Oregon Comprehensive Cancer Plan

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92SECTION IV. PUBLIC POLICY AND LEGISLATION 96SECTION V. DATA MANAGEMENT AND SURVEILLANCE 107APPENDICES 108References 111Glossary of Cancer-Related Terms 116Acronyms 117National Comprehensive Cancer Control Partners and Resources 119Partnership Vision, Mission, Roles and Values 121Partnership Membership Form Table of Contents May 2005 To All Oregonians: This year, 18,000 Oregonians will hear those three dreaded words: cYou have cancer. d They will join thousands of individuals in the state who are already living with the disease. Sadly, by the end of this year, family members, friends and co-workers will mourn the cancer-related deaths of 7,000 Oregonians. Repeatedly, people ask, cWhy can 9t we do something about cancer? d In 2004, the Oregon Partnership for Cancer Control was formed to address this deadly disease. Specifically, the Partnership developed Oregon 9s first statewide cancer control plan, providing a blueprint for action that targets the unique challenges of cancer prevention, treat- ment and survivorship. This cancer plan, created with the assistance of more than 50 organiza- tions, builds on Oregon 9s many existing services and programs. The plan is merely the beginning of Oregon 9s statewide, coordinated effort to reduce the burden that cancer places on individuals, families and communities. Together, we 9ll work to: "Prevent cancer from occurring, whenever possible. "Find cancer in its earliest stage when it does occur. "Treat cancer with the most appropriate therapy available. "Ensure the best quality of life for each individual with cancer. "Promote policies and supportive environments that help Oregonians make healthy choices easy choices. Thank you for using the Oregon Comprehensive Cancer Plan. The Oregon Partnership for Cancer Control invites you to join us in our ongoing efforts to reduce the impact of cancer in our state. Regards, Jane M. MooreDave Rogers Co-ChairCo-Chair CO-CHAIRS Jane M. Moore, PhD, RD Oregon Health Services Dave Rogers American Cancer Society COORDINATING COMMITTEE Don Austin, MD, MPH OHSU Cancer Institute Byron Backlar, MS, JD Volunteer, American Cancer Society Michael Becker Regence BlueCross BlueShield of Oregon Peggy Carey, BSN, MPA St. Charles Medical Center - Bend David W. Cook, MD, FACS American College of Surgeons, Commission on Cancer Sue Cook, RN, OCN Providence St. Vincent Medical Center Courtni Dresser American Cancer Society Chris McDonald Oregon and SW Washington Affiliate Susan G. Komen Breast Cancer Foundation Lillian Nail, PhD, RN, FAAN OHSU, School of Nursing Ederlinda Ortiz-Clawson Oregon Health Services Emily Puukka, MS Northwest Portland Area Indian Health Board Kathryn Richert-Boe, MD, MPH Kaiser Permanente Liling Sherry NW Tribal Cancer Control Project DeeDee Simmons Volunteer Stephanie Anderson Stroup St. Charles Cancer Treatment Center Roshanthi Weerasinghe, MPH OHSU Cancer Institute Celeste Whitewolf Native People 9s Circle of Hope PROJECT STAFF Patricia Schoonmaker, MPH patricia.schoonmaker@state.or.us Tammy Turner, BA Tammy.n.turner@state.or.us FOR MORE INFORMATION: www.healthoregon.org/cancer Phone: 503-731-4273 Fax: 503-731-4082 Oregon Partnership for Cancer Control 1 During 2004, more than 85 meetings were convened in Oregon to create the goals, objec- tives and strategies in this plan. The Partnership 9s Coordinating Committee and Workgroup co-chairs extend a heartfelt thank you to the following individuals and organiza- tions for their contributions to this statewide cancer plan: Coordinating Committee Co-Chairs: Jane M. Moore, PhD, RD, Oregon Health Services; Dave Rogers, American Cancer Society Stephanie Anderson Stroup, St. Charles Cancer Treatment Center; Donald Austin, MD, MPH, OHSU Cancer Institute; Byron Backlar, MS, JD, Volunteer, American Cancer Society; Michael Becker, Regence BlueCross BlueShield of Oregon; Peggy Carey, BSN, MPA, St. Charles Medical Center; David W. Cook, MD, FACS, American College of Surgeons, Commission on Cancer; Sue Cook, RN, OCN, Providence St. Vincent Medical Center; Courtni Dresser, American Cancer Society; Sue Fratt, Christine McDonald, Susan G. Komen Breast Cancer Foundation; Lew Montague, Volunteer; Lillian M. Nail, PhD, RN, FAAN, OHSU School of Nursing; Ederlinda N. Ortiz-Clawson, Oregon Breast and Cervical Cancer Program; Emily Puukka, MS, Northwest Portland Area Indian Health Board, Northwest Tribal Registry Project; Kathryn Richert-Boe, MD, MPH, Kaiser Permanente; Liling Sherry, Northwest Tribal Cancer Control Project; DeeDee Simmons, Volunteer; Roshanthi Weerasinghe, MPH, OHSU Cancer Institute, Office of Diversity and Multicultural Affairs; Celeste Whitewolf, Native People 9s Circle of Hope PLANNING WORKGROUPS Prevention and Early Detection Co-Chairs: Stephanie Anderson Stroup, St. Charles Cancer Treatment Center; Karen Garrison, American Cancer Society Eric Aikko, Oregon Health Services, Physical Activity; Ann Blaker, Susan G. Komen Breast Cancer Foundation, Volunteer; Tomasz Beer, MD, OHSU, Oncology; Michelle Berlin, MD, MPH, OHSU Center of Excel- lence in Women 9s Health; Katherine Briant, Cancer Information Service, Pacific Region; Gary Brodowicz, PhD, Portland State University; Thomas Brundage, Oregon Health Services; K.D. Burnett, OMPRO; Amy Camburn, RN, Tuality Healthcare; Jim Chesnutt, MD, OHSU Family Medicine; John Chism, Oregon Health Services; Minot Cleveland, MD, Oregon Coalition for Promoting Physical Activity; Nancy Crumpacker, MD, Rachel 9s Friends Breast Cancer Coalition; Curtis Cude, Center for Research on Occupational and Environmental Toxicology; Catherine Cushing, Oregon Health Services; Stacy Everts, RD, OHSU Bone Narrow Program; John Fisher, PhD, Oregon Research Institute; Mark Garzotto, MD, OHSU, Urology; Sharon Genasci, NWDA Health and Environment Committee; Wayne Gilbert, MD, FACS, Kaiser Permanente Northwest; Tom Grimm, cancer survivor; Emily Ho, PhD, Oregon State University, Nutrition and Food Management; Kelly Jurman, Washington County Health Department; Dana Kaye, Tobacco Free Coalition of Oregon; Karen Kwong, MD, FACS, Veteran 9s Administration Cancer Committee; Jess Lawrence, Oregon Department of Education; David Lieberman, MD, OHSU, Gastroenterology; Diane Lund, Rachel 9s Friends Breast Cancer Coalition; Melinda M. Manore, PhD, RD, Oregon State University, Nutrition and Food Management; Jennifer Mead, Seniors and People with Disabilities; Julie McFarlane, Oregon Health Services, Women 9s Health Program; Marjorie McGee, OHSU Center of Excellence in Women 9s Health; Ron Melver, cancer survivor; David Monk, Oregon Toxics Alliance; Lew Montague, Volunteer; Joan Ottinger, Oregon Health Services; Kathryn Richert- Boe, MD, MPH, Kaiser Permanente; Jackelin Shannon, PhD, RD, OHSU Public Health and Preventive Medicine; Recinda Sherman, CTR, Oregon State Cancer Registry; Laurel J. Standley, PhD, Watershed Solutions, LLC; Angie Thompson, Multnomah County Health Depart- ment; Larry Tuttle, Center for Environmental Equity; Judith Van Osdol, BSN, RN, MHSA, Office of Medical Assistance Programs; Tony Wilcox, PhD, Oregon State University; Charlyn Wilson, Legacy Cancer Services; Amy Zlot, Oregon Health Services, Genetics Program Acknowledgements ACKNOWLEDGEMENTS Treatment and Quality of Life Co-Chairs: Sue Cook, RN, OCN, Providence St. Vincent Medical Center; Lillian M. Nail, PhD, RN, FAAN, OHSU School of Nursing Selma Annala, Legacy Health System; Paul Bascom, MD, OHSU Internal Medicine; Peggy Carey, BSN, MPA, St. Charles Medical Center; David W. Cook, MD, FACS, ACoS, Commission on Cancer; Sean P. Cosgriff, PharmD, BCOP, Portland Veteran 9s Administration Medical Center; Kimberly Earp, MBA, RT, Adventist Medical Center, Radiation Oncology; Stacey Evert, RD, LD, OHSU, Department of Food and Nutrition; Sue Frymark, RN, Cancer Care Resources; Elly