Cancer Control

The Cancer Control tookit is available from: http://www.newhealth.govt.nz/toolkits/cancercontrol.htm

Here are links to resources on Cancer Control

• New Zealand
• Maori and Pacific
• International
• NZ Links and other resources
  

New Zealand

• The Hype over Herceptin - WHA paper June 2006
• Cervical Cancer Audit report findings - WHU January 2005
• From Cartwright to Gisborne and Back Again: Making Sense of Cervical Screening in Aotearoa/ New Zealand, Suzanne Phibbs, Women's Studies journal, Aut 2000; 16(1):77-93
  Provides a historically based, systemic analysis of cervical screening in NZ. Examines 4 elements, the historical legacy of the Cartwright Inquiry, the National Cervical Screening Programme (NCSP), the Bethsheba Cytology Classification System ad the National Cervical Screening Register, as examples of attempts to construct standardised networks that will ensure certainty in a field of uncertainty. Suggests that the Gisborne inquiry illustrates how attempts to implement standards across sites and/or practices do not remove local discretion and variability.
  Available from Women's Studies Journal here
• Alice, Lynne (with Women's Cancer group) (1997). Songs of Strength:16 women talk about cancer. Sydney: Pan Macmillan.
• Alice, Lynne. (1997.). Women Experiencing Cancer: a collaborative community based research project. April, 1997., Postgraduate Students Medical Society Seminar Series., Palmerston North Public Hospital.
• Alice, Lynne. (1997.). (Seminar paper.). Hot Property 3: Cancer is/as spectacle, an analysis of illness as art. Report on a collaborative research project.. Feminist Scholarship Seminar Series., April, 1997., University of Canterbury..
• Bimler, D.//Kirkland, J. (2000). Career quest research, phase 1. Career Services:
• J. Rigby, B. Wheeler & K. Mason (2003) Variations in the uptake of cervical and breast screening services. Report prepared for the Ministry of Health Fishbone Project, May 2003.
  There are two major services in New Zealand, offering cervical and breast screening programmes. This work explores the rates of participation in those services according to age, ethnicity and geographical area of residence.
  

Maori and Pacific

• J. Rigby, B. Wheeler & K. Mason Ethnic variations in screening uptake across New Zealand. Presentation at 10th International Symposium in Medical Geography, University of Manchester, Manchester, England, 14th to 18th July, 2003.

International

• Lung Cancer Risk Higher in Women Smokers but Survival Better
  Women who smoke appear more susceptible to tobacco carcinogens than men, but women's lung-cancer death rate is lower, according to researchers. http://www.cwhn.ca/hot/research/default.html#dawnLung
  
• The OHSU Cancer Institute is pleased to announce Oregon's first Cancer Disparity Conference 'Comprehensive Approaches to Cancer Control - Reducing Disparities through Collaboration'. March 3-4th, 2006, Oregon, USA
  The conference is co-sponsored by the Centers for Disease Control and Prevention, Susan G Komen Foundation Oregon and SW Washington Affiliate, Oregon Partnership for Cancer Control, and Astra Zeneca International.
  The overarching goal of the conference is to convene community, health professionals and researchers to have a meaningful outcome based dialog on overcoming issues of cancer disparity in underserved communities. Specific conference goals are to: Educate attendees about the comprehensive cancer control model; Understand and address cancer disparities in Oregon; Create sustainable collaborative partnerships within the cancer continuum.
  The long term outcomes will focus on:
  
