (4) psychosocial issues, and (5) cultural factors. For uninsured women, lack of health insurance was the primary barrier to mammography. CONCLUSIONS Multilevel interventions at the health-care provider and system levels are needed to address barriers women experience to undergoing regular mammography screening. Ultimately, breast cancer screening with mammography is an individual behavior; therefore, individual behavioral change strategies will continue to be needed.

Health behaviors and cancer screening among Californians with a family history of cancer

Purpose:The purpose of this study was to compare health behaviors and cancer screening among Californians with and without a family history of cancer.Methods:We analyzed data from the 2005 California Health Interview Survey to ascertain cancer screening test use and to estimate the prevalence of health behaviors that may reduce the risk of cancer. We used logistic regression to control for demographic factors and health-care access.Results:Women with a family history of breast or ovarian cancer were more likely to be up to date with mammography as compared with women with no family history of cancer (odds ratio = 1.69, 95% confidence interval (1.39, 2.04)); their health behaviors were similar to other women. Men and women with a family history of colorectal cancer were more likely to be up to date with colorectal cancer screening as compared with individuals with no family history of cancer (odds ratio = 2.77, 95% confidence interval (2.20, 3.49)) but were less likely to have a body mass index <25 kg/m2 (odds ratio = 0.80, 95% confidence interval (0.67, 0.94)).Conclusion:Innovative methods are needed to encourage those with a moderate-to-strong familial risk for breast cancer and colorectal cancer to increase their physical activity levels, strive to maintain a healthy weight, quit smoking, and reduce alcohol use.Genet Med 2013:15(3):212–221

Differences in Non-Hodgkin Lymphoma Survival Between Young Adults and Children

OBJECTIVE To examine differences in non-Hodgkin lymphoma (NHL) survival between young adults and children/adolescents. DESIGN Survival analysis using 13 Surveillance, Epidemiology, and End Results registries. SETTING Cancer survival information from population-based cancer registries from 1992 through 2001. PARTICIPANTS A total of 2442 cases of NHL among children/adolescents (aged 0-19 years) and young adults (aged 20-29 years). MAIN EXPOSURE Differences in NHL survival between young adults and children. MAIN OUTCOME MEASURES Comparison of 5-year survival by constructing Kaplan-Meier survival curves and modeling 5-year survival with multivariate Cox proportional hazards. RESULTS Young adults were more likely to die compared with children/adolescents (hazard ratio = 2.06; 95% confidence interval, 1.65-2.56) even after accounting for NHL subtype and stage at diagnosis. Persons diagnosed with stage III disease (hazard ratio = 1.71; 95% confidence interval, 1.20-2.46) and stage IV disease (hazard ratio = 3.19; 95% confidence interval, 2.47-4.13) were more likely to die compared with persons diagnosed with stage I disease. CONCLUSIONS Being a young adult at diagnosis and having a higher stage of disease at diagnosis were associated with higher risk of death from NHL. Increasing survival with NHL is dependent on receiving appropriate cancer therapy. Therefore, efforts to address survival should include improving enrollment in clinical trials as well as increasing access to care.

Rationale and design of the National Program of Cancer Registries' breast, colon, and prostate cancer patterns of care study

AbstractBackground: Investigators from the Centers for Disease Control and Prevention (CDC), National Program of Cancer Registries (NPCR), are collaborating with public health professionals from seven states and the District of Columbia to conduct the Patterns of Care study to assess the quality of cancer data and to determine whether stage-specific treatments are being carried out. Methods: To assess the quality and completeness of cancer care data in the United States, trained staff from the Patterns of Care study are abstracting medical records to obtain detailed clinical data on treatment, tumor characteristics, stage at diagnosis, and demographics of representative samples of patients diagnosed with breast, colon, and prostate cancer. Altogether staff from each of the eight participating cancer registries will abstract 500 cases of breast, prostate, and colon/rectum/anus cancer for the CONCORD study and an additional 150 cases of localized breast cancer, 100 cases of stage III colon cancer, and 100 cases of localized prostate cancer for the Patterns of Care study. Chi-square tests will be used to compare routine registry data with re-abstracted data. The investigators will use logistic regression techniques to describe the characteristics of patients with localized breast and prostate cancer and stage III colon cancer. Age, race, sex, type of insurance, and comorbidity will be examined as predictors of the use of those treatments that are consistent with consensus guidelines. The investigators plan to use data from the CONCORD study to determine whether treatment factors are the reason for the reported differences between relative survival rates in the United States and Europe. Conclusions Results from the methodology used in the Patterns of Care study will provide, for the first time, detailed information about the quality and completeness of stage and treatment data that are routinely collected by states participating in the NPCR. It will add significantly to our understanding of factors that determine receipt of treatment in compliance with established guidelines. As part of the CONCORD study, it will also examine differences in survival among cancer patients with breast, prostate, and colon/rectum/anus cancers in the United States and Europe.

