A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC

 
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
A Call to Action
North Carolina Comprehensive Cancer Control Plan
                              2014-2020
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
Preface
The North Carolina Comprehensive Cancer Control Plan
2014-2020: A Call to Action was developed by a large
and diverse group dedicated to saving lives and improving
the quality of life for North Carolinians affected by cancer.
The effort to reduce the cancer burden in North Carolina
will require a coordinated and collective effort of
communities, public and private organizations and
individuals. Representatives of the North Carolina
Advisory Committee on Cancer Coordination and Control;
North Carolina Cancer Partnership; North Carolina
Department of Health and Human Services; Division
of Public Health; Cancer Prevention and Control Branch
and many others interested in reducing the cancer
burden in North Carolina are listed in Appendix H.
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
Dear Fellow North Carolinians:

             We are pleased to share the North Carolina Comprehensive Cancer Control Plan 2014-2020: A Call to Action. Cancer has been
             the leading cause of death in North Carolina since 2009. We are all affected by cancer, and it has an enormous economic,
             physical and emotional impact on North Carolinians. The purpose of this Cancer Plan is to reduce the cancer burden in our state.

             This Cancer Plan is organized using the cancer continuum: prevention, early detection, care and treatment and focuses
             on six specific cancers: lung, colorectal, breast, prostate, cervical and melanoma. It does not have detailed cancer information,
             so comprehensive references are provided in the Appendices. An interdisciplinary collaboration of professionals from across
             the state designed this plan to provide a framework for cancer prevention and control.

             We hope that public health and healthcare agencies, community organizations and individuals across North Carolina will benefit
             from using this Cancer Plan as they work together to address cancer prevention and control. One part of the Plan entitled:
             “Everyone Has A Part to Play in the Fight Against Cancer” describes specific strategies for individuals, community organizations,
             schools, businesses, healthcare professionals and policy makers.

             We hope you find the Cancer Plan useful in your efforts to make a difference in the fight against cancer in North Carolina.

             Regards,

             Dr. Tom Shea, Chair                                                                Morgan Daven, Co-Chair

             North Carolina Advisory Committee
             on Cancer Coordination and Control
             5505 Six Forks Road Raleigh, NC 27609

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                                  i
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
Executive Summary
North Carolina Comprehensive Cancer Control Plan 2014-2020: A Call to Action (Cancer Plan) is a statewide blueprint for cancer
prevention and control in North Carolina. The Cancer Plan was developed through a collaboration of an interdisciplinary team
of individuals who devoted many hours to designing a plan that is specific to the particular needs of North Carolina. Cancer has been
the leading cause of death in North Carolina since 2009. As such, it has a huge psychological, social and economic effect on individuals
and the state.

The overarching purpose of the Cancer Plan is to reduce the morbidity and mortality associated with cancer in our state. There are
five goals that are designed to help achieve this. They are preventing new cancers, detecting cancer at its earliest stages, treating
all cancer patients with the most appropriate/effective therapy, enhancing the quality of life for every person affected by cancer
and reducing cancer-related disparities in North Carolina. The six specific cancers that are the focus of this Cancer Plan are lung,
colorectal, breast, prostate, melanoma and non-melanoma skin cancers and cervical cancer. In order to meet our goals, the Cancer Plan
has specific objectives and strategies to address the cancer continuum and the six specific cancers. It also describes evaluation strate-
gies to measure progress towards meeting our goals.

Prevention: The Cancer Plan focuses on behaviors, policies and environmental changes that can reduce North Carolinians’ cancer
risk. After describing the behaviors that place people at risk for cancer, the Cancer Plan provides guidance on ways to lower these risks
by adopting healthy behaviors and promoting environmental changes. Recommendations made are for both individuals and
organizations/systems.

Early Detection: The focus of early detection is on promoting and delivering cancer screenings based on the guidelines and
recommendations of the N.C. Advisory Committee on Cancer Coordination and Control. An emphasis in this area is on reaching
people most at risk and those with limited access to screenings.

Care and Treatment: The Cancer Plan provides guidance on ways to improve access to care, enhance care coordination and assure
quality treatment for all cancer patients and their families. It describes professional and public education strategies that will provide
information on patient navigation systems, cancer clinical trials and appropriate services for palliation and survivorship services.

Woven throughout this Cancer Plan are ways to address disparities in cancer among populations experiencing a disproportionate
burden of disease, disability and death. It is critically important that we reach underserved populations with cancer prevention, early
detection and treatment messages and services.

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                             iii
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
Everyone has a part in the fight against cancer. The grid on page 28 describes ways that individuals, community organizations,
 healthcare professionals and policy makers can help prevent, detect and treat cancer. It also suggests ways to advocate for policy
 changes that reduce the risks for cancer and promote good care for those with the disease.

 This Call to Action is designed to address the barriers to cancer prevention and care while outlining a plan of action. The action plan
 will be implemented by a diverse partnership of North Carolina cancer programs, organizations and individuals in order to assure North
 Carolinians timely and equitable access to healthcare throughout the cancer care continuum. We hope you find this a useful tool.

iv			               North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
Table of Contents
Introduction		                                                           1
North Carolina Cancer Burden		                                           5
      Unequal Burden in North Carolina                                   7
Access to Cancer Care		                                                  9
North Carolina Comprehensive Cancer Control Plan		                      11
  Cancer Risk and Protective Factors			                                 12
		      Poor Nutrition, Physical Inactivity, Overweight and Obesity		   13
		      Tobacco Use and Exposure to Secondhand Smoke		                  15
		Environmental Exposures		                                             17
		      Ultraviolet Radiation Exposures                                 18
		Viral Exposures		                                                     19
		Alcohol Use		                                                         19
  Cancer Prevention and Control Action Plan		                           20
		Cancer Prevention		                                                   21
		Early Detection		                                                     22
		      Cancer Care Continuum		                                         23
			Cancer Care		                                                        25
			Cancer Survivorship		                                                26
		      Everyone Has a Part in the Fight Against Cancer                 23
		      N.C. Priority Cancers		                                         32
			Lung Cancer                                                          33
			Colorectal Cancer		                                                  34
		              Breast Cancer 		                                        35
			Prostate Cancer		                                                    36
			Cervical Cancer		                                                    37
			Melanoma Skin Cancer		                                               38
		Cancer Surveillance		                                                 39
		      Cancer Plan Evaluation		                                        40

North Carolina Comprehensive Cancer Control Plan 2014-2020   		              v
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
Summary		                                                                                                                                              43
 References		                                                                                                                                           44