  • Increasing breast and cervical cancer screening in the high-risk and never been screened populations
  • Reducing tobacco use among youth
  • Increasing cancer prevention research collaborations
    Detailed information and Online Registration is available at http://www.ohsucancer.com/
• Vaccines against cervical cancer, Kathrin U Jansen, Expert Opinion on Biological Therapy, 1 November 2004, vol. 4, no. 11, pp. 1803-1809(7), Ashley Publications
  Cervical cancer and precancerous lesions of the genital tract are a major threat to women’s health worldwide. Although the introduction of screening tests to detect cervical cancer and its precursor lesions has reduced overall cervical cancer rates in the developed world, the approach was largely unsuccessful for developing countries, primarily due to a lack of appropriate infrastructures and high costs. Annually, 470,000 cervical cancer cases are diagnosed worldwide, of which 80% occur in developing countries. Despite advances in treatment of cervical cancer, approximately half of the women afflicted with the disease will die. Over 20 years of dedicated research has provided conclusive evidence that a subset of human papillomaviruses are the aetiological agents for cervical cancer. Finding a viral origin for this disease provided the basis to fight cervical cancer using prophylactic or therapeutic vaccination. Both vaccine approaches are reviewed here, with an emphasis on recent clinical data.
• Colorectal Cancer Screening Disparities Related to Obesity and Gender; Allison B. Rosen; Eric C. Schneider; Journal of General Internal Medicine, April 2004, vol. 19, no. 4, pp. 332-338(7) 
• 4th Cancer Culture and Literacy Institute
  The Cancer, Culture and Literacy Institute is a series of educational activities that examine the nexus of culture and literacy relating to effective communications and research. This NCI funded program includes a five-day hands-on intensive learning experience in Tampa, Florida, January 8-13, 2005, as well as monthly continuing educational modules delivered via the Web, and mentoring experiences with nationally recognized scholars involved in this area of scientific inquiry. A yearlong commitment is expected where participants apply new knowledge in their research activities. Tuition, transportation, lodging, meals and resources are provided to participants during the five-day program. Doctorally prepared investigators (PhD, DrPH, MD, DNS, ScD or equivalent) wishing to enrich their perspectives on culture and literacy in the conceptualization and design of cancer control/population science research should apply. Deadline for receipt of application: September 20, 2004, 5:00 pm EST.For more information about the Institute and eligibility requirements call (813) 745-6031, E-mail Dr. Cathy Meade cdmeade@moffitt.usf.edu or visit our Website at http://www.moffitt.usf.edu/Education/ccl_institute/index.asp
  
• "Coming Out About Lesbians and Cancer" is the research report from the Lesbians and Breast Cancer Project.
  "There's actually a title that says, Lesbians and Cancer - I could not believe it when I saw that those two words actually existed in the same sentence. I mean seriously, that's the first time I've ever seen it, you know." ~ Sarah (research participant)
  The report [in summary form, and now as the full 100+ page document] is available for download from the DAWN Ontario website, http://dawn.thot.net/lbcp (in either HTML, PDF and/or WORD format) Paper copies of the summary report are available free of charge from Willow Breast Cancer Support & Resource Services. Toll-free: 1-888-778-3100; in Toronto: 416 778-5000; TTY: 416 778-4082; Email: info@willow.org
• Attitudes about genetic testing for breast cancer susceptibility: A survey of general practitioners, medical students and women in the northern region of New Zealand Linda D Cameron, Jeanne Reeve, Anne Readings and Ingrid Winship, New Zealand Family Physician, Aug 2002; 29(4):234-239
  Assesses attitudes towards testing for genetic risk for breast cancer. Distributes an anonymous survey to randomly-selected GPs and samples of medical students, women attending GPs, and survivors of breast cancer and their first degree relatives. Available in .pdf format here.
• Cancer Screening in New Zealand New Ethics Journal, Nov 2003; 6(11):15-26, Journal Article.
  Addresses the question of whether NZ should proceed with more cancer screening as technology permits. Highlights the prerequisites of a screening programme and identifies the 4 ways in which screening practices can fail. Clarifies terms relating to screening, including sensitivity, specificity, lead-time and positive predictive value. Discusses the national cervical and breast screening programmes and their performances to date. Considers the viability of colorectal and prostate cancer screening, and screening for other cancer sites.
• Lung Cancer Risk May be Higher in Female Smokers February 5, 2004 (Reuters Health)
• Journal of the National Cancer Institute, Vol. 95, No. 19, 1431-1433, October 1, 2003
  Report Examines Association Between Cancer and Socioeconomic Status Tom Reynolds
• A service of the Intercultural Cancer Council. The American Cancer Society has released Cancer Facts & Figures for Hispanics/Latinos 2003-2005. This publication summarizes recent information on cancer occurrence and cancer screening in the Hispanic/Latino population and estimates the number of new cancer cases and cancer deaths among Hispanic/Latinos for 2003. In addition, the publication includes sections on cancer risk factors for Hispanic/Latinos, such as tobacco use, physical activity, and the use of cancer screening examinations. To download this publication (500KB Adobe Acrobat file) see . . . http://www.cancer.org/downloads/STT/CAFF2003HispPWSecured.pdf
• The Cancer, Culture and Literacy Institute is a series of educational activities that examine the nexus of culture and literacy relating to effective communications and research. This NCI funded program includes a five-day hands-on intensive learning experience in Tampa, Florida, January 10-15, 2004, as well as monthly continuing educational modules delivered via the Web, and mentoring experiences with nationally recognized scholars involved in this area of scientific inquiry. A yearlong commitment is expected where participants apply new knowledge in their research activities. Tuition, transportation, lodging, meals and resources are provided to participants during the five-day program. Doctorally prepared investigators (PhD, DrPH, MD, DNS, ScD or equivalent) wishing to enrich their perspectives on culture and literacy in the conceptualization and design of cancer control/population science research should apply. Deadline for receipt of application: September 22, 2003, 5:00 pm EST. For more information about the Institute, application and eligibility requirements please visit our website at: http://www.moffitt.usf.edu/promotions/cclinstitute My apologies for any cross-posting. Thank you, Dina Martinez, MA, MPH Cancer, Culture and Literacy Institute Research Coordinator Dinorah (Dina) Martinez, M.A., M.P.H. Research Coordinator Education Program H. Lee Moffitt Cancer Center & Research Institute 12902 Magnolia Drive Tampa, FL 33612-9497 (813) 903-6812 FAX: (813) 632-1442 E-mail: martind@moffitt.usf.edu , website: http://www.moffitt.usf.edu
• Impact of cancer screening on women's health; Elovainio L.; Nieminen P.1; Miller A.B. International Journal of Gynecology and Obstetrics, July 1997, vol. 58, no. 1, pp. 137-147(11)
  Document available online and click on proceed
  Abstract: Worldwide, 31% of cancers in women are in the breast or uterine cervix. Prevention of cervical cancer is effective with the use of the cervical Pap smear test if applied in an organized and continuous fashion, including treatment of precancerous lesions. At best such programs have led to a 60% decrease in cervical cancer incidence and mortality in the Nordic countries. Early detection of breast cancer in a population based screening may lead to a 30% reduction of mortality from this disease in the screened population. Measures to guarantee high coverage and attendance, adequate field facilities, organized program for quality control and adequate facilities for diagnosis and treatment are prerequisites of successful programs. In absolute terms the contribution of screening to the total mortality reduction among middle-aged populations is small, much smaller than the potential gains from cancer prevention.
  