Hayes, Legacy Mount Hood; Susan Hedlund, LCSW, Cancer Care Resources; Ann Jackson, Oregon Hospice Associa- tion; Jennifer Kue, IRCO/Asian Family Center; Cynthia McConnell, RN, Samaritan Regional Cancer Center; Rosemary McDermott, RN, OCN, Cancer Care Resources; Carol Misrack, RN, Oregon Health Services, Pain Management Program; Lew Montague, Volunteer; Deb Schiro, American Cancer Society; Sue Sumpter, RN, MS, Leukemia and Lymphoma Society; Eric Vinson, Northwest Portland Area Indian Health Board; Celeste Whitewolf, Native People 9s Circle of Hope Cancer Disparities Co-Chairs: Ederlinda N. Ortiz-Clawson, Oregon Breast and Cervical Cancer Program; DeeDee Simmons, Volunteer; Roshanthi Weerasinghe, MPH, OHSU Cancer Institute Kiley Ariail, Oregon Health Services, Genetics Program; Katherine Briant, MPH, Cancer Information Service, Pacific Region; Abby Bruns, Willamette Valley Medical Center; Debra Bufton, Hambleton Project; Judith Charley, Confederated Tribes of Warm Springs; Jan Dillon, Hambleton Project; Amy Drake, OHSU Center on Community Accessibility; Charles E. Drum, JD, PhD, OHSU Center on Community Accessibility; Cicelly Gabriel, Northwest Portland Area Indian Health Board; Willi Horner-Johnson, PhD, OHSU Center on Community Accessibility; Mary Jo Riggs, LPN, CTR, Samaritan Cancer Registry; Dave Rogers, American Cancer Society; Betty Tarpley, Elders in Action; Angela Weaver, OHSU Office of Health and Disability; Cheri Wick, BSN, Columbia River Oncology Program Public Policy and Legislation Co-Chairs: Michael Becker, Regence BlueCross BlueShield of Oregon; Courtni Dresser, American Cancer Society Byron Backlar, MS, JD, Volunteer, American Cancer Society; Sean DeMaio, Oregon State Cancer Registry; Andrea Easton, Oregon Medical Association; Richard Leman, MD, Oregon Health Services; Roxanne Payne, RN, OCN, Providence Health System; Paige R. Sipes- Metzler, DPA, Oregon Health Services; Jill Thompson, Oregon Health Services; Lisa White, Northwest Cancer Specialists Data Management and Surveillance Co-Chairs: Donald Austin, MD, MPH, OHSU Cancer Institute; Emily Puukka, MS, Northwest Portland Area Indian Health Board Thomas Brundage, Oregon Health Services, Environ- mental and Occupational Epidemiology; Sean DeMaio, Oregon State Cancer Registry; Elly Hayes, Oregon Cancer Registrars Association; Richard Leman, MD, Oregon Health Services; Mary Jo Riggs, LPN, CTR, Samaritan Cancer Registry; Carol Schultz, Client Services Registry Representative; Recinda Sherman, CTR, Oregon State Cancer Registry; Donald Shipley, MS, Manager, Oregon State Cancer Registry; Amy Zlot, Oregon Health Services, Genetics Program Special thanks to Word Jones, Inc. ( LeeAnn Kriegh, Jim Moore and Geena Park ) and the Cancer Plan Review Committee: Donald Austin, MD, MPH ; Emily Puukka, MS; Dave Rogers; and Roshanthi Weerasinghe, MPH We couldn 9t have done it without you! OREGON COMPREHENSIVE CANCER PLAN 2005 320103 Section 13 Executive Summary Because of the magnitude of cancer 9s burden and our limited resources, we need a coordinated statewide effort that provides every Oregonian with access to the full range of cancer services. Cancer is a complex and deadly disease that has no single cause or simple cure. As a state, we currently address cancer through a variety of approaches that include cancer prevention, treatment, survivorship and end-of-life services. This five-year plan is Oregon 9s first comprehen- sive cancer control plan. It is designed to con- solidate and further the state 9s ongoing efforts to address cancer and its consequences. The Oregon Partnership for Cancer Control (the Partnership) was formed in 2004 to develop and implement this cancer plan for Oregon. The plan was created through collaboration between individuals from more than 50 public and private organizations, with input and assistance from many cancer survivors. The plan provides a blueprint for action, guiding cancer prevention and control activities at the state, organizational and community levels. WHY DO WE NEED A COMPREHENSIVE PLAN IN OREGON? " Currently, we don 9t have a coordinated approach to cancer prevention and control. Only by working together can we optimize the state 9s limited resources and ensure that individuals receive the services they need. " We must increase our cancer prevention efforts. Three-quarters of cancers are attributed to completely preventable lifestyle behaviors, such as smoking and poor nutrition. 1 The daily impact of cancer: Each day, an average of 51 Oregonians are diagnosed with cancer, and 20 Oregonians die as a result of the disease. Source: Cancer in Oregon, 2002. Oregon 9s rank as compared to other states: " 5 th in lung cancer incidence among women. " 3 nd in breast cancer incidence. " 2 nd in mortality rate for invasive melanoma. Source: Cancer in Oregon, 2002. EXECUTIVE SUMMARY cWe do not walk through the cancer experience alone. We walk hand in hand with our partner, our traditional and extended families and the sphere of people we encounter as friends and associates. Life is an amazing gift to cancer survivors ... and for those who support them. d 3LOLLY CHAMPION (RIGHT), BREAST CANCER SURVIVOR, AND JOHN CHAMPION, BEND 1 Cancer Facts and Figures 2005. 2 Cancer in Oregon: A Call to Action, March 2004. 3 Cancer Facts and Figures 2005. 4 Cancer in Oregon, 2002. " Cancer care is extremely costly. The esti- mated economic burden of cancer in Oregon was $2 billion in 2002. That 9s $603 for every man, women and child in the state. 2 " Cancer care is complex. We must advocate for continuity of care and management, much like other chronic diseases 4especially because more than 85 percent of all cancer patients now live five or more years beyond diagnosis. 3 This statewide comprehensive cancer control approach will allow us to: "Identify ongoing activities that already con- tribute to the plan 9s goals and objectives. "Identify resources and gaps in cancer-related services at the state, regional and local levels. "Reduce duplication of services. "Promote collaborations among diverse organi- zations to implement cancer control activities. "Ensure individually and culturally appropriate cancer services for all Oregonians. "Develop effective resource and referral mecha- nisms for cancer services. This plan includes good news about Oregon 9s progress in the fight against cancer: "Across the state, more cancers are being found in early stages, thanks to improved technology and increases in cancer screening rates. "The death rate from cancer in Oregon is decreasing about 1 percent each year. 4 "Oregon has 21 Commission on Cancer programs and an active network of cancer-related health care, community and volunteer- based organizations. OREGON COMPREHENSIVE CANCER PLAN 2005 320105 This plan also identifies actions Oregonians need to take: " We must reduce deaths from cancer. Oregon 9s cancer mortality (death) rate is 25 percent above the National Healthy People 2010 objective. 5 " We must reduce cancer disparities. Some Oregonians do not receive adequate cancer screening services, and their cancers are therefore being diagnosed at later, often more life-threatening stages. Disparities also relate to age, race and ethnicity, which are increas- ingly important considerations because Oregon 9s population is rapidly aging and becoming more diverse. " We must ensure equal access to quality cancer services. The percent of uninsured Oregonians increased from 14 percent in 2002 to 17 percent in 2004. 