Urban/rural patterns in receipt of treatment for non-small cell lung cancer among black and white Medicare beneficiaries, 2000-2003.

BACKGROUND Receipt of treatment for lung cancer varies by a number of demographic factors, including race/ethnicity and urban/rural residence. We examined urban/rural patterns in receipt of treatment for non-mall cell lung cancer (NSCLC) (ie, surgery, chemotherapy, radiation therapy) among black and white Medicare beneficiaries in Alabama. METHODS After linking Alabama State Cancer Registry data with state Medicare data, we identified 3481 cases of stages I to IV and unknown-stage NSCLC diagnosed from 2000-2002 and obtained their treatment data for 1999-2003. We used bivariate and multivariate analyses to examine racial and urban/rural differences in receipt of treatment. Significant bivariate associations were tested using chi2 tests. RESULTS Among beneficiaries with resectable NSCLC (ie, stages I-IIIA), urban whites were more likely to undergo surgical resection than urban blacks (49.3% vs 33.0%, respectively), and more rural whites than rural blacks (49.8% vs 23.9%, respectively) underwent surgery. There was less variation by race and urban/rural residence in the receipt of chemotherapy and radiation therapy. After controlling for age at diagnosis, gender, stage at diagnosis, comorbidity score, and socioeconomic status, the racial disparity for surgery remained. Black beneficiaries in urban counties had 45% lower odds of undergoing surgery than urban white beneficiaries (OR, 0.55; 95% CI, 0.31-0.96), and those in rural counties had 67% lower odds of receiving this treatment than their white counterparts (OR, 0.33; 95% CI, 0.19-0.57). CONCLUSIONS Differences in receipt of surgery exist for both urban and rural black Alabamians with NSCLC. Future studies should explore access to care and perceptions about treatment among lung cancer patients in this state.

Targeting children through school-based education and policy strategies: Comprehensive cancer control activities in melanoma prevention

BACKGROUND Primary school-based educational strategies are proven interventions to raise childrens awareness and knowledge about sun safety. OBJECTIVE We highlight barriers and facilitators to implementing interventions across multiple populations in 3 state comprehensive cancer control programs/partnerships that implemented primary school-based sun-safety educational programs. METHODS Using a case study approach, we collected semistructured program information and evaluation results from New Mexicos Raising Awareness in Youth about Sun Safety Project, the Sun Protection in Florida Project, and the Arizona SunWise Program. RESULTS Each program used different strategies for implementing school-based educational programs in their respective state based on local needs, funding constraints, and unique characteristics of their populations. Barriers to implementation included difficulties reaching schools and school administrators and changes in staff workload. Facilitators to implementation included using innovative recruitment approaches (mini grants, school assemblies), having community partners, reaching out to educators in various settings, and having program advocates within schools. Each program placed emphasis on supplementing educational programs with sun-safety policies. LIMITATIONS We only present a case study from 3 comprehensive cancer control programs/partnerships. Rigorous evaluation methods are needed to test the effectiveness of the various strategies that were used to implement these programs on a population-based level. CONCLUSION Partnerships and program advocates are important for successfully implementing and sustaining sun-safety programs. Innovative strategies for reaching school administrators are likely needed to effectively implement sun-safety programs and policies. School policy and environmental change are important and valued components of sun-safety programs.

Use of Evidence-Based Practices and Resources Among Comprehensive Cancer Control Programs.