 Appendices
      Appendix A – North Carolina Cancer Prevention and Control Branch		                                                                                47
      Appendix B – Scientific Information Resources                                                                                                     48
      Appendix C – Commission on Cancer Accredited Hospital Information and Maps                                                                        50
      Appendix D – Body Mass Index Chart                                                                                                                58
      Appendix E – North Carolina Table of Measurements					                                                                                            59
      Appendix F – North Carolina Cancer Maps                                                                                                           61
      Appendix G – Glossary                                                                                                                             71
      Appendix H – North Carolina Cancer Plan Contributors                                                                                              74

vi			           North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
Introduction                                     together to address cancer prevention and
                                                         control.
                                                                                                       discussed. The Appendices contain
                                                                                                       detailed cancer information and
                                                                                                       resources. The Cancer Plan with
The 2014-2020 North Carolina                             The purpose of the Cancer Plan is to reduce   accompanying information and
Comprehensive Cancer Control Plan                        the cancer morbidity and mortality in North   a community brochure that can
(Cancer Plan) provides not only current                  Carolina. The overarching goals are           be copied and used locally, are
cancer information for North Carolina                    to prevent future cancers, detect cancer      available on the N.C. Division of
but also provides a framework for action                 at its earliest stages, treat all cancer      Public Health, Chronic Disease and
to reduce the effects of cancer. Cancer                  patients with the most appropriate and        Injury Section Web site located
is a complicated disease with many                       effective therapy, enhance the quality        at http://publichealth.nc.gov/
different signs and symptoms. Nearly                     of life for every person affected by cancer   chronicdiseaseandinjury.
everyone knows someone who has been                      and reduce cancer-related disparities
affected by cancer – a friend, family                    in North Carolina.                            History
member, coworker or neighbor. Maybe
                                                                                                       North Carolina’s commitment
you have had cancer or have been a                       Cancer Plan Organization                      to cancer prevention and control
caregiver for someone who has cancer.
                                                         The Cancer Plan is organized using the        dates back to 1945 when the
According to the North Carolina Central                  cancer continuum: prevention, early           leadership from the N.C. Medical
Cancer Registry 2011 data, approximately                 detection and care and treatment. It also     Society and the American
140 people in North Carolina are newly                   emphasizes six specific cancers:              Cancer Society (ACS) worked
diagnosed with cancer every day. Another                                                               with the North Carolina General
                                                             • the four most deadly cancers (lung,
50 people lose their lives daily to this                                                               Assembly to pass the Cancer
                                                               colorectal, breast and prostate),
disease.1                                                                                              Control Act of 1945. This
                                                             • the most common cancers                 legislation created the first Cancer
                                                               (melanoma and non-melanoma skin         Control Program in the nation
The Cancer Plan is not intended to provide
                                                               cancers) and                            and originally included funding
in-depth cancer information. This
information can be found in the resources                    • the cancer that can be prevented        to assist indigent cancer patients.
listed in the Appendices. Instead, it serves                   through vaccination and early
as a working guide to help public health                       detection: cervical cancer.             Legislation was passed in 1993
and healthcare groups, community                                                                       to create the N.C. Advisory
organizations, institutions, agencies and                The sections have information specific to     Committee on Cancer Coordination
individuals across North Carolina work                   North Carolina and the priority cancers       and Control (Advisory Committee)

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                               1
A Call to Action 2014-2020 - North Carolina Comprehensive Cancer Control Plan - CDC
and the N.C. Comprehensive Cancer            Evaluation, Surveillance and Research –                    Evaluation, Surveillance and Research
 Program, which is part of the Cancer         are listed below.                                          Subcommittee
 Prevention and Control Branch                                                                           This subcommittee conducts an
 in the Chronic Disease and Injury            Prevention Subcommittee                                    assessment of partners’ activities
 Section, Division of Public Health,          This subcommittee promotes healthy                         in meeting the goals and objectives
 N.C. Department of Health and                behaviors and environments that reduce                     related to the Cancer Plan. The
 Human Services.                              the risk of developing cancer. Topics                      subcommittee provides surveillance
                                              include nutrition and physical activity,                   in the monitoring and review of the data
 N.C. Advisory Committee                      tobacco prevention and control, ultraviolet                regarding the health of North Carolinians.
 on Cancer Coordination                       radiation exposure, chemoprevention and                    This subcommittee also assists with
                                              genetic testing.                                           research for position statements,
 and Control                                                                                             provides data for the Cancer Plan and
 The mission of the Advisory                  Early Detection Subcommittee                               assists with writing white papers.
 Committee is to facilitate the               This subcommittee works to expand the
 reduction of cancer incidence                appropriate use of proven cancer-related                   Legislation and Education
 and mortality in North Carolina              early detection methods and appropriate                    Subcommittee
 and to enhance access to quality             follow-up of abnormalities. Foci include                   This subcommittee recommends policies
 treatment and support services.              colorectal, breast, cervical, prostate, skin               on cancer-related issues. The
 It also recommends a coordinated,            and lung cancers.                                          subcommittee is made up of legislators and
 comprehensive cancer control                                                                            Advisory Committee members, with the
 plan to the Secretary of the N.C.            Care and Treatment Subcommittee                            Advisory Committee Co-Chair serving as an
 Department of Health and                     This subcommittee addresses a continuum                    ex-officio member.
 Human Services. There are five               of services from cancer diagnosis
 subcommittees made up of                     to treatment, care, survivorship and                       The subcommittees also may prepare
 members of the Advisory                      palliative care. Tasks of the Care                         position statements that are presented
 Committee, the N.C. Cancer                   Subcommittee include identifying and                       to the Advisory Committee.
 Partnership and the Cancer                   reducing financial, geographic and other
 Prevention and Control Branch.               barriers to cancer diagnosis, treatment and                The N.C. Cancer Prevention and Control
 The responsibilities of these                healthcare services as well as pain control,               Branch (Branch) provides staff for the
 subcommittees – Prevention; Early            patient navigation and survivorship.                       Advisory Committee. (See Appendix A
 Detection; Care and Treatment;                                                                          for Branch Information) The Branch
 Legislation and Education and

2			               North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
focuses on prevention, screening and early
detection, treatment and survivorship, as
well as education efforts. They emphasize
the importance of evidence-based
measures to ensure that effective programs
and policies are implemented to make
efficient use of limited resources.

N.C. Cancer Partnership
The N.C. Cancer Partnership, a larger
group of interested cancer survivors,
organizations, individuals and
professionals assists the Advisory
Committee with its work. All members
of the Advisory Committee, N.C. Cancer
Partnership and Branch will work toward
implementation of this Cancer Plan.

