1
Introduction
In 1996 the National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC) discussed with the National Academies’ National Research Council and Institute of Medicine (IOM) the advantages of creating a National Cancer Policy Board (“the Board”) administered by the IOM. In 1997, funded primarily by the NCI and CDC with some private sector contributions (for example, from the American Cancer Society [ACS or “the Society”]), the Board was established as a division of the IOM. The Board has 19 members with expertise in cancer medicine, science, and advocacy drawn from the national cancer community. As an independent entity, the Board sets its own agenda which involves identifying emerging policy issues in the nation’s effort to combat cancer and preparing reports that address these issues, including those that arise in the prevention, control, diagnosis, and treatment of cancer.
One of the earliest and most important issues that the Board identified was the quality of care received by Americans with cancer. This was assessed and found wanting in a report titled Ensuring Quality Cancer Care (1999). That report concluded “that for many Americans with cancer, there is a wide gulf between what could be construed as the ideal and the reality of their experience with cancer care.” The report also identified problems in cancer prevention and early detection, although it did not emphasize or explore all their implications. Given the importance of prevention and early detection to national cancer incidence and mortality, a closer examination of those issues became a logical next step for the Board.
That next step was taken in March 2003 with the release of Fulfilling the Potential of Cancer Prevention and Early Detection. Under the close guid-
ance of Board members, Tim Byers and Susan Curry1, that report explored in great detail the deadly implications of the gap between what is known about cancer prevention and detection and what interventions are actually carried out. The report found that even modest sustained implementation of preventive programs of proven effectiveness would reduce annual cancer incidence by 100,000 and deaths by 60,000 by the year 2015. Twelve recommendations described actions that should be taken to enhance prevention and detection strategies and delivery of services. The Board and the IOM concluded that this important message needed to be disseminated and rein-forced as widely and strongly as possible.
The ACS has been continuously represented on the Board, and was an important supporter and contributor to the prevention report during its planning and preparation. In addition, the Society has a long history of work in defining, supporting, and implementing cancer prevention and early detection, both domestically and internationally, and was prepared to share in the planning and costs of disseminating the information and urging the actions described in Fulfilling the Potential of Cancer Prevention and Early Detection. The ACS and the IOM decided that getting out the message of the report could best be accomplished by a symposium gathering together and hearing from those who knew most about prevention delivery, research, and education and asking them to share insights and consider ways in which the objectives of the Board’s report could be achieved. These contributions could then be documented and distributed widely and could continue to draw attention to and expand the reach of the report and the salience of prevention and early detection as important national contributors to the control of cancer and to the public health.
An ACS/IOM planning group designed a one-day symposium in two major parts. The morning featured an overview plenary session with presentations from senior experts in cancer research and care, cancer epidemiology and control, health care disparities, and preventive services delivery and financing, representing the NCI, ACS, academia, and private sector delivery systems and health insurers. The afternoon consisted of group discussions on four major topics important to prevention and early detection and relevant to the recommendations of the report: policy in tobacco and obesity; payer/provider/managed care issues; applied research; and prevention though education and primary care. A brief summary session at the end of the day allowed the two rapporteurs of the group discussions to sum up the information and recommendations presented during the afternoon sessions. The agenda identifying the morning speakers and describing the group dis-
cussions, posed the questions for assigned speakers, and related the topics to specific recommendations in the report. It can be found in the appendix. The speakers in each group discussion were assembled from different governmental, academic, and private sector organizations to provide a range of perspectives. All those invited speakers are also identified with their titles and affiliations in the agenda.
Following this Introduction, Chapter 2 presents the remarks of the morning plenary speakers in order of appearance, Chapter 3 presents the speakers and discussion from the afternoon group discussions, and Chapter 4 concludes the symposium with the summing up and further discussion from the rapporteurs and audience. All the presentations and discussions were edited for facile reading and to add graphic material from slides used in the presentations in the form of figures where essential. In this less formal forum than a Board report, much interesting information and analysis and many provocative ideas and suggestions could emerge during the day from the experts, officials, and opinion leaders who participated. This record of the day should provide continuing food for thought and ideas for actions in support of cancer prevention and early detection.
Roger Herdman
and
Leonard Lichtenfeld
