Fulfilling the Potential of Cancer Prevention and Early Detection: An American Cancer Society and Institute of Medicine Symposium (2004)

Fulfilling the Potential of Cancer Prevention and Early Detection

Institute of Medicine and American Cancer Society Symposium

June 30, 2003,

National Academy of Sciences,

2100 C Street, N.W.

Washington, B.C., 20418

Tobacco use and obesity are major contributors to the cancer burden. Initiatives to increase the adoption, reach, and impact of evidence-based cancer prevention interventions need to occur at multiple levels across multiple behavioral targets. The policy recommendations in the IOM National Cancer Policy Board report reflect similarities and differences in the state of the science for tobacco compared to obesity interventions. Progress in both areas will be enhanced when all states have comprehensive cancer control plans that include public and private partnerships for community-based programs (Recommendation #3). There is sufficient evidence to recommend enactment and enforcement of federal and state initiatives that reduce tobacco use (e.g., increased excise taxes, clean indoor air acts—Recommendation #1). Still needed is a coordinated, national strategy to address obesity, unhealthy diet, and physical inactivity (Recommendation #2). In light of these similarities and differences, group discussion topics include:

• What opportunities are there to link and create synergies between policy initiatives for tobacco and obesity? Particularly important is avoiding competition between the two targets, as would happen if we concluded that we’ve fixed tobacco and need now to turn to obesity.

• Where and how can tobacco policy successes pave the way for timelier implementation of obesity-related policies as new evidence emerges?

• What policy initiatives have the greatest potential to address and help eliminate health disparities related to tobacco and obesity?

A vital role of the health care system in filling the gap between what we know and what we do for cancer prevention and early detection is to ensure universal access to evidence-based prevention interventions. The IOM National Cancer Policy Board recommends: that public and private insurers consider such evidence-based services as essential benefits (Recommendation #4); that support be increased for programs that provide primary care to uninsured and low income people (Recommendation #5); that existing national programs such as CDC’s National Breast and Cervical Cancer Early Detection Program receive adequate support and be expanded for colorectal cancer screening (Recommendation #6); and that the USDHHS conduct a comprehensive review to assess whether evidence-based preventive services are being offered and successfully delivered in federal health programs (Recommendation #7). umping off from these recommendations, group discussion topics include:

• What are the optimal leverage points for improving access to proven prevention interventions? Of the recommendations noted by the IOM, what opportunities are there for timely and early successes in their implementation?

• What types of decision making strategies and benefit policies may be needed with regard to access to, and coverage for, cancer prevention interventions that generate high demand, but have uncertain or even unproven evidence to support them?

• What policy initiatives have the greatest potential to address and help eliminate cancer-related health disparities?

Estimates are that it takes an average 17 years for a clinical innovation to move from research into practice. Strategies to minimize this lag include timely assessment and synthesis of emerging evidence and rapid dissemination of the resulting evidence-based recommendations (Recommendation #9) as well as increased attention to building the evidence base for effective strategies to disseminate evidence-based prevention interventions (Recommendation #12). Discussion of these recommendations by the group can focus on the following issues:

• How can we change the current process of funding, reporting, and disseminating research results in cancer prevention to decrease the time it takes to get information on effective cancer prevention strategies into clinical practice and public awareness?

• What new research funding initiatives are needed to increase the number of studies that apply rigorous scientific methods to evaluate dissemination strategies, and what opportunities are there for shared funding of such research across NIH and other federal agencies, as well as through government-private funding partnerships?

Primary care providers in health care settings are effective agents of behavioral change. However, maximizing their effectiveness requires programs to improve education and training, monitor adherence to evidence-based guidelines, and enhance practice environments to support provision of cancer prevention and early detection services (Recommendation #8). Key discussion issues for this group include:

• Who is accountable for ensuring that graduate curricula and continuing education programs include adequate coverage of cancer prevention and early detection? How can professional organizations and academic medical centers be encouraged to have this as an educational priority?

• What leverage points are there for monitoring the performance not only of health care providers but also of the systems of health care delivery, to ensure infrastructure and accountabilities for delivering evidence-based prevention interventions?

• How can state health departments and federal agencies such as CMS advance this priority?