North Carolina Comprehensive Cancer Control Plan 2014-2020   		   3
Between 2008 and 2012, there were over

2008    89,500
            2012                 cancer
                               2008
                                 deaths.           2012
       Nearly
                18,412         of those deaths
                               occurred in 2012.
N.C. Cancer                                                                   Cancer Mortality and Incidence Rates
                                                                                                         50
        Burden and                                       Lung and Bronchus
                                                                                                              69                                    2012 Mortality Rate**
                                                                                            14
        2014-2020                                        Colon and Rectum                           38                                              2011 Incidence Rate**

        Priorities                                       Melanoma (Skin)              3
                                                                                               22

                                                         Breast (Female)*                     21
                                                                                                                                                    159
Cancer has been the leading cause of
death in North Carolina since 2009.1                     Prostate (Male)*                     21
                                                                                                                                              140
Between 2008 and 2012, there were over
                                                         Cervical (Female)*           2
89,500 cancer deaths. Nearly 18,412 of                                                 7
those deaths occurred in 2012.1 Nationally               *    Sex-specific rates cannot be compared to other cancer site rates because the denominators represent different
and in North Carolina, cancer is the leading                  populations.
cause of death among 45-64 year olds,                    **   Rate per 100,000 population; Age-adjusted to US census NC Central Cancer Registry. Statistics and Reports.
and the second leading cause of death
for people 65 and over.1,2 In 2010, the North            average of 8.2 years of life due to cancer.6                       in 2003 in women. From 2006
Carolina age-adjusted death rate for cancer,             (See Appendix F for a series of maps showing                       to 2010, rates decreased 2.9 percent
177.8 per 100,000, was higher than the 2010              cancer mortality and incidence rates by county)                    per year in men and 1.4 percent
national rate, 171.8 per 100,000.3 2010 is                                                                                  per year in women. This gender
the most recent national data.                           Priority Cancers                                                   difference in lung cancer deaths
                                                                                                                            reflects historical differences
                                                         Lung cancer has been the leading cause                             in patterns of smoking uptake and
Cancer has a huge economic effect
                                                         of cancer deaths in North Carolina for over                        cessation over the past 50 years.8
on individuals, the state and the nation.
                                                         two decades. Between 2008 and 2012, over
According to the National Institutes of
                                                         27,000 deaths were due to lung cancer                              Colorectal cancer was the second
Health (NIH), total cancer care cost the
                                                         in North Carolina. Of those, nearly 5,454                          leading cause of cancer deaths
United States an estimated $125 billion
                                                         lung cancer deaths occurred in 2012.1                              in North Carolina in 2012. There
in 2010.4 During the same period, the
                                                         According to the 2014 Surgeon General’s                            were 1,533 colorectal cancer deaths
average cost per cancer case in North
                                                         Report, 87 percent of lung cancer deaths                           in 2012 and over 7,550 deaths from
Carolina was $41,401.5 This total does
                                                         are preventable. Survival rates (20%)                              2008-2012 in North Carolina.1
not account for indirect costs due to lost
                                                         for lung cancers are poor.7                                        According to the 2012 Behavioral
productivity from illness and premature
death. It is estimated that in 2010 North                                                                                   Risk Factor Surveillance System
                                                         ACS reports that lung cancer death rates                           (BRFSS), 70.6 percent of North
Carolinians under the age of 75 lost an
                                                         began declining in 1991 in men and                                 Carolina adults over age 50

North Carolina Comprehensive Cancer Control Plan 2014-2020    		                                                                                                              5
report “ever having had a                     are no established guidelines for preventing               Cervical cancer (female only) was
 sigmoidoscopy or colonoscopy                  pancreatic cancer and no screening tests.                  responsible for about 0.6 percent of all
 screening for colorectal cancer.”9                                                                       cancer deaths in North Carolina in 2012.
 It is estimated that between 2007             Prostate cancer (male only) was the fifth                  There were 117 cervix uteri (cervical)
 and 2011, about 40 out of every 100           leading cause of cancer deaths among                       cancer deaths in 2012 and over 560 deaths
 deaths from late-stage colorectal             males in North Carolina in 2012. There                     from 2008-2012 in N.C.1 Cervical cancer
 cancer could have been prevented              were 844 prostate cancer deaths in 2012                    can be prevented by HPV vaccine and
 if all men and women aged 50 years            and over 4,350 deaths from 2008-2012 in                    detected through Pap test screening and
 or older were routinely screened.10           the state.1 Prostate cancer death rates                    the HPV test. If detected, early treatment
                                               have been decreasing since the early 1990s                 of pre-cancerous conditions can prevent
 Breast cancer (female only) was               in men of all races and ethnicities, although              cervical cancer. In 2012, 35.5 percent
 the third leading cause of cancer             they remain more than twice as high                        of girls and 8.6 percent of boys ages 13-17
 deaths among North Carolina                   in African Americans as in any other racial                in North Carolina completed three or more
 females in 2012. There were 1,286             or ethnic group.8 In 2012, 31.6 percent of                 doses of the HPV vaccine.11
 female breast cancer deaths                   men were told by a health professional
 in 2012 and over 6,350 deaths                 of the advantages and disadvantages of                     Melanoma skin cancer was responsible
 from 2008-2012.1 According to the             a Prostate-Specific Antigen (PSA) test, a                  for 72.8 percent of all North Carolina skin
 2012 BRFSS, 66.6 percent of North             blood test used to check men for prostate                  cancer deaths in 2010. There were 289
 Carolina women reported, “ever                cancer.9 Almost 60 percent (58.9 %) of men                 melanoma cancer deaths in 2012 and over
 having had a mammogram.”9                     in the same group stated they had “ever                    1,479 deaths from 2008-2012 in the state.
 Between 2007 and 2011, 95                     had a PSA test.”9                                          The rate of new melanoma diagnoses is
 percent of women in North Carolina                                                                       rising rapidly—with an average increase of
 diagnosed in the earliest stage               The two cancers discussed below are not                    more than five percent per year from 1995
 of breast cancer survived five years          in the top ten causes of cancer deaths                     to 2011.1
 compared to 34 percent diagnosed              in North Carolina but are important
 in the advanced stages. Early                 to North Carolinians for different reasons.                Childhood and Adolescent cancer
 detection saves lives.10                      Cervical cancer is included because it is                  According to the National Cancer Institute
                                               preventable through the use of Human                       (NCI), cancer is the leading cause of death
 Pancreatic cancer was the fourth              Papillomaviruses Vaccine (HPV). It can                     by disease among United States children
 cause of North Carolina cancer                also be easily detected through screening                  between infancy and age 14. The causes of
 deaths in 2012.1 In 2012, there               and treated in early stages. Melanoma and                  most childhood cancers are unknown, and
 were 1,175 pancreatic cancer                  other skin cancers are included because                    for the most part they cannot be prevented.
 deaths. It is not included in this            they are the most common cancers.                          The major types of childhood cancers are
 Cancer Plan since there currently