6 " We must ensure appropriate and timely services and referrals for all Oregonians with cancer. Half of the Oregonians using hospice services are cancer patients, and the average length of service is only 15 days. 7 Baseline Measures and Targets for Change This plan includes the most current Baseline Measures and Targets for Change. These measures will help us track Oregon 9s progress in improving cancer-related services. Baseline Measures include cancer incidence, mortality and screening rates, as well as health behaviors, such as the percentage of youths and adults who smoke. Baseline Measures provide the starting point for measuring Oregon 9s progress over time. Targets for Change are 5-year goals for Oregon, based on the national health objectives set forth in Healthy People 2010. PUTTING THE PLAN INTO ACTION This cancer plan serves as a blueprint of action for individuals and organizations throughout Oregon over the next five years. The plan is divided into five sections, which address 16 individual topics. For each cancer-related topic, we describe Oregon 9s key issues, current efforts and remaining challenges. These are followed by goals, objectives and strategies that were identi- fied by the Partnership 9s workgroups. By using the plan, grass-roots organizations, local coalitions, community-based organizations, health care providers, businesses, legislators and other Oregonians can become part of a state- wide effort to battle cancer in a unified manner. EXECUTIVE SUMMARY SUMMARY OF GOALS TO BE ACHIEVED BY 2010 SECTION I. Prevention and Early Detection Prevention Goals " Tobacco and Related Cancers: Decrease the incidence and impact of tobacco-related cancers among all Oregonians. " Physical Activity and Nutrition: Increase Oregon 9s community support and promotion of healthy eating, daily physical activity and healthy weight as a means of cancer preven- tion and risk reduction. " Environmental Risk Factors: Reduce the risk among all Oregonians of cancers related to environmental carcinogens. " Genetics: Increase awareness and knowledge among all Oregonians about genetic factors that influence individual cancer risk. Early Detection Goals " Breast Cancer Screening: Reduce deaths from breast cancer among Oregon women. " Cervical Cancer Screening: Prevent all cases of invasive cervical cancer among Oregon women, and reduce deaths from cervical cancer. " Colorectal Cancer Screening: Reduce deaths from colorectal cancer among all Oregonians. " Prostate Cancer: Reduce deaths from pros- tate cancer among all Oregon men. Increase informed and shared decision-making between men and their health care providers regarding the risks and benefits of prostate cancer screening and treatment. " Skin Protection and Melanoma Prevention: Reduce skin cancers and deaths from mela- noma among all Oregonians. This cancer plan 9s five sections are: Section I. Prevention and Early Detection. Section II. Cancer Treatment and Quality of Life. Section III. Cancer Disparities. Section IV. Public Policy and Legislation. Section V. Data Management and Surveillance. OREGON COMPREHENSIVE CANCER PLAN 2005 320107 5 Cancer in Oregon, 2002. 6 Office for Oregon Health Policy and Research, January 2005. 7 Oregon Hospice Association, 2002. GOAL: An overarching goal of this cancer plan is promotion of universal access to health care and continuity of cancer care services for all Oregonians. SECTION III. Cancer Disparities The goal is to eliminate cancer disparities in Oregon through incremental reductions, with a focus on public, patient and provider education, research, data and public policy. SECTION IV. Public Policy and Legislation The goal is to achieve the public policy objec- tives of this comprehensive cancer plan, as related to cancer prevention, early detection, treatment and cancer surveillance. This involves a three-tiered approach that includes a policy committee, a legislative cancer caucus and grass- roots advocacy. SECTION II. Cancer Treatment and Quality of Life " Access to Quality Cancer Treatment: Ensure that all Oregonians have access to quality cancer treatment and information services that are culturally and individually appropriate by age, financial situation and geographic location. " Symptom Management: Ensure that all Oregonians with cancer receive information and treatment for effective management of the side effects and symptoms of their cancer treatment. The information and treatment should be culturally and individually appro- priate by age, financial situation and geo- graphic location. " Survivorship: Improve cancer survivors 9 quality of life through services that address the physical, emotional, social and vocational challenges of survivorship. " Palliative Care and End-of-Life Issues: Ensure that all Oregonians have access to and utilize high-quality palliative and hospice care that is culturally and individually appropriate by age, financial situation and geographic location. EXECUTIVE SUMMARY SECTION V. Data Management and Surveillance The goal is to fully implement cancer surveil- lance 4the collection, analysis, dissemination and utilization of cancer information 4for Oregon 9s Comprehensive Cancer Plan. A Cancer Surveillance Advisory Workgroup will be established to ensure design of an appropriate evaluation for each objective in this plan and to identify a source of data on which to base each evaluation. PLEASE JOIN US! Please join the Partnership as we work together to reduce the burden of cancer in Oregon through a shared vision, mutual goals and collective action. We look forward to reporting each year on our statewide progress toward meeting the goals and objectives detailed in this cancer plan. OREGON COMPREHENSIVE CANCER PLAN 2005 320109 The Face of Cancer in Oregon While statistics cannot convey the emotional toll that cancer takes on Oregonians, the data and trends reported below may help us better understand cancer 9s enormous impact on our state and its citizens. Each day in 2002, an average of 51 Oregonians were diagnosed with cancer, and another 20 Oregonians died of cancer. As shown in Figure 1, below, cancer surpassed heart disease in 2000 to become the leading cause of death among Oregonians, causing one of every four deaths in the state. 1 Estimates indicate that nearly half (46 percent) of males and four out of 10 females (38 percent) will develop cancer at some point in their lifetime. 2 The primary causes or contributors to cancer are lifestyle factors, inherited risk and tobacco, as described below: "Approximately one-third of all cancer deaths in 2005 will be related to lifestyle-related factors such as poor nutrition, physical inactivity, obesity and being overweight. "Inherited risk (passed from parents to chil- dren) causes between 5 and 30 percent of all cancers. 3 "In 2002, tobacco contributed to 23 percent of all deaths in Oregon. 4 cMore than 60 percent of all cancer deaths could be prevented if Americans stopped smoking, exercised more, ate healthier food and got the recommended cancer screenings. d 3THE AMERICAN CANCER SOCIETY, REPORTED ON MARCH 31, 2005. Leading Causes of Death Historical Trends, Oregon 1996 32002 Source: Cancer in Oregon, 2002. Figure 1 250 225 200 175 150 125 100 75 50 1996 1997 1998 1999 2000 2001 2002 YEAR All Cancers Heart Disease Stroke DEATHS PER 100,000 Section 13 The Face of Cancer in Oregon THE FACE OF CANCER IN OREGON THE COSTS OF CANCER IN OREGON The estimated economic costs of cancer are tremendous. Oregon Health Services estimates that in the year 2000, cancer-related hospitaliza- tions alone cost $210 million. If we consider indirect expenses such as loss of productivity from disability and death, the economic burden of cancer in 2000 was more than $2 billion dollars. That 9s $603 for every man, woman and child in Oregon. 5 CANCER IN OREGON: WHAT THE DATA TELL US The Oregon State Cancer Registry (OSCaR) collects data from hospital registries and physi- cians throughout the state. The registry analyzes new cancer cases (incidence), deaths (mortality) and stage of diagnosis (in situ, localized, re- gional and distant) data. The registry 9s cCancer in Oregon d annual reports provide state, re- gional and county data, as well as five-year trends and comparisons between Oregon and national cancer rates (www.healthoregon.org/ cancer). 