NZ Links and other resources

• New Zealand Cancer Control Strategy: On 5 December Health Minister Annette King released for consultation Towards a Cancer Control Strategy for New Zealand, a discussion document that will provide the basis for a New Zealand Cancer Control Strategy
• The New Zealand Cancer Control Strategy is the first phase in the development and implementation of a comprehensive and co-ordinated programme to control cancer in New Zealand. The strategy includes purposes, principles and goals to guide existing and future actions to control cancer. The next phase will involve identifying priorities for action, planning implementation and defining processes to manage, monitor and review implementation.
• Report of the 2003 Cancer Control Workshop A national workshop entitled From Policy to Action: Working Together to Implement the Cancer Control Strategy was held in Wellington on 30 September 2004. The workshop marked the transition from policy development to planning for the Strategy's implementation. It provided an opportunity for those with expertise and responsibility in various aspects of cancer control, to identify what was needed to ensure effective and ongoing implementation of the Strategy, and to contribute to the development of an implementation plan.
  Towards a Cancer Control Strategy for New Zealand will be distributed widely and will be posted on the Trust (www.cancercontrol.org.nz) and Ministry of Health (www.moh.govt.nz) websites. You can make written submissions or attend a consultation forum. These forums are likely to begin in early February and may continue until the end of March. All theseTrust publications are available from their website at: http://www.cancercontrol.org.nz/publications.php
• J. Rigby, B. Wheeler & K. Mason Ethnic variations in screening uptake across New Zealand. Presentation at 10th International Symposium in Medical Geography, University of Manchester, Manchester, England, 14th to 18th July, 2003.
• NZHTA Report   - The Early Detection and Diagnosis of Breast Cancer: A Literature Review — An Update (January 1999 Volume 2 Number 2).   [html] [word7] [248 KB)] [PDF]
• Cancer Genetics Laboratory
• Hugh Adam Cancer Epidemiology Unit
• Guidelines for the Surgical Management of Breast Cancer - go to : http://www.nzgg.org.nz/index.cfm and enter Breast Cancer into search option
  