6			                North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
leukemia, lymphoma, brain and other                             • racial and ethnic minorities;                                disability and death through
central nervous system tumors. These                                                                                           prevention, early detection, care
                                                                • residents of rural areas including
account for more than half of new cases                                                                                        and treatment.
                                                                  Southern Appalachia;
of childhood cancer. White and Hispanic
children are more likely than children                          • lesbian, gay, bisexual and                                   Health Equity
from any other racial or ethnic groups                            transgender people,
                                                                                                                               Health equity occurs when every
to develop cancer.12                                            • older people,                                                person has the opportunity to attain
                                                                • people with disabilities;                                    his or her full health capability and
Although cancer is not as common
                                                                                                                               no one is blocked from achieving
in adolescents and young adults (AYA) as                        • people with low incomes and
                                                                                                                               this capability because of his or her
in adults, there are certain cancers that
                                                                • people who are uninsured.4                                   social position or circumstances.16
affect this group. These include lymphoma
                                                                                                                               The World Health Organization
thyroid, brain and central nervous system
                                                         Across all chronic health conditions, health                          states, “These circumstances are
cancers. AYA cancer patients are a
                                                         disparities exist. Cancer is no different.                            shaped by the distribution of money,
special group with unique challenges.
                                                         It is critical to work effectively with                               power and resources, which are
Among those are the need for school and
                                                         communities to eliminate all disparities.                             themselves influenced by policy
career counseling, fertility counseling and
                                                         This Cancer Plan addresses disparities                                choices.”17 The goal is to achieve
fertility protecting services, genetic
                                                         in cancer among populations experiencing                              the highest level of health possible
counseling and AYA-specific psychosocial
                                                         a disproportionate burden of disease,                                 for all groups. Research shows
support.13
                                                                                                                               health outcomes for minorities –
Unequal Burden in North
                                                                                North Carolina Cancer Incidence and Mortality Rates
Carolina                                                                            by Race and Gender per 100,000 Population
                                                                                       Age-Adjusted to the 2000 US Census**
Health Disparities
                                                                                          White             White             Minority          Minority
NCI defines health disparities as                                                                                                                                    Total
                                                                                          Males            Females             Males            Females
differences in the incidence, prevalence,                    Cancer Mortality
                                                                                           203.1             138.5              245.3             155.4              170.5
mortality and survival of a disease and the                    Rate 201214
related adverse health conditions that exist                 Cancer Incidence
                                                                                           521.9             444.4              550.6             424.2              476.7
among specific population groups                               Rate 201115
including:                                                      ** Note: The N.C. State Center for Health Statistics often publishes data by race for only two groups: white and
                                                              minority. The State Center recognizes and appreciates the various population groups in North Carolina and the need
                                                             for more details on race. A number of factors have hampered efforts to obtain accurate data on minority populations.

North Carolina Comprehensive Cancer Control Plan 2014-2020    		                                                                                                                    7
African Americans, American                        Build community                                           Use a variety of culturally
 Indians and Hispanic/Latinos –                      empowerment to address health                              competent media to market cancer
 are worse than for Whites. Social                   disparities at the                                         information to diverse populations
 and economic factors such as in-                    local level.                                               in a variety of settings.
 come, education, racism, housing,
                                                    Encourage alternative ways of                             Educate about the benefits
 employment, food accessibility,
                                                     thinking about public health                               of increased access to care
 transportation and the environment
                                                     practice, such as dialogues                                for underserved populations
 are key components in determining
                                                     on the impact of structural racism                         to include:
 an individual’s health status.
                                                     on health.                                                    • healthcare coverage,
 Therefore, it is necessary to address
 these underlying factors in order                  Advocate, encourage and                                       • increased funding for
 to improve the health status                        support diversity within the                                    preventive screening programs,
 of individuals and eliminate                        workforce at all levels and positions.                          such as Breast and Cervical
 health disparities.                                Increase funding for the                                        Cancer Control Programs
                                                     development of initiatives                                      (BCCCP) and colorectal
 Health Equity Recommendations                       for addressing health disparities                               screening programs and
 These health equity recommenda-                     and creating health equity.                                   • increased access to nutrient
 tions to reduce health disparities                                                                                  dense foods through the
 in general are adapted from the               Specific Cancer Recommendations                                       elimination of food deserts.
 Centers for Disease Control and               The following recommendations are                               Develop research projects to study
 Prevention (CDC) and the National             designed to specifically reduce disparities                      the differences in participation
 Association of County and City                in cancer.                                                       in, and results from, cancer
 Health Officials.18                                                                                            prevention and care clinical trials
                                                    Improve early detection through
     Identify/build strategic                                                                                  between minority/ ethnic and other
                                                     routine screenings.
      partnerships with                                                                                         population groups.
      community organizations                       Implement evidence-based
                                                                                                               Increase funding for preventive
      in a variety of settings                       community interventions designed
                                                                                                                cancer screening programs.
      to address social                              to improve the health of minority
                                                     populations.                                              Increase access to nutrient dense
      determinants of health
                                                                                                                foods through the elimination of
      such as employment,
                                                                                                                food deserts.
      transportation, housing and
      public policy initiatives.

8			                North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
Access to                                        Lack of transportation and insufficient
                                                         resources are major barriers to health care
        Cancer Care                                      in North Carolina’s rural communities
                                                         where access to primary care physicians
                                                         may be very limited.
Differences in survival between population
groups are influenced by many different                  The United States Census Bureau reports
factors.                                                 that between 2008 and 2012, 16.8 percent
                                                         of North Carolinians were living                      In 2012,
Lack of Medical Coverage                                 in households whose income was
People with little or no health insurance                at or below the federal poverty level.20
coverage have a serious problem getting
care. The North Carolina Institute of                    In 2012, approximately 22.7 percent of
Medicine report, Healthy North Carolina                  North Carolinians lived in rural areas.21
2020 states there are an estimated 1.7                   Many cancer centers and doctors across          approximately

                                                                                                        22.7%
million uninsured individuals under the                  North Carolina provide cancer care and
age of 65 living in North Carolina.19 People             treatment to rural patients close to home.
with little or no health insurance are more              However, the need for specialized care
likely to be diagnosed with cancer at later              or treatment away from home is needed
stages and, thus, have less chance of                    sometimes for rare kinds of cancer
cancer survival.                                         or late-stage cancers. North Carolina
                                                         has several nationally recognized cancer                 of
                                                         centers that can give that specialized care.   North Carolinians lived
Unequal Access to Cancer                                                                                   in rural areas.21
                                                         However, care at these centers often
Prevention, Early Detection                              requires traveling long distances, a
and Treatment                                            particular challenge for low-income people.
Many North Carolinians face additional                   (See Appendix C for information on cancer
financial and physical barriers to receiving             hospitals)
preventive health care and health
education as well as treatment for
existing health problems.

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                   9
The cancer continuum, which includes prevention, early detection, care and
 treatment and survivorship, is a useful framework to view plans, priorities
      and progress as well as identifying research and resource needs.
North Carolina Comprehensive Cancer Control Plan
The Cancer Plan is designed to address the barriers to cancer prevention and care while outlining a plan of action for cancer programs,
community organizations, policy makers and individual North Carolinians.

The overarching goals of the Cancer Plan are:
     Prevent new cancers.
     Detect cancer at its earliest stages.
     Treat all cancer patients with the most appropriate/effective therapy.
     Enhance the quality of life for every person affected by cancer.
     Reduce cancer-related disparities in North Carolina.

In order to meet these goals, the Cancer Plan has specific objectives and strategies to address the cancer continuum, the six specific
cancers, cancer surveillance and plan evaluation.

The cancer continuum, which includes prevention, early detection, care and treatment and survivorship, is a useful framework
to view plans, priorities and progress, as well as identifying research and resource needs.

The Action Plan will be implemented by a diverse partnership of North Carolina cancer programs, organizations and individuals
in order to assure North Carolinians timely and equitable access to healthcare throughout the cancer care continuum.