1 Cancer in Oregon, 2002. 2 SEER Cancer Statistics Review, 1975 32001. 3 National Cancer Institute, PDQ, Genetics, 2004. 4 Oregon Death Certificate Statistical File, 2002. 5 Cancer in Oregon: A Call to Action, March 2004. MOST COMMON CANCERS While more than 100 different types of cancer exist, over half of the cancers diagnosed among Oregonians each year are one of four types: breast, prostate, lung or colorectal. Most Commonly Diagnosed Cancers in Oregon Cancer SiteNo. of People 1. Breast3,293 2. Prostate2,519 3. Lung2,446 4. Colorectal1,799 5. Melanoma1,613 Source: Cancer in Oregon, 2002. OREGON COMPREHENSIVE CANCER PLAN 2005 3201011 CANCER INCIDENCE In 2002, 18,713 new cases of cancer were diagnosed among Oregonians. Nationally, Oregon men ranked 23rd for all-cancer inci- dence and Oregon women ranked eighth. Oregon women ranked among the nation 9s top 10 due to the state 9s high incidence rates of breast and lung cancers. For the 10 most common cancers for males and females, Figures 2 and 3 show the number of new invasive cases and the number of deaths in Oregon, in 2002. 6 Overall, men have a higher incidence rate of invasive cancers and a higher mortality rate than women. For several cancers, Oregon 9s incidence rates are very high. In 2002, Oregon ranked: "Fifth in the nation for lung cancer among women. "Third in the nation for breast cancer. Between 1998 and 2002, female breast cancer and colorectal cancer increased 1 percent each year in Oregon, and prostate cancer increased 4 percent each year. Lung cancer decreased 1 percent each year, and colorectal cancer incidence decreased 2.6 percent each year. Leading Sites 4Cancer Incidence and Mortality, Oregon Males, 2002 Prostate Lung and Bronchus Colorectal Urinary Bladder Melanomas of the Skin Lymphomas Kidney and Renal Pelvis Oral Cavity and Pharynx Leukemia Pancreas Source: Cancer in Oregon, 2002. Figure 2 500 1000 1 500 2000 2500 NUMBER OF CASES Male Incidence Male Mortality Leading Sites 4Cancer Incidence and Mortality, Oregon Females, 2002 Breast Lung and Bronchus Colorectal Uterine Lymphomas Melanomas of the Skin Ovary Pancreas Urinary Bladder Thyroid Source: Cancer in Oregon, 2002. Figure 3 500 1000 1500 2000 2500 NUMBER OF CASES Female Incidence Female Mortality THE FACE OF CANCER IN OREGON 6 Cancer in Oregon, 2002. 7 Ibid. STAGE OF DIAGNOSIS For all the cancers diagnosed between 1998 and 2002, more were diagnosed in early stages (defined as in situ and localized stages). Diag- noses of early-stage colorectal cancer increased among women, and early-stage prostate cancer diagnoses increased among men. In situ breast cancer among women also increased, while there was a decrease in early-stage diagnosis of cervical cancer. There were geographic differences in the stages at which cancer was diagnosed in Oregon between 1998 and 2002. Figure 4 shows that the percentage of early-stage diagnoses is gener- ally lower in eastern Oregon and higher in western Oregon. 7 These differences may be attributed to differences in cancer reporting, screening practices and lifestyle behaviors. All Cancer Incidence in Oregon Percentage of Early-Stage Diagnosis Regional Variation, 1998 32002 Source: Cancer in Oregon, 2002. Below Average State Average Above Average Figure 4 OREGON COMPREHENSIVE CANCER PLAN 2005 3201013 CANCER MORTALITY An estimated 7,360 individuals in Oregon will die from cancer in 2005. 8 Oregon 9s mortality rate due to cancer declined 1 percent each year since 1996, but remains higher than the national mortality rate. In 2002, Oregon 9s overall cancer mortality rate was 199.2 deaths per 100,000 in population. This is 25 percent above the national Healthy People 2010 target of 159.9 deaths per 100,000. For Oregon males, the mortality rate was 246.1 per 100,000. For Oregon females, it was 173.2 per 100,000. Between 1999 and 2002, Oregon 9s mortality rates for lung cancer and melanoma were far higher than Healthy People 2010 targets. Oregon 9s lung cancer mortality rate, 56.7 deaths per 100,000, was 26 percent above the Healthy People 2010 target of 44.9 deaths per 100,000. Oregon 9s melanoma mortality rate was the second highest in the nation. During the five-year period between 1998 and 2002, Oregon 9s breast, prostate and colorectal cancer mortality rates decreased among women, and lung cancer mortality rates decreased among men. Men 9s mortality rates due to colorectal cancer remained stable during this period but decreased 3.6 percent each year among Oregon women. This decease is likely due to a combination of improved screening, early-stage diagnosis and enhanced treatment. Figure 5 shows the reduction in deaths for cscreenable d cancers by comparing figures from 1996 and 2002. Only cervical cancer failed to show a decrease in mortality rate over these years. 9 Screenable Cancers Age-Adjusted Mortality Rates Oregon, 1996, 2002 40 30 20 10 0 Source: Cancer in Oregon, 2002. Figure 5 Female Breast Cervical Colorectal Prostate RATES PER 100,000 0 1996 2002 Leading Causes of Cancer Deaths in Oregon Cancer SiteNo. of People 1. Lung2,057 2. Colorectal665 3. Breast501 4. Prostate435 5. Bladder200 6. Melanoma123 Source: Cancer in Oregon, 2002. THE FACE OF CANCER IN OREGON OREGON DEMOGRAPHICS: THE IMPACT ON CANCER BURDEN Oregon 9s population is changing rapidly, both in age distribution and racial and ethnic composi- tion. While the state 9s 3.5 million residents are mostly White (87 percent), the Hispanic popu- lation makes up 9.2 percent of Oregon 9s popula- tion and is expected to continue its rapid growth. 10 In addition, the U.S. Census predicts Oregon 9s Native American population will increase by 9 percent by 2010, and Oregon 9s African American population will grow by 11 percent. 11 Given these statistics, further assessment of the impact of cancer on Oregon 9s population must include examination of variables such as age, gender, race, ethnicity, geographic location and the percent of Oregonians without health insurance. AGE Cancer risk increases with age, and Oregon 9s population is rapidly aging. According to U.S. Census figures from 2003, 12.8 percent of Oregonians are age 65 or over. The size of this age group is expected to almost double by 2020, which will have serious implications for Medic- aid and Medicare programs, and for the health care system as a whole. 8 Cancer Facts and Figures 2005. 9 Cancer in Oregon, 2002. 10 U.S. Census, 2003. 11 Office for Oregon Health Policy and Research, January 2005. The incidence of cancers among children in Oregon (0 314 years of age) is low compared to adults. In 2002, there were 115 invasive cancers diagnosed in Oregon children and 19 children died from cancer. GENDER, RACE AND ETHNICITY Figure 6 shows cancer incidence and mortality rates by race and ethnicity. As is seen nationally, African American men in Oregon have the highest rate of cancer incidence and mortality, with Whites second. Among all racial groups, Asian/Pacific Islanders had Oregon 9s lowest rates of cancer incidence and mortality. Oregon Cancer Incidences & Mortality Age-Adjusted Rates, 1996 32002 Race and Ethnicity 500 250 0 Source: Cancer in Oregon, 2002. Figure 6 Female Breast Cororectal Prostate RATES PER 100,000 0 Incidence Mortality White African American American Indian/ Alaskan Natives Asian/Pacific Islander Hispanic Non-Hispanic OREGON COMPREHENSIVE CANCER PLAN 2005 3201015 Among Oregon men, lung cancer was the most common cause of cancer death for all racial and ethnic groups. For women, lung cancer was also the leading cause of cancer death, except among the Asian/Pacific Islander and White Hispanic populations. For women in these two groups, breast cancer was the leading cause of cancer death. Liver and bile duct cancers are among the top five cancer-related causes of death only in the Asian/Pacific Islander population. 