CONTEXT While efforts to promote use of evidence-based practices (EBPs) for cancer control have increased, questions remain whether this will result in widespread adoption of EBPs (eg, Guide to Community Preventive Services interventions) by comprehensive cancer control (CCC) programs. OBJECTIVE To examine use of EBPs among CCC programs to develop cancer control plans and select interventions. DESIGN Conducted Web-based surveys of and telephone interviews with CCC program staff between March and July 2012. SETTING CCC programs funded by the Centers for Disease Control and Preventions National Comprehensive Cancer Control Program (NCCCP). PARTICIPANTS Sixty-one CCC program directors. MAIN OUTCOME MEASURES 1) Use of and knowledge/attitudes about EBPs and related resources and 2) EBP-related technical assistance needs. RESULTS Seventy-five percent of eligible program directors reported use of EBPs to a moderate or great extent to address program objectives. Benefits of using EBPS included their effectiveness has been proven, they are an efficient use of resources, and they lend credibility to an intervention. Challenges to using EBPs included resource limitations, lack of culturally appropriate interventions, and limited skills adapting EBPs for local use. Most respondents had heard of and used Web sites for The Guide to Community Preventive Services (95% and 91%, respectively) and Cancer Control P.L.A.N.E.T. (98% and 75%, respectively). Training needs included how to adapt an EBP and its materials for cultural appropriateness (state 78%, tribe 86%, territory 80%) and how to maintain the fidelity of an EBP (state 75%, tribe 86%, territory 60%). CONCLUSIONS While awareness, knowledge, and use of EBPs and related resources are high, respondents identified numerous challenges and training needs. The findings from this study may be used to enhance technical assistance provided to NCCCP grantees related to selecting and implementing EBPs.

Cancer Plan Index: a measure for assessing the quality of cancer plans.

OBJECTIVE To (1) conduct an in-depth assessment of the content of comprehensive cancer control plans and (2) obtain data that can be used to provide guidance to grantees supported by the Centers for Disease Control and Preventions National Comprehensive Cancer Control Program (NCCCP) as they refine their plans, and to other health professionals as similar planning is done. DESIGN Through an iterative development process, a workgroup of subject matter experts from NCCCP and Research Triangle Institute International (RTI International) identified 11 core or essential components that should be considered in cancer plans on the basis of their professional experience and expertise. They also developed a tool, the Cancer Plan Index (CPI), to assess the extent to which cancer plans addressed the 11 core components. SETTING Sixty-five comprehensive cancer control programs in states, tribes, territories, and jurisdictions funded by the NCCCP. DATA SOURCE Raters reviewed and abstracted all available cancer plans (n = 66), which included plans from 62 funded programs and 4 states of the Federated States of Micronesia funded by Centers for Disease Control and Prevention as a subcontractor of one funded program. Of the 66 plans, 3 plans were used to pilot test the CPI and the remaining 63 plans were subsequently reviewed and abstracted. MAIN OUTCOME MEASURE(S) The primary outcome measures are national-level component scores for 11 defined domains (global involvement of stakeholders, developing the plan, presentation of data on disease burden, goals, objectives, strategies, reduction of cancer disparities, implementation, funds for implementation of plan, evaluation, usability of plan), which represent an average of the component scores across all available cancer plans. RESULTS To aid in the interpretation and usability of findings, the components were segmented into 3 tiers, representing a range high (average score = 2.01-4.00), moderate (average score = 1.01-2.00), and low (average score = 0-1.00) levels of description of the component. Programs overall provided relatively comprehensive descriptions of goals, objectives, and strategies; moderate description of the plan development process, presentation of data on disease burden, and plans on the reduction of cancer disparities; and little to no description of stakeholder involvement plans for implementation, funds for implementation, and evaluation of the plan. CONCLUSIONS Areas of the CPI with low average component scores should stimulate technical assistance to the funded programs, either to increase program activities or to increase discussion of key activities in the plan.

Prostate cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study: US PCa Survival by Race and Stage

The 5‐year relative survival for prostate cancers diagnosed between 1990 and 1994 in the United States was very high (92%); however, survival in black males was 7% lower compared with white males. The authors updated these findings and examined survival by stage and race.