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                           11
Cancer Risk and                                             Specific Risk Factors’ Relationship to Priority Cancers
 Protective Factors
                                                                        Lung         Colorectal       Breast        Prostate        Cervical         Skin

 Risk Factors
                                                 Family History
 Risk factors increase a person’s
 chances of developing cancers.
 In addition to the risk factors listed           Tobacco Use
 in the chart, additional factors are
 growing older and gender. Risk                     Unhealthy
 factors such as growing older,                     Lifestyles
 gender and family history of cancer
 are beyond a person’s control.                  Environmental
                                                     Toxins
 However, knowledge of family
 history may help with early
 detection of cancers with a strong                Alcohol Use
 genetic link. Cancers known to run
 in families include melanoma skin                  Ultraviolet
 cancer and cancers of the breast,                  Exposure
 ovary, prostate and colon.
                                                     Viruses
 Protective Factors
 For cancers without a known
 genetic link, a person can
 significantly lower his or her risk
 by adopting protective healthy
 behaviors and improving the
 environments where he or she lives.
 Both risk and protective factors are
 discussed in the following pages.

12			                North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
Cancer Risk Associated                                       Poor Nutrition, Physical Inactivity         people do. Physically active women
                                                             and/or Overweight/Obesity                   have a significantly lower risk of
with Poor Nutrition, Physical                                increases the risk for these                breast cancer. In addition, cancer
Inactivity, Overweight                                       cancers:22                                  survivors have a better quality of life
and Obesity                                                     breast		 prostate
                                                                                                         if they are physically active
                                                                                                         compared to survivors who are
About one third of the most common                              liver		 colorectal                       inactive.23
cancers in the United States can be
prevented by a healthy diet, physical                           esophageal     kidney
                                                                                                         The American Institute for Cancer
activity and weight management                                  stomach		      lung                      Research recommends meeting
according to the American Institute of                          pancreas                                 physical activity and healthy eating
Cancer Research.22                                                                                       recommendations in addition
                                                                endometrial (uterine)
                                                                                                         to maintaining a healthy body
Overweight and Obesity                                          mouth, pharyngeal
                                                                                                         weight.22
                                                                and laryngeal
The percentage of overweight and obese
adults and children has increased                                                                        All adults should avoid inactivity.
markedly over the past few decades.                                                                      Some physical activity is better than
                                                         In general, the higher the number, the more
In North Carolina, more than two-thirds                                                                  none at all.
                                                         body fat a person has, although there are
of adults are overweight or obese.24                     exceptions. BMI in a range from 18.5 to 24.9
                                                         is considered healthy. Persons who have a
Almost one third of North Carolina’s                     BMI range from 25.0 to 29.9 are considered
children ages 10 to 17 are overweight                    overweight. A BMI of 30 or greater
or obese.18 High rates of overweight                     indicates that the person is obese.7
and obesity in the state and nation cause
decreases in life expectancy, productivity
                                                         Physical Activity
and quality of life.
                                                         and Healthy Eating
A healthy weight depends on a person’s                   Physical activity and healthy eating are risk
height so recommendations for a healthy                  factors for cancer independent of healthy
weight are often expressed in terms of body              weight. The 2008 Physical Activity
mass index (BMI). BMI is a number that is                Guidelines for Americans notes that
calculated using both weight and height.                 physically active people have a significant-
(See Appendix D for Body Mass Index Chart)               ly lower risk of colon cancer than inactive

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                                    13
Core Behaviors to Reduce                       meats by baking, broiling or poaching                        Adult Physical Activity Guidelines
 Overweight and Obesity25                       rather than by frying or chargrilling.                       • Adults should do at least 2½
                                                Cooking meats at high temperatures can                         hours (150 minutes) of
 Increase Physical Activity                     cause the formation of toxins that have                        moderate-intensity or 1¼
 A pattern of regular physical                  been shown to cause cancer in animals.                         hours (75 minutes) of
 activity beginning in childhood or                                                                            vigorous-intensity aerobic
 adolescence is critical for lifelong           Drink Less Sugar-Sweetened Beverages                           physical activity per week.
 weight management. Physical                    Reduce the number of sugar-sweetened                         • Adults should also do
 activity burns calories both during            beverages, including soda, sweet tea,                          muscle-strengthening activities
 and after activity. Physical activity          energy drinks and sports drinks. These                         that are moderate or high
 should consist of not only aerobic             beverages provide calories with little                         intensity and involve all major
 activities that get the heart                  or no nutritional value.                                       muscle groups on 2 or more
 pumping, such as walking
                                                                                                               days a week.
 or bicycling, but also activity that
                                                Decrease Television Viewing
 strengthens muscles and bones                                                                               Note: U.S. Department of Health and
                                                and Screen Time
 and increases flexibility.                                                                                  Human Services, 2008 Physical Activity
                                                Reduce television and screen time so there                   Guidelines for Americans
 Eat More Fruit and Vegetables                  is more time for physical activity. This also
                                                reduces exposure to advertisements
 Fresh fruits and vegetables are low            for foods that are high in fat and sugar.                  Encourage Breastfeeding
 in calories and high in vitamins,
 minerals, fiber and antioxidants.                                                                         Promote breastfeeding to increase healthy
                                                Eat Less Energy-Dense Foods                                nutrition for infants, and decrease the risk
 A diet with lots of fruits and
 vegetables is higher in volume and             Reduce the number of calorie-rich foods                    of childhood obesity. Some studies
 fiber while being lower in calories.           such as packaged snack foods; frosted                      suggest that breastfeeding may slightly
                                                cakes, cookies and candies; cheeseburgers;                 lower breast cancer risk in mothers.
 Eat Less Red and Processed                     fried chicken; French fries and doughnuts.                 (For additional North Carolina information see
 Meats                                          Foods that are energy-dense contain a large                North Carolina’s Plan to Address Obesity: Healthy
                                                number of calories, mostly from fat and                    Weight and Healthy Communities 2013-2020
 High intake of processed meats                 sugar. Decreasing the portion sizes of these               at http://www.eatsmartmovemorenc.com/
 such as bacon, sausage, lunchmeats             foods reduces calories.                                    ESMMPlan/ESMMPlan.html)
 and hot dogs are linked to an
 increase in colorectal cancer
 incidence and mortality. Prepare