12 Whites have the highest percentage of cancers diagnosed at an early stage, while American Indian/Alaskan Natives have the lowest. Hispan- ics also have a lower percentage of cases diag- nosed at an early stage than non-Hispanics. Oregon 9s Asian/Pacific Islander and Hispanic populations have lower incidences of lung, colorectal, breast and prostate cancers, and lower mortality rates for lung, colorectal, breast and prostate cancers than all other racial groups. Historically, Oregon 9s American Indian/Alaskan Native (AI/AN) population has had the lowest incidence rate of cancer across all racial ethnic groups. However, when AI/AN individuals are properly classified, AI/AN incidence rates are substantially higher. OSCaR links each year with local and national tribal registries to correct racial coding. With these corrections, Oregon may have a higher AI/AN rate than those seen nationally. OREGON 9S RURAL GEOGRAPHY Among Oregon 9s 36 counties, the Office of Rural Health designated 105 rural service areas as having unmet health care needs. 13 The dis- tance to cancer screening and treatment services can impact use of recommended screening or treatment services. For example, in eastern Oregon, a woman may need to travel 120 miles to receive a mammogram. Figure 7 shows the population designation of Oregon 9s 36 counties as frontier, rural or urban. A frontier county has fewer than six persons per square mile; a rural county has no city with a population of more than 50,000; and an urban county has one or more cities with more than 50,000 people or a total population of more than 100,000. Population Designation: Frontier, Rural and Urban Source: Cancer in Oregon, 2002. Counties: Frontier Rural Urban Figure 7 THE FACE OF CANCER IN OREGON HEALTH INSURANCE COVERAGE Many factors influence health insurance rates, including the economy and employment rates. Oregon 9s recent high unemployment rates, increasingly expensive health insurance premi- ums and the shrinking of the Oregon Health Plan contribute to Oregon 9s growing uninsured population. Figure 8 shows the percent of Oregon 9s popula- tion without health insurance between 1990 and 2004. During this 14-year period, the highest percent of the state 9s population without insurance was 18 percent in 1992, while the lowest was 11 percent in 1996. Most recently, the percentage of uninsured Oregonians increased from 14 percent in 2002 to 17 percent in 2004. At 17 percent, an esti- mated 609,000 individuals, or one out of six Oregonians, lacked health insurance. 14 12 Cancer in Oregon, 2002. 13 Office of Rural Health, 2004. 14 Office for Oregon Health Policy and Research, January 2005. OREGON 9S CALL TO ACTION To reduce the burden of cancer among Orego- nians, we need to ensure equal access to cancer prevention, screening and treatment services. We must remove barriers to cancer services across the continuum of care for Oregon 9s increasingly diverse communities. The solutions lie in creative collaborations among partners at state, regional and commu- nity levels. Source: Cancer in Oregon, 2002. Figure 8 Percent Without Health Insurance in Oregon, 1990 32004 20 10 0 1990 1992 199 4 1996 1998 2000 2002 2004 OREGON COMPREHENSIVE CANCER PLAN 2005 3201017 PERCENT UNINSURED YEAR CANCER CONTROL PLANNING AND IMPLEMENTATION In 2002, a group of 12 volunteers from public health, health care, volunteer and health insur- ance organizations planted the seeds for the foundation of the Oregon Partnership for Cancer Control (the Partnership). In 2004, the Partnership officially formed to develop Oregon 9s first statewide, comprehensive cancer plan. The steps in the planning process were as follows: "The Partnership (www.healthoregon.org/ cancer) was formed in March 2004, guided by a 20-member Coordinating Committee. "Five planning workgroups drafted goals, objectives and strategies for 16 priority topics. The workgroups reviewed cancer incidence rates, mortality data and screening rates, and assessed local, state and national resources. The workgroups selected topics based on numbers of individuals affected, availability of evidence-based interventions, existing state and local resources, and feasibility of implementation. "More than 85 meetings were held, with 20 percent of participants coming from outside the Portland metropolitan area. "The Coordinating Committee reviewed draft goals, which were then placed on the Web site for a public review and comment period. The Oregon Partnership for Cancer Control The five planning workgroups: 1. Prevention and Early Detection. 2. Cancer Treatment and Quality of Life. 3. Cancer Disparities. 4. Public Policy and Legislation. 5. Data Management and Surveillance. THE OREGON PARTNERSHIP FOR CANCER CONTROL Implementation of the Cancer Plan: This five-year cancer plan serves as a blueprint for action by individuals and organizations throughout the state. The Partnership will link individuals and organizations with mutual goals and priorities, and define short-term and long- term activities for cancer control. The Partnership will: "Convene implementation workgroups: Prevention and Early Detection, Cancer Treatment and Cancer Disparities. "Form standing committees: Cancer Surveillance Advisory Workgroup (CSAW), Public Policy Committee. "Continue to assess resources and activities of individuals and organizations. "Develop networks for resource sharing. "Evaluate Partnership efforts. Organization of the Cancer Plan: The plan contains five sections and 16 topics. For each topic, a brief narrative describes key issues, current efforts and remaining challenges. This is followed by information about the most current baseline measures for screening rates, health behaviors, cancer incidence and mortality rates. Where applicable, National Healthy People 2010 objectives are noted as cTargets for Change. d Each topic concludes with a list of goals, objectives and strategies. Implementation of this statewide cancer plan depends on effective evaluation. For this reason, we will track progress towards goals and objec- tives on an annual basis, and the Coordinating Committee will produce an annual report. Together we can make cancer history. For more information about the Partnership, visit our Web site: www.healthoregon.org/cancer. OREGON COMPREHENSIVE CANCER PLAN 2005 3201019 Guiding Principles for Comprehensive Cancer Control in Oregon 1.Everyone in Oregon will be touched by cancer at some time. Thus, cancer control is the responsibility of all Oregonians 4public and private organizations, individual citi- zens, communities, families and businesses. 2.This cancer plan promotes a common vision for Oregon 9s cancer control activities, from prevention and early detection through treatment, rehabilitation, end of life and cancer survivorship. 3.This cancer plan is a roadmap of the efforts needed in Oregon to reduce the state 9s cancer burden. The plan is to be used to establish priorities for action 4opportunities to work together to address the greatest needs and perform the most achievable, realistic actions. 4.This cancer plan actively supports the recommendations and strategies found in other statewide plans that address cancer- related activities, such as the Oregon State- wide Tobacco Control Plan 2005 32010, A Healthy Active Oregon Statewide Physical Activity and Nutrition Plans 2003, and Healthy Kids Learn Better. 5.The Partnership seeks to recognize and enhance the many worthwhile and effective efforts of dedicated individuals and organizations that contribute to Oregon 9s cancer control efforts. 6.Special emphasis in this plan will be given to Oregon 9s urban and rural communities, as well as underserved populations that may face cancer disparities. 7.The statewide cancer control plan will define priority activities to be implemented by a broad range of partners. 