Cancer Control in the Community
Successful public health initiatives to prevent, detect and treat cancer require widespread community participation.
By Marci A. Landsmann
Tomeka Harps hadn’t seen a doctor in five years, despite a history of abnormal Pap tests that showed precancerous cells in her cervix. The mother of three didn’t have health insurance and found her medical appointments at the community health clinic to be inconvenient and impersonal.
“It was just a hassle and it took so much time,” says the 34-year-old Brandon, Mississippi, resident. “You never had one-on-one with the doctor in a personal way. They didn’t know me from the man in the moon, so I just stopped going.”
But Harps never misses a Sunday service at New Horizon Church in Jackson. When a nurse in her congregation mentioned a cancer screening event that offered same-day results at the University of Mississippi Medical Center (UMMC) Cancer Institute clinic in Jackson, Harps put the event on her calendar. The free event—which featured breast and cervical cancer screenings and melanoma skin checks—also provided lunch, entertainment for children, an opportunity to meet with a financial adviser, and cooking and exercise demonstrations.
After her Pap test, Harps found herself waiting for the results. “I thought they forgot about me,” she says, noting that people she knew from church had come and gone. That’s when she was escorted into a room and told she had cervical cancer.
“It was the worst day of my life, but it was the best day, too,” Harps says. “I have never in all my life been treated so kindly.” Nurses stayed late to comfort her and call her husband, and staff from the county health department helped her sign up for health insurance through Medicaid.
Within days of the screening, Harps had seen an oncologist, and by the end of the week, she had a treatment plan for her stage IIB cervical cancer. She completed treatment—which included radiation, chemotherapy and brachytherapy—at UMMC Cancer Institute in May 2017.
Stephen Raab, a pathologist at UMMC, decided to plan the event to help medically underserved communities in the area. Mississippi has the highest percentage of people living below the poverty line of any state in the Union. In addition, from 2000 to 2014, the state ranked 50th out of 51 for cancer mortality out of 50 states and the District of Columbia. The event that Harps attended, called “See, Test & Treat,” was sponsored by the CAP Foundation, the charitable arm of the College of American Pathologists.
“Cervical cancer is a completely preventable disease if you can catch a cervical abnormality early,” says Karim Sirgi, a pathologist and president of the CAP Foundation. “And breast cancer is treatable if detected early, so that’s our [rationale] in focusing on these two.”
Programs like “See, Test & Treat” fall under the wide umbrella of cancer control—efforts to reduce the burden of cancer through screening, vaccinations and public education campaigns that emphasize healthy behaviors. These initiatives, which often are part of a statewide cancer control plan, rely on the cooperation of community members, hospitals, advocacy groups and government at all levels.
The best-known example of a cancer control effort is the group of initiatives put in place since the release of the 1964 U.S. Surgeon General’s report, Smoking and Health
. The trailblazing report directly linked smoking to lung cancer. Since then, the proportion of U.S. adults who smoke has dropped from more than 42 percent in 1965 to just 15 percent in 2015. However, smoking is still the leading cause of preventable death in the U.S. (See “The Ebb and Flow of Tobacco Control
A First in the First State
Cancer control efforts often focus on cancers that carry the greatest burden and are associated with proven strategies for making an impact on incidence and mortality. “In the domain of cancer control, you always have to start with tobacco control because it has the greatest impact, and then you work your way down the list of major cancer domains, including colorectal cancer screening, HPV vaccination, and obesity as a risk factor for many types of cancer,” says Robert T. Croyle, director of the National Cancer Institute (NCI) Division of Cancer Control and Population Sciences.
In 2016, experts noted that colorectal cancer screening, human papillomavirus (HPV) vaccination and increased tobacco control efforts could avert approximately 390,000 new cancer cases and 318,000 cancer deaths in the U.S. each year. The statistics, included in a report released by the National Cancer Moonshot Initiative, were cited to support recommendations for accelerating cancer research and spurring progress against the disease. Former Vice President Joe Biden led the Moonshot effort.
Biden needed to look no further than his home state, Delaware, for an example of what an effective colorectal cancer screening initiative looks like. In 2001, then-Governor Ruth Ann Minner established a task force to determine how to combat high rates of cancer and cancer mortality in the state. Two years later, a newly formed Delaware Cancer Consortium—with appointed volunteers from private industry and government—devised a statewide colorectal cancer screening and treatment program.
“We knew we couldn’t solve all the problems at once. So we asked, ‘Can we pick a couple of problems to solve and show that we can get things done so we can move on to new projects?’ ” says Stephen Grubbs, an oncologist who served on the consortium and worked at Christiana Care’s Helen F. Graham Cancer Center and Research Institute in Newark, Delaware.