14			                North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
Cancer Risk Associated with                                  Tobacco use increases cancer                 because of exposure to secondhand
                                                             risk for:8                                   smoke. There is no risk-free level of
Tobacco Use and Exposure                                                                                  exposure to secondhand smoke.
to Secondhand Smoke                                             lung            stomach                   Thus, for every one person who
Tobacco use is the number one preventable                       colon/rectum liver                        dies from smoking, 20 more suffer
cause of premature death and disease                            breast		 head/neck                        at least one serious tobacco-related
in North Carolina and the nation. Annual                                                                  illness.26
                                                                prostate		      pancreas
North Carolina medical costs incurred from
                                                                bladder		       kidney                    Protection from Tobacco
smoking are $3.8 billion.1
                                                                skin		 ovarian                            Exposure
In the United States, tobacco use is                            cervix		 uterus                           Protect and promote the health of
responsible for:                                                acute myeloid leukemia                    everyone by reducing tobacco use
    • nearly 20 percent of all deaths,                                                                    and exposure to secondhand smoke.
                                                                                                          This will reduce cancer incidence
    • at least 30 percent of all cancer
                                                                                                          and prevalence, as well as help
      deaths and                                         17 percent, a rate that has barely changed
                                                                                                          North Carolinians live longer, be
    • 87 percent of lung cancer deaths.        8         for more than 20 years.8 In North Carolina,
                                                                                                          more productive and have happier
                                                         the five-year observed survival rate for lung
                                                                                                          lives.
                                                         cancer is 20 percent.1
Smoking
In North Carolina, more than 12,200 people               Other tobacco products
                                                                                                          Key Strategies
die each year due to smoking. Lung                                                                        Protect people from tobacco
cancer is the leading cause of cancer death              Smokeless tobacco users have an increased
                                                                                                          smoke
in North Carolina and the United States                  risk of developing cancer of the oral cavity.
                                                         There is no known safe form of tobacco           Create more smoke-free/tobacco-
for both men and women.1
                                                         use including e-cigarettes, snuff, chewing       free spaces where people live,
                                                         tobacco, cigars and hookahs.                     work, play and learn.
Survival rates
                                                                                                              Maintain a statewide
Survival rates for lung cancer are among                 Secondhand smoke                                      smoke-free law for all North
the lowest of all cancers despite medical
                                                         Nonsmokers die from lung cancer and                   Carolina restaurants and
developments in its diagnosis and
                                                         heart disease and hundreds of thousands               bars.
treatment. The national five-year survival
rate for lung cancer in 2003-2009 was                    of children suffer from respiratory infections

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                                   15
 Build support for the                                                                                   Educate about the need for
      adoption of a comprehensive                                                                              recurring state funding for a
      smoke-free law that protects                                                                             statewide media campaign
      all workers from exposure                                                                                to educate North Carolinians,
      to secondhand smoke.                                                                                     particularly youth, about the
                                                                                                               harmful effects of tobacco use.
     Promote smoke-free and
      tobacco-free local
      regulations.                                                                                       Enforce bans on tobacco advertising,
                                                                                                         promotion and sponsorship
     Promote tobacco-free
      colleges and community                                                                                  Maintain compliance with the NC
      colleges.                                                                                                Youth Access to Tobacco law so
                                                   Promote QuitlineNC (1-800-                                 that North Carolina meets federal
     Maintain North Carolina’s                                                                                requirements to keep youth tobacco
                                                    QuitNow or 1-800-784-8669) and
      tobacco-free schools and                                                                                 sales rates below 10 percent.
                                                    www.QuitlineNC.com for all N.C.
      hospitals.
                                                    tobacco users who want to quit.                           Maintain activity under contract
     Promote smoke-free                                                                                       with the FDA to enforce the North
                                                   Educate about the need for
      multi-unit housing in North                                                                              Carolina’s requirements of the
                                                    increased funding for QuitlineNC,
      Carolina.                                                                                                Family Smoking Prevention and
                                                    so that evidence-based nicotine
                                                    replacement therapy will be                                Tobacco Control Act.
 Offer help to quit tobacco use                     available for all QuitlineNC users
 Encourage people who use any type                  who want to quit tobacco.                            Raise the price of tobacco products
 of tobacco products to quit.                                                                            through increased taxes on cigarettes
                                              Warn people about the dangers                              and other forms of tobacco
     Increase the number of
      healthcare systems that                 of tobacco use                                                  Educate and inform the public and
      adopt clinical practice                      Promote evidence-based media                               decision-makers of the health and
      guidelines for treating                       campaigns and local interventions                          economic benefits of tobacco price
      tobacco use dependence,                       that educate about the harms and                           increases to prevent young people
      and make it a systematic                      addictiveness of tobacco use, the                          from becoming addicted and to help
      part of clinical assessment,                  dangers of secondhand smoke and                            tobacco users who want to quit.
      much like a vital sign.                       the best practices to reduce tobacco
                                                    use.

16			              North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
 Work with partners to educate                      Cancer Risk Associated with                    tasteless and odorless when it
      about the specific benefits of an                                                                 leaches into groundwater.
      increase in tobacco excise tax and
                                                         Environmental Exposures                        Long-term exposures to high levels
      a comparable increase for other                    According to NCI, researchers have             of arsenic have been linked with
      tobacco products.                                  estimated that as many as 67 percent           non-melanoma skin cancers, lung
                                                         of cancer cases are linked to some type        cancer and other types of cancer.
Sustain tobacco prevention and control                   of environmental factor such as exposures
infrastructure and policies                              to radiation, infectious agents and            Pesticides are chemicals used
                                                         substances in the air, water and soil.4 Some   to reduce or eliminate unwanted
     Educate and inform the public and
                                                         workers may be exposed to cancer-causing       pests or weeds. Exposure to
      decision-makers about the return
                                                         chemicals and other substances in their        pesticides may occur through
      on investment of comprehensive
                                                         workplaces.                                    inhalation, skin contact and
      tobacco control programs
                                                                                                        ingestion. Exposure to pesticides
      in coordination with state and
                                                         Certain types of exposures are linked          has been linked with prostate,
      national programs.
                                                         to specific cancers; for instance, radon       breast, bladder, colon and other
     Incrementally increase North                       exposure is linked to lung cancer.             types of cancer.
      Carolina’s investment in tobacco
      prevention and control in order                    Radon is a radioactive gas that cannot be      Low-level medical radiation is
      to meet the 2014 CDC Best Practices                seen, smelled or tasted. It is considered      commonly used for x-rays to
      annual investment recommendation                   the primary cause of lung cancer for           diagnose broken bones and dental
      by 2020.                                           non-smokers. When released naturally           cavities. The risk of cancer from
                                                         from soil and rocks, it can accumulate         such radiation is considered
     Educate about the benefits
                                                         and reach harmful levels when trapped          very small since they are used
      of recurring state appropriations
                                                         in enclosed spaces such as homes, schools      infrequently and at very low doses.
      for evidence-based youth tobacco
                                                         or other buildings. If detected, building
      prevention and cessation programs
                                                         modifications can be made to prevent the       High-level medical radiation is
      to develop and sustain strong
                                                         accumulation of high levels of radon. The      used to diagnose and treat certain
      tobacco use preventive
                                                         N.C. Department of Health and Human            types of cancer; it can increase
      interventions at the community
                                                         Services Radon Program (ncradon.org)           cancer risk later in life.
      and state level in North Carolina.
                                                         offers monitoring and mitigation guidance.
(For more information see North Carolina Tobacco
Prevention and Control Branch Web site at http://        Arsenic is a naturally-occurring element
www.tobaccopreventionandcontrol.ncdhhs.gov.)
                                                         found in natural rock formations. It is