8.The Partnership understands the need for cultural competency among Oregon 9s health professionals and health systems to achieve effective communication and the best possible cancer care. 9.The Partnership will advocate for individual, organizational, community and environ- mental conditions that promote healthy behaviors to reduce cancer risk. 10. Data and evaluation are integral compo- nents of all comprehensive cancer control activities and will guide decision-making. 11.The Partnership members will seek funding sources, as needed, to implement priority activities. 12. The Partnership will establish and maintain mechanisms to share information, resources and progress of individuals and organiza- tions throughout the state. GUIDING PRINCIPLES FOR COMPREHENSIVE CANCER CONTROL IN OREGON Oregon 9s Call to Action, 2005 32010 GOALS, OBJECTIVES AND STRATEGIES SECTION I.Prevention and Early Detection SECTION II.Treatment and Quality of Life SECTION III.Cancer Disparities SECTION IV.Public Policy and Legislation SECTION V.Data Management and Surveillance OREGON COMPREHENSIVE CANCER PLAN 2005 3201021 Section I. Prevention and Early Detection KEY ISSUES In the nine Prevention and Early Detection chapters that follow, we discuss lifestyle and behavioral changes through which we can prevent many cancers from occurring. We also discuss proven methods for early detection of cancer, such as Pap tests and mammograms. Early detection means screening when there are no symptoms of a problem. Regular cancer screening examinations by a health professional can find cancer at its earliest stage, when treat- ment is most effective and the chances for survival are increased. Screening can effectively detect breast, cervix and colon cancer. Some cancers, such as cervical and colorectal, can actually be found and treated in a pre-cancerous condition 4before cancer even develops. Other cancers, such as oral cavity and skin cancers, can be found by noting changes in the look or feel of an area. CURRENT EFFORTS In Oregon, many efforts promote healthy behaviors that reduce cancer risk and prevent cancer-related deaths in children and adults. These efforts are outlined in the chapters that follow, each of which defines a concern and discusses key issues, current efforts and remain- ing challenges. At the end of each chapter, objectives and strategies define actions that individuals and organizations in Oregon can take, such as creating supportive environments to contribute to cancer control efforts. Cancer control depends on preventing cancer whenever possible and 4when cancer does occur 4detecting it at the earliest possible stage. Cancer Risk Factors "Age. "Gender. "Lifestyle behaviors such as lack of physical activity, poor nutrition and use of tobacco and alcohol. "Genetics. "Environmental exposures. "Infectious agents such as Hepatitis B and C and Human Papilloma Virus. Overall Goals Prevention and Early Detection: "Promote healthy behaviors that can reduce cancer risk. "Promote screening for early detection of cancer. "Reduce deaths from cancer. SECTION I.PREVENTION AND EARLY DETECTION cI 9m sick and tired of all the talk about a cure. If we 9re ever going to conquer cancer, it 9s time to focus our efforts on prevention. d 3DIANE LUND-MUZIKANT, 9-YEAR BREAST CANCER SURVIVOR, PORTLAND The nine Prevention and Early Detection topics in this section were selected based on: "The number of Oregonians affected. "The available and known interventions, such as screening to reduce cancer risk and deaths, and the identification of specific at-risk populations. The prevention topics in this section are: "Tobacco and Related Cancers. "Physical Activity and Nutrition. "Environmental Risk Factors. "Genetics. The early-detection topics are: "Breast, Cancer Screening (in Women). "Cervical Cancer Screening. "Colorectal Cancer Screening. "Prostate Cancer. "Skin Protection and Melanoma Prevention. Key Cancer Prevention Messages Source: Modifiable Risk Factors of Cancer, C.J. Stein and G.A. Colditz, The British Journal of Cancer. Vol. 90, #2, 2004, pgs. 209 3303. Bladd er Breast Cervical Colorectal O esophageal Kidney Lung Oral Pancreatic Prostate Skin Stomach Uterus Limit number of sexual partners and use condoms. Avoid tobacco use. Be physically active. Maintain a healthy weight. Eat a healthy diet. Limit alcohol. Get appropriate cancer screening tests. Avoid excess sun exposure. Prevention Strategy OREGON COMPREHENSIVE CANCER PLAN 2005 3201023 CANCER RISK REDUCTION BENEFIT Section I. Tobacco and Related Cancers KEY ISSUES Simply put, tobacco use kills: "Lung cancer is the leading cause of cancer death in Oregon, and in 2002, Oregon ranked fifth in the nation in lung cancer deaths among women. 1 "Tobacco use leads to lung, oral, bladder, cervical, pancreatic and gastrointestinal cancer, among many others. "Each year, 7,000 Oregonians die from tobacco use. "Nationwide, tobacco use kills more people than motor vehicle crashes, suicide, AIDS and murders combined. Despite the dangers of use, half a million Oregonians smoke cigarettes, and 75,000 chew tobacco. Three out of four smokers say they want to quit, and 27 percent say they are planning to quit within the next 30 days. 2 Helping tobacco users quit, and preventing others from starting, would save lives 4and millions of dollars each year: 3 "Tobacco use cost Oregonians a total of $1.8 billion in 2000. "The direct cost of tobacco use to Oregon 9s health care system was nearly $9 million in 2000. CURRENT EFFORTS The 2004 Surgeon General 9s Report states the need for a ccomprehensive approach d to cancer prevention and smoking cessation. According to the report, the best approach is cone that optimizes synergy from a mix of educational, clinical, regulatory, economic and social strategies. d Tobacco use is Oregon 9s and the nation 9s leading preventable cause of disease and death. Each year, tobacco use costs Oregonians more than we can afford to pay 4both in the thousands of lives lost and the billions of dollars spent on treatment and care. In Oregon, tobacco use is higher in these communities: "African Americans. "Native Americans. "18- to 24-year-olds. "Some Asian/Pacific Islander groups. "Persons of low socioeconomic status. "Gay, lesbian, bisexual and transgender persons. "Some rural and frontier counties. Source: Closing the Gaps: Identifying and Eliminating Tobacco-Related Disparities in Oregon, 2002. Lung Cancer Facts "Lung cancer is the leading cause of cancer death among men and women in Oregon. "In 2002, lung cancer killed 2,444 Oregonians. "In 2002, Oregon women had the fifth-highest death rate in the U.S. for lung cancer. Source: Cancer in Oregon, 2002. SECTION I.PREVENTION AND EARLY DETECTION TOBACCO AND RELATED CANCERS Oregon 9s comprehensive approach includes wise investment in tobacco control efforts, resulting in a dramatic reduction since 1996 in tobacco use by both adults and children. Compared to 1996, Oregon now has 75,000 fewer smokers, two billion fewer cigarettes sold each year and 63 percent fewer eighth graders who smoke. 4 Oregon 9s tobacco prevention activities involve private citizens, state and local coalitions, schools, businesses, health care providers and community organizations. Our current tobacco control efforts include: "Public policies such as Ballot Measure 44, which increased the tobacco tax by 30 cents, and the Indoor Clean Air Act, which protects over 95 percent of Oregon employees from secondhand smoke at work. "Educational efforts in schools, businesses and workplaces about the health effects of tobacco use. "Education about how to quit smoking, through sources such as the Oregon Quit Line (1-877-270-STOP). REMAINING CHALLENGES We know that to reduce tobacco use in Oregon, we must tackle the problem from several directions at once. Many factors influence a person 9s decision to use tobacco, so effective tobacco prevention techniques come from many angles at once 4including where people live, work and play. Our continued success requires continued investment in a healthy Oregon. A responsible approach to tobacco control: "Keeps kids from starting. "Protects people from secondhand smoke. "Helps people quit smoking. cI lost my mother to lung cancer. She was only 59 years old. Please keep funding education about cancer and the effects it has on our lives. d 3VIKKI GALANOPOULOS, TIGARD 1 Cancer in Oregon, 2002. 