From Women's Health Action publications

• Cartwright Inquiry
• Cartwright Inquiry Follow-up
  • Summary of findings and recommendations from Cartwright Report, WHA 1988
  • The Unfortunate Experiment: The full story behind the Inquiry into cervical cancer treatment, Penguin, 1988 - Excerpts
  • Reforms in patients' rights and health service restructuring: Obstacles to change, by Sandra Coney in Reproductive Health Matters No 6, November 1995
  • Out of the Frying Pan: Inflammatory writing 1972-89, Penguin Books, 1990 - excerpts
• Gisborne Inquiry
  • Gisborne Inquiry 2001 updates
  • Evidence given at the Gisborne Inquiry
  • Gisborne Inquiry article by Sandra Coney critiquing the report, Sunday-Star Times, February 2000
  • Otago Breast Screening Extenal Inquiry
• Breast Screening
• Cervical Screening
• Be part of cancer control strategy development - WHU Vol6 no4 January 2003
• HRT & Ovarian Cancer - WHW Sept 2002
• HRT & Gallbladder cancer - WHW Sept 2002
• NZ Cancer Control Strategy - WHW June 2002
• National cancer control strategy - WHU Oct 1999
• No increase in cancer for pill users - WHW Sept 1999
• Little evidence magnetic fields cause cancer - WHW Sept 1999
• Cancer survival related to socioeconomic class - WHW Jul 1999
• Cancer rates - Women - WHW April 1998
• Melanoma is third most common cancer in women - WHU Jan 1999
• Palliative chemotherapy - more harm than good? - WHW Dec 1998
  

Journal of the National Cancer Institute, Vol. 95, No. 19, 1431-1433, October 1, 2003

Report Examines Association Between Cancer and Socioeconomic Status Tom Reynolds
The National Cancer Institute has published its first monograph focusing on the effects of socioeconomic status on cancer.
Area Socioeconomic Variations in U.S. Cancer Incidence, Mortality, Stage, Treatment, and Survival, 1975-1999, published in July, is aimed at helping public health researchers and policy-makers track the nation's progress toward reducing the cancer burden and health disparities among the U.S. population.

"The impact of socioeconomic factors on cancer has been less well studied in the past than for other chronic diseases such as heart disease, diabetes, stroke, and respiratory conditions," noted Gopal Singh, Ph.D., the monograph's lead author. "And the association is a complex one."

Singh and colleagues examined incidence, mortality, stage at diagnosis, and survival for all cancers combined and for breast, cervical, colorectal, lung, and prostate cancers and melanoma. They also studied surgical treatment patterns in breast, lung, and prostate cancers. Mortality data are for the entire U.S. population, and other types of data were extracted from the 11 cancer registries that are part of NCI's Surveillance, Epidemiology, and End Results (SEER) program. They classified counties in a three-tiered system according to the proportion of inhabitants living in poverty. They also analyzed SEER data at the level of the census tract, an area containing about 4,000 residents and designed by the Census Bureau to be relatively homogeneous in socioeconomic status.

About 13% of the U.S. population lives in counties classified as high-poverty, with more than 20% of their population living below the poverty threshold, defined for the 1990 U.S. census as an annual income of $12,674 for a family of four. About 56% of the population lives in counties where between 10% and 20% of residents are below the poverty level (medium-poverty areas), and 31% of the population lives in counties with a poverty level of less than 10% (low-poverty areas).

In a time when U.S. health disparities are a subject of increasing concern, the report includes some troubling findings. In general, Singh said, high-poverty areas were characterized by later-stage diagnosis, poorer survival, and higher mortality rates.

"Even though we see a substantial decline in mortality over time in all [socioeconomic] groups, there is still a considerable gradient" where the poor have worse outcomes, he said. For all cancers combined in men, the mortality rate was 2% higher in high-poverty areas in 1975. But by 1999, the difference had risen to 13%. For women, all-cancer mortality was 3% lower in high-poverty areas than low-poverty areas in 1975, but 3% higher in high-poverty areas in 1999.