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                               17
Protection from                                    Wear protective clothing, gloves                     Key Strategies
 Environmental Exposures                             and eye protection when working
                                                                                                          Protect the skin with sunscreen
                                                     with pesticides or other chemicals.
 Minimize environmental exposures                    Work outside or in a well-ventilated                 Use a generous amount of sunscreen with a
 to radiation, chemicals and other                   area.                                                sun protection factor (SPF) of at least 30.
 toxic substances at home, schools,
 offices and the worksite.                          Wash hands and clothes thoroughly
                                                     after working with pesticides or                     Avoid long periods of exposure
                                                     other chemicals. Remove shoes                        to the sun
 Key Strategies
                                                     outside the home.                                    Especially avoid the sun between 10 a.m.
 Check homes, buildings, and                                                                              and 4 p.m. when it is the strongest.
                                                    Wash fruits and vegetables
 schools for high levels of radon
                                                     thoroughly before eating. Select
 Test and monitor for elevated levels                organic when possible.                               Wear protective clothing and
 of radon. A radon reduction system                                                                       sunglasses with UV protection
 may be installed to remove the                Reduce exposure to diagnostic X-rays                       Protective clothing includes wide brimmed
 radon trapped under the building                                                                         hats and tightly woven long sleeve shirts
 and vent it to the atmosphere at a            Speak with your doctor about alternative
                                               diagnostic methods.                                        or clothing with sun protection embedded
 safe distance from the building.                                                                         in it.8

 Test well water for arsenic                   Cancer Risk Associated
                                                                                                          Educate about the importance of a
 levels exceeding state and                    with Ultraviolet Radiation                                 state law to protect minors from UV
 federal limits                                Exposure                                                   exposure at indoor tanning beds
 Test according to North Carolina              UV radiation comes from the sun, sunlamps                  Several measures have shown to decrease
 Well Water and Health schedule. If            and tanning beds. It causes early aging of                 the use of tanning salons by adolescents:
 levels are elevated, seek assistance          the skin and skin damage that can lead to
 to treat water or use alternative                                                                             imposing an age limit or requiring
                                               skin cancer.                                                     parental permission,
 source of safe drinking water.
                                               Protection from UV Exposure                                     mandating salons to post the
 Minimize or avoid use of                                                                                       warning signs of tanning bed use
 pesticides and other chemicals                Avoid exposure to ultraviolet radiation from                     and
                                               the sun and other sources such as tanning
     Research and use alternative                                                                             limiting advertisement.
                                               beds.
      methods of pest control.

18			               North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
Cancer Risk Associated                                   Schedule regular Pap test screenings             mouth cancers is especially high
                                                         according to recommended guidelines              because alcohol and tobacco both
with Viral Exposure                                      to detect cancer early                           come in direct contact with those
Human papillomaviruses (HPVs) infection                                                                   areas.
                                                         (See Appendix B – Cancer Information Resources
is the main cause of cervical cancer.                    for cancer screening information)
Tobacco use, long use of birth control pills                                                              Protection from Alcohol
and having given birth to three or more
                                                         Cancer Risk Associated                           Abuse
children are also risk factors for cervical
cancer. HPV infection also may be a risk                 with Alcohol Use                                 According to the American Institute
factor for other types of cancer such as oral            Drinking too much alcohol can increase the       of Cancer Research, studies show
cancers.                                                 chance of developing cancers of the mouth,       an association between alcohol
                                                         throat, esophagus, larynx, liver, breast,        drinking and several types of
Protection from Viral Exposures                          colon and rectum. Cancer risk increases          cancer. Reduce the risk by reducing
                                                         with the amount of alcohol a person drinks.      or eliminating alcohol use. People
Since HPV is a major contributor to cervical                                                              who drink alcohol should limit their
cancer, there is a focus on the prevention                                                                alcohol intake to two drinks per day
and treatment of HPV. The HPV vaccine is                 Smoking alone is a known risk factor
                                                         for some cancers. Smoking and drinking           for men and one drink per day
proven effective in the prevention of many                                                                for women.20
forms of HPV and can prevent cervical                    together intensifies the cancer-causing
cancer as well as anal cancer, mouth and                 properties of each substance and poses
throat cancers, cancer of the penis in men               an even greater risk. The risk of throat and
and esophageal cancers in gay men.
                                                             A standard alcoholic drink in the United States contains 14.0 grams
Regular Pap tests can prevent cervical                       (0.6 ounces) of pure alcohol.
cancer by detecting cancer at an early
stage, so successful treatment can begin                     Generally, this amount of pure alcohol is found in
early.
                                                             • 12 ounces of beer (3 - 7 percent alcohol)
                                                             • 8 ounces of malt liquor beer (3 - 7 percent alcohol)
Key Strategies
                                                             • 5 ounces of wine (9 - 15 percent alcohol)
Protect children with HPV vaccines
                                                             • 1.5 ounces or a “shot” of 80-proof liquor (usually 35 - 40 percent
HPV vaccines are recommended for boys                          alcohol), but can be higher.
and girls starting around 11 to 12 years old
until age 26, if appropriate.

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                                  19
Cancer Prevention and
 Control Action Plan
 In order to decrease the cancer risk
 and increase cancer protective
 factors, the Cancer Plan has five
 overarching goals. They are:
     Prevent new cancers.
     Detect cancer at its earliest
      stages.
     Treat all cancer patients
      with the most appropriate
      and effective therapy.
     Enhance the quality of life
      for every person affected
      by cancer.
     Reduce cancer-related
      disparities in North Carolina.

 The Cancer Plan focuses on four
 areas: prevention, early detection,
 care and treatment and survivorship
 including palliative care.

20			               North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
Cancer Prevention Strategies
    Cancer Prevention                                    Education and promotion of healthy behaviors
    Focus                                                     Provide education on evidence-based practices, policies, systems and
                                                               environmental change approaches that focus on: health disparities, tobacco use
    Change behaviors, policies,                                prevention and control, cancer screening, physical activity and healthy eating.21,25
    environments or other                                     Develop and use strategic, effective and tailored messaging and media campaigns
    systems to reduce North                                    in combination with other strategies to support healthy behaviors and reduce risk
    Carolinians’ cancer risk.                                  factors.
                                                              Continue the N.C. Department of Public Instruction Standard Course of Study
                                                               for K-12 students that promotes healthy behaviors.
                                                              Promote radon testing/mitigation in homes, schools, workplaces and other
Most cancers can be prevented by taking
                                                               community settings.
steps to reduce risk factors such as:
                                                              Promote HPV vaccination for girls and boys starting at age 11 or 12 years until age
    • avoiding tobacco use and                                 26, if appropriate.
      secondhand smoke,
                                                              Promote cancer-screening tests that may prevent future breast, colorectal, cervical
    • limiting exposure to environmental                       and skin cancers.
      toxins,
    • limiting alcohol use,                              Promotion of public policy
    • limiting exposure to ultraviolet rays                   Support the development and enforcement of state and local policies to prevent
      from the sun and tanning beds,                           and minimize tobacco use, eliminate secondhand smoke and promote quitting.
                                                              Support the development of state and local policies to encourage colorectal cancer
    • eating a variety of fruits and
                                                               screening for preventive purposes in people between the ages of 50 and 75.
      vegetables,
                                                              Support education and policy approaches in worksites and communities that can
    • maintaining a healthy weight,                            reduce occupational and environmental exposures to carcinogens.
    • being physically active and                              • Promote education and policy approaches that limit unprotected exposure
                                                                   to ultraviolet light.
    • having recommended check-ups.
                                                               • Promote radon testing, radon resistant construction and mitigation of radon
(See Appendix B – Scientific Information                           in schools, daycare centers, workplaces and homes.
Resources)
                                                              Support health education and health promotion policies, processes and
                                                               interventions that increase the awareness of cancer screenings.