2 Oregon Behaviorial Risk Factor Surveillance System (BRFSS), 2003. 3 Oregon Tobacco Facts, 2003. 4 Tobacco Prevention and Education Program Report, 2003 32005. OREGON COMPREHENSIVE CANCER PLAN 2005 3201025 GOAL: Decrease the incidence and impact of tobacco-related cancers among all Oregonians. OBJECTIVE 1: Increase the percentage of Oregonians who do not use tobacco products. Oregon 9s tobacco control community has been formally organized since 1994. Many of the goals, objectives and strategies in this plan are taken from the Oregon Statewide Tobacco Control Plan 2005 32010, which was developed by over 30 statewide and local tobacco control advocates, and is available at: www.healthoregon.org/tobacco TOBACCO AND RELATED CANCERS Baseline Measures: Tobacco Youth smoking 8th graders11% 11th graders19% Source: Oregon Healthy Teen Survey, 2003. Adult smoking21% Smoking in homes17% Source: Behavioral Risk Factor Surveillance System, 2003. Strategies: "Raise tobacco taxes. "Increase and stabilize funding for comprehensive tobacco control programs. "Implement goals identified by the Tobacco Disparities Planning Project 2002, in cClosing the Gaps: Identi- fying and Eliminating Tobacco Related Disparities in Oregon d (www.healthoregon.org/tobacco). "Stabilize resources to ensure that comprehensive tobacco programs are available to every school districts in Oregon. "Conduct a statewide tobacco control public education and awareness campaign. "Provide tobacco cessation resources through partner- ships between public agencies and private businesses. "Increase the proportion of Oregonians who want to quit, have access to cessation resources and use available resources. SECTION I.PREVENTION AND EARLY DETECTION TOBACCO AND RELATED CANCERS OBJECTIVE 2: Increase the percentage of Oregonians who are not exposed to secondhand smoke. Strategies: "Protect all workers from exposure to secondhand smoke by closing the loopholes in the Indoor Clean Air Act. "Conduct an effective education and awareness campaign about the dangers of secondhand smoke. "Increase resources dedicated to enforcement of the Indoor Clean Air Act. "Increase the number of Oregonians reporting a policy against smoking in their homes and cars. OBJECTIVE 3: Increase the proportion of health care providers who counsel patients about tobacco cessation. Strategies: "Educate physicians and other health care providers about the c5 A 9s d for reducing tobacco use. "Promote the widespread use of the 5 A 9s in health care systems. The c5 A 9s d for health care providers to help people quit smoking: A sk about tobacco use. A dvise to quit. A ssess willingness to make a quit attempt. A ssist in quit attempts. A rrange follow-up. Source: Treating Tobacco Use and Dependence, Clinical Practice Guidelines, 2000. OBJECTIVE 4: Monitor the scientific litera- ture for evidence-based cancer screening for tobacco-related cancers. Strategies: "Review the literature for advances in screening technology for disease such as lung cancer. "Promote the use of evidence-based screening for tobacco-related cancers. OREGON COMPREHENSIVE CANCER PLAN 2005 3201027 Section I. Physical Activity and Nutrition KEY ISSUES Unhealthy eating and lack of physical activity lead to obesity, and in 2000, obesity was associated with 112,000 deaths nationwide. The statistics, gathered in 2003, are staggering: 1 "58 percent of Oregon adults are overweight or obese. "23 percent of Oregon 9s eighth graders are overweight or at risk of becoming overweight. "At 21 percent, Oregon 9s rate of adult obesity is the highest of any state west of the Rockies. "Between 1990 and 2003, the number of overweight adults in Oregon increased 92 percent. "Just 50 percent of Oregonians meet the Surgeon General 9s recommendations for physical activity. "Only 24 percent of Oregonians eat the recommended amount of fruits and vegetables a day. The situation is not hopeless. Changing our environment and habits can result in significant health benefits. According to the Surgeon General, you can obtain significant health benefits through moderate physical activities such as 30 minutes of brisk walking, and by eating five or more fruits and vegetables a day. In 1997, the American Institute for Cancer Research estimated that a healthy diet and physical activity may reduce the incidence of cancer by the following percentages: "Colon, rectum66 375% "Breast33 350% "Stomach66 375% "Prostate, endometrium, cervix, bladder, thyroid10 320% Poor nutrition and physical inactivity contribute significantly to each of the leading causes of disease and death in Oregonians: cancer, obesity, heart disease and diabetes. Eating right and being physically active is more than just a good idea 4it 9s a matter of life and death. cObesity is not just a matter of personal health 4it 9s a costly and deadly public health concern that affects economic productivity, state budgets, and personal and family well-being. d 3NATIONAL GOVERNORS ASSOCIATION CENTER FOR BEST PRACTICES, ISSUE BRIEF, JUNE 13, 2002. SECTION I.PREVENTION AND EARLY DETECTION PHYSICAL ACTIVITY AND NUTRITION cEarly detection, treatment and cure is the answer to surviving cancer. We need ongo- ing support of screening programs and every dollar possible for cancer research. d 3KATHY GILLESSE, SALEM CURRENT EFFORTS In response to the obesity epidemic, Oregon has taken action. In 2003, Oregon produced its first statewide physical activity and nutrition plans. These plans outline strategies to address policy and environmental changes that will make healthy choices easy choices for children and adults in Oregon 9s schools, worksites and communities. In 2004, Healthy Active Oregon teams formed in rural and urban communities to address environmental and policy changes, and to promote healthy behaviors. Oregon also sup- ports national campaigns that promote healthy eating and physical activity for children and adults, such as the 5 A Day Campaign, Walk to School Day and TV Turn-Off Week. Bills introduced in Oregon 9s 2005 legislative session include restrictions on foods sold at schools that are not part of the school lunch program, and requirements for physical education in schools. REMAINING CHALLENGES The following are among the challenges we need to address: "Many school education policies do not require adequate physical education classes for students. "Few worksite health promotion policies exist that promote and enable physical activity and healthy eating. "Many communities do not support and promote daily physical activity, healthy eating and maintaining a healthy weight. "Few restaurants provide easily accessible and clear nutrition information about menu items. 