Singh said the findings probably reflect a lack of health insurance, lack of access to care, and lack of information about cancer detection and treatment among the poor.
"High-poverty areas have substantially lower rates of mammography and colorectal cancer screening," he said. Residents of high-poverty areas were also less likely to receive optimal surgical treatment for breast, prostate, and lung cancers.

"One thing that struck me was cervical cancer distribution by stage," added coauthor Barry Miller, Dr.P.H. "It's one of the cancers where we know screening is important to catch cases before they become lethal, and great strides have been made in an effort to get all women screened. Yet we still see a socioeconomic differential." While 59.6% of cervical cancer cases were diagnosed at the localized stage in low-poverty areas, the proportion falls to 52.3% in high-poverty areas.

Nancy Krieger, Ph.D., at the Harvard School of Public Health, studies socioeconomic position and disease, and has worked to develop methods of "geocoding" such as those used in the NCI study.

"It's remarkable, and disturbing, to have counties where more than 20% of the residents are below poverty level, and you can see the impact of that on adverse outcomes, particularly for mortality and survival for many cancer sites," Krieger said.

She added that the inclusion of longitudinal data on trends in the report is particularly useful. "One reason why this kind of monograph is so important is it allows us to see how [the impact of socioeconomic status on cancer] plays out over the long term-something you can't always see in a cross-sectional study.
" Because counties are a fairly large unit of analysis and may include substantial socioeconomic variation within them, Krieger said, "it's good to see they have some of the census-tract-level data as well" in the NCI study. Yet she said additional detailed analyses at the census tract level are needed. As a participant in the Department of Health and Human Services Cancer Disparities Health Review, Krieger has recommended that the nation's cancer registries include geocoding as a routine part of their monitoring.

Among other highlights of the report:

• Women in poor areas are less likely to be diagnosed with breast cancer than women in more affluent areas, with an 18% difference in incidence between high- and low-poverty areas for 1997-1999. Reproductive patterns, such as earlier childbearing, are believed to reduce risk among poorer women. But while women in poor areas also used to be less likely to die of breast cancer (15% lower mortality rate in 1976), their mortality rate has now surpassed that of women in wealthier areas (17% higher mortality for 1995-1997). "Breast cancer is simultaneously a disease of affluence and of poverty," Krieger said.
• For prostate cancer, incidence and mortality show socioeconomic gradients in opposite directions: incidence is higher, but mortality lower, in areas with less poverty. From 1975 through 1989, prostate cancer mortality did not vary much by area poverty rates. But since 1990, the authors wrote, "there has been a widening of the area socioeconomic gradient, with men in high-poverty counties in 1999 experiencing a 22% higher prostate cancer mortality than men in low-poverty counties." Singh said this may in part be a result of greater adoption of PSA screening among more affluent segments of the population during the 1990s. Among men in high-poverty areas, 9.1% of cases were diagnosed when they already had distant metastases; for men in low-poverty areas the number was 4.8% (See Stat Bite, p. 1432).
• Both lung and colorectal cancer rates seem to reflect the effects of changing patterns of consumption in American society. In the mid-20th century, cigarette smoking was more common among the affluent, while toward the century's end it became a habit more associated with lower socioeconomic status. Lung cancer mortality was 7% greater in high-poverty areas in 1975 and 25% greater in high-poverty areas in 1999. Similarly, diets among the poor may once have been healthier than affluent Americans' diets, particularly when meat was less affordable. Now, the poor are believed more likely to eat high-fat diets that increase risk for colorectal cancer. The colorectal cancer mortality rate for men in high-poverty areas in 1975 was 12% lower than in low-poverty areas, but by 1999 men in poorer areas had 5% higher mortality. * Risk for melanoma-and death from melanoma-increases with socioeconomic status. Incidence rates were 69% higher for men and 82% higher for women in low-poverty areas during 1997-1999. Mortality rates were 32% and 25% higher for men and women, respectively, in low-poverty counties in 1999. Singh said this might reflect the fact that lighter-skinned Americans (at higher skin cancer risk) are more likely to be affluent than their darker-skinned counterparts, and they may also have more opportunities to enjoy recreation in the sun.

The report is available on the NCI Website at http://seer.cancer.gov/publications/ses.