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                                  21
Early Cancer
    Detection Focus
    Promote the adoption                                                          “Never give up and early detection
    of recommended                                                                saves lives.”
    cancer screening
                                                                                                              – Patricia, cervical cancer survivor since 1992
    and early detection
    methods and referral
    procedures.

 Screening means checking the
 body for cancer before a person has
 symptoms. Appropriate screening               (See Appendix B – Scientific Information Resources for information on cancer screenings)
 and early detection methods can
 have a significant impact on the
 incidence and mortality from                  Early Cancer Detection Strategies
 certain cancers.                              Education and promotion of healthy behaviors
 Recommended screening varies                       Encourage healthcare providers to recommend and deliver cancer screenings
 depending on the type of cancer.                    based on the latest screening recommendations. (See Appendix B – Scientific
 Regular screening tests may find                    Information Resources for information on cancer screenings)
 breast, cervical, colorectal and skin              Partner with public and private healthcare providers and community leaders to:
 cancers early when treatment might                  • increase cancer awareness,
 be most successful.
                                                     • improve opportunities for cancer screening with emphasis on people with high
 Research on effective cancer                            risk of developing cancer and
 screening is an ongoing process                     • improve opportunities for cancer screening with emphasis on people with
 with new methods being tested and                       limited access to screenings.
 released while approved older                      Promote research for early detection that will lead to improved outcomes, cancer
 methods are reevaluated. Check                      care and quality of life. (See Appendix B – Scientific Information Resources
 sources for up-to-date information                  for information on clinical trials and research)
 on recommended cancer screening.

22			               North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
Cancer Care Continuum                                        • transportation which makes it
                                                               difficult or impossible to get
The cancer care continuum begins with                          to treatment or other care,
cancer screening or diagnosis, goes
through treatment, continues throughout                      • lack of health insurance,
survivorship and includes end-of-life care.                  • fear of the unknown and/or

Survivorship covers the physical,                            • distrust of the medical system.
psychosocial and economic issues of
disease, beyond the diagnosis and                        Patient navigators often work with a patient
treatment phases. It may include issues                  starting with diagnosis and continuing
related to:                                              through all phases of the cancer
                                                         experience. These navigators offer help
    • accessibility of healthcare and                    to patients, families and caregivers
      follow-up treatment,                               by working with the healthcare system
    • continued effects of treatment,                    to ensure they receive needed care.
    • reoccurring and/or additional
      cancers and
                                                         Quality Care
                                                         According to the National Institute of
    • quality of life.
                                                         Medicine (IOM), patients should receive
                                                         cancer care that:
Palliative care involves taking care of
symptoms and providing relief from pain                      • is given by qualified medical
and stress of an illness.                                      providers,                               “...we can live with hope
Patient navigation involves helping
                                                             • is decided by both the patient and
                                                               the medical team (called shared
                                                                                                        because we are not alone
patients, families and caregivers work
through issues that arise during the cancer
                                                               decision making),                        in this journey.”
journey. All cancer patients, especially                     • considers age, sex, race, ethnic
                                                               background, customs, social                            – Lidia and Ana Maria,
low-income patients, can have problems
                                                               background and religion,                              breast cancer survivors
getting cancer care. Some of these                                                                                      since 2006 and 2010
problems might be:                                           • is given in a safe and helpful way
                                                               and

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                          23
• is done in a way that saves              The continuum provides patients, their
      money and time.                          loved ones and/or caregivers with the
                                               knowledge, resources and tools to support
 There are other issues involved               them through their cancer experience.
 in providing cancer care. They are
 the need for:
    • a well-trained and reliable
      work force in which
      evidence-based practice
      guidelines are used,
    • continuous monitoring of
      the quality of care across the
      state to be sure everyone is
      working together and
      following guidelines,
    • patient navigation to help
      patients, families and
      caregivers work with the                                                                                     The daffodil –
      healthcare system to receive
      needed care and                                                                                              the flower
    • health information                                                                                           of cancer
      technology (HIT) and
      electronic health records                                                                                    survivorship
      (EHRs) to keep track of
      referrals made, evidence-
      based care given and
      guidelines followed.

24			               North Carolina Department of Health and Human Services | North Carolina Public Health | North Carolina Cancer Prevention and Control Branch
Cancer Care Strategies
    Cancer Care Focus                                    Access to Care and Care Coordination
                                                            Work with professional associations and other groups to:
    Improve access to care,
    enhance care coordination                                •   promote a statewide patient navigation model with increased training and
                                                                 networking of patient navigators,
    and assure quality treatment.
                                                             •   increase the number of patient navigators available to help patients overcome
                                                                 both structural and psychosocial barriers to care across the cancer continuum,
                                                             •   promote increased access to clinical trials for cancer care that will lead to improved
Cancer care includes:                                            outcomes and quality of life, especially for medically underserved populations and
                                                             •   promote adherence to national guidelines for cancer diagnosis and treatment.
    • taking care of symptoms and relief
      from pain beginning at diagnosis,
                                                         Quality Treatment
    • focusing on the whole person,
                                                            Offer educational opportunities and support to non-Commission on Cancer (CoC)
    • watching to see if the cancer returns                  accredited cancer centers, general physicians, other healthcare workers and local
      (recurrence) or if an additional new                   agencies so they can:
      cancer develops and
                                                             •   follow national guidelines for cancer diagnosis and treatment,
    • supporting the patient, the                            •   offer evidence-based, value-based and patient-centered care and communications,
      patient’s family, other loved ones
                                                             •   engage the patient in the care and treatment plan, including informed decision
      and caregivers throughout
                                                                 making,
      survivorship.
                                                             •   use electronic health records,
Care and treatment should be based                           •   provide age-sensitive and age-appropriate cancer treatment for pediatric,
on the age of the patient. The very young                        adolescent, young adult (AYA) and geriatric cancer patients,
and very old need care and treatment                         •   utilize a team approach to patient care that uses appropriate specialist and
by healthcare professionals who specialize                       non-specialist professionals,
in cancer care for their population groups.                  •   achieve and adhere to CoC quality guidelines for accreditation and
Adolescent and young adult (AYA) cancer                      •   provide educational opportunities for healthcare professionals that enhance
patients are another group who require                           or increase their knowledge and skills in:
special attention.                                                comprehensive, team-based cancer care,
                                                                  palliative care and
                                                                  end-of-life services.

North Carolina Comprehensive Cancer Control Plan 2014-2020   		                                                                                      25
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