1 Oregon Overweight, Obesity, Physical Activity and Nutrition Facts, September 2004. OREGON COMPREHENSIVE CANCER PLAN 2005 3201029 GOAL: Increase Oregon 9s community support and promotion of healthy eating, daily physical activity and healthy weight as a means of cancer prevention and risk reduction. OBJECTIVE 1: Increase the percentage of Oregon youth and adults who engage in moderate, daily physical activity. The goals, objectives and strategies in this plan are taken from A Healthy Active Oregon: The Statewide Public Health Nutrition Plan and The Statewide Physical Activity Plan, February 2003. These plans were developed by the Oregon Coalition for Promoting Physical Activity and the Nutrition Council of Oregon: www.healthoregon.org/hpcdp/ physicalactivityandnutrition PHYSICAL ACTIVITY Baseline Measures: Physical Activity Percent with moderate physical activity: Children*8th graders80% 11th graders70% Adults**38% *Source: Oregon Healthy Teen Survey, 2003. **Source: Behavioral Risk Factor Surveillance System, 2003. Strategies: "Promote daily physical activity in schools by increasing the percentage of school-age youth who participate in daily physical activity through physical education classes, sports and other organized, school-based activities. "Promote daily physical activity in worksites by increasing the percentage of worksites that support and promote opportunities for physical activity among their employees and their communities. "Promote daily physical activity in communities by increasing the opportunities for physical activity at neighborhood community centers and through parks and recreation programs. Promote development of walking and biking trails and lanes, and walkable sidewalks. "Promote daily physical activity in health care settings by increasing the number of health care systems and providers who support and promote physical activity among their employees, patients and communities. "Recommend that health care professionals imple- ment a screening protocol for cancer risk with patients who are overweight or obese. SECTION I.PREVENTION AND EARLY DETECTION PHYSICAL ACTIVITY AND NUTRITION OBJECTIVE 2: Promote environmental and policy changes to increase physical activities in Oregon communities. Strategies: "Mandate changes in elementary, middle and high school policies, requiring provision of daily physical activity not limited to physical education classes. "Improve land-use development policies to increase the number of communities where transportation and land-use planning encourage daily physical activity. "Improve community and environmental design policies to enable and promote facilities for recreation, green spaces, parks, walkable sidewalks and interconnected trails in all neighborhoods and communities. "Modify insurance-industry policies to provide incentives for physical activity by reducing life- and health-insurance premiums for individuals who participate in regular physical activity. OREGON COMPREHENSIVE CANCER PLAN 2005 3201031 OBJECTIVE 1: Increase the percentage of Oregon 9s youth and adults who consume at least five daily servings of fruits and vegetables. NUTRITION NUTRITION Baseline Measures: Nutrition "Increase promotion of c5 A Day d messages in local public health, community, state and school nutrition and health programs through increased access to training, technical assistance and funding. "Increase access to fruits and vegetables in schools, worksites and communities. "Work with the Oregon 5 A Day Partnership to meet established goals. "Use information created by the 5 A Day Program in cancer programming and events. OBJECTIVE 2: Increase the percentage of youth and adults in Oregon who are at a healthy weight. Strategies: "Increase public awareness of the importance of healthy eating, daily physical activity and maintaining healthy weight to reduce cancer risk; also, increase awareness of the need for supportive policies and environments. "Increase awareness and knowledge among local and state policymakers and decision-makers about the connections between healthy eating, daily physical activity, obesity and cancer; about the impacts of these issues on health outcomes and economic costs in Oregon; and about the benefits of policy interventions. Percent who consume five or more fruits and vegetables a day: Children*8th graders27% 11th graders23% Adults**24% Percent overweight or at risk of becoming overweight: Children*8th graders23% 11th graders22% Percent overweight: Adults**37% Percent obese: Adults**21% *Source: Oregon Healthy Teen Survey, 2003. **Source: Behavioral Risk Factor Surveillance System, 2003. SECTION I.PREVENTION AND EARLY DETECTION PHYSICAL ACTIVITY AND NUTRITION Recommendations for individual choices: 1. Eat a variety of healthful foods, with an emphasis on plant sources. "Eat five or more servings of a variety of vegetables and fruits each day. "Choose whole grains in preference to processed (refined) grains and sugars. "Limit consumption of red meats, especially those high in fat and processed. "Choose foods that help maintain a healthful weight. 2. Adopt a physically active lifestyle. "Adults: Engage in at least moderate activity for 30 minutes or more on five or more days of the week; "Encourage and recognize chealthy-weight friendly d policies and programs in public- and private-sector worksites, schools and institutions. "Identify, provide and promote opportunities for health care providers to expand their knowledge and use of best-practice methods to help individuals reach and maintain healthy weights. "Increase access and availability of healthy food choices in schools, worksites and communities. "Promote and support state and local legislation and policies that create environments conducive to healthy eating, daily physical activity and healthy weight, such as limiting access to soft drinks and fast foods in schools, reducing portion size and requiring calorie, fat and sugar information on containers for soft drinks and snacks sold in convenience stores. engaging in 45 minutes or more of moderate-to- vigorous activity on five or more days per week may further enhance reductions in the risk of breast and colon cancer. "Children and adolescents: Engage in at least 60 minutes per day of moderate-to-vigorous physical activity at least five days per week. 3. Maintain a healthful weight throughout life. "Balance caloric intake with physical activity. "Lose weight if currently overweight or obese. 4. If you drink alcoholic beverages, limit consumption. American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Prevention Source: American Cancer Society, June 2002. Recommendations for community action: Public, private, and community organizations should work to create social and physical environments that support the adoption and maintenance of healthful nutrition and physical activity behaviors. "Increase access to healthful foods in schools, worksites and communities. "Provide safe and accessible environments for physical activity in schools, transportation and recreation. OREGON COMPREHENSIVE CANCER PLAN 2005 3201033 Section I. Environmental Risk Factors KEY ISSUES About three-quarters of the nation 9s cancer deaths are associated with environmental factors, broadly defined to include smoking, diet and infectious disease, as well as pollution, some chemicals and radiation. 1 Although much remains to be learned about links between the environment and cancer, the following is known: "Certain racial, ethnic and socioeconomic groups are disproportionately exposed to environmental hazards. "Known environmental carcinogens include arsenic, asbestos, benzene, diesel fuel exhaust, PCBs (polychlorinated biphenyls) and radon. "Exposure to ionizing radiation 4from sources such as diagnostic X-rays and radiotherapy, as well as nuclear waste and radioactive elements like uranium 4increases the risk of leukemia, as well as thyroid, breast and lung cancers. "Workers exposed to asbestos and silica suffer from serious lung problems, including cancer. "Workers exposed to certain solvents are at increased risk for bladder cancer. "A link exists between cancer and some pesticides, such as those containing arsenic. Cancer is linked to exposure to chemicals such as pesticides and radiation in our air, food, water and soil. Much can be done to improve our understanding of Oregon 9s environmental risk factors and how to reduce them. To prevent exposure to environmental carcinogens: "Test for radon in homes through Oregon 9s Radon Indoor Air Program. "Avoid breathing diesel exhaust. "Use respiratory masks when varnishing and performing other tasks near d

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