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Breast Cancer Committee

Breast Cancer Committee. Kathy J. Helzlsouer, M.D., M.H.S. Chair Donna Gugel, M.H.S., Co-Chair Cathy Copertino, RN, BSN, MS, OCN Committee Member, Presenter. Average Annual Breast Cancer Cancer Death Rate 1995-1999 Per 100,000 women. State/District Rate Rank.

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Breast Cancer Committee

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  1. Breast Cancer Committee Kathy J. Helzlsouer, M.D., M.H.S. Chair Donna Gugel, M.H.S., Co-Chair Cathy Copertino, RN, BSN, MS, OCN Committee Member, Presenter

  2. Average Annual Breast Cancer Cancer Death Rate 1995-1999Per 100,000 women State/District Rate Rank District of Columbia 39.1 01 Delaware 32.6 02 Maryland 31.4 05 Utah 24.5 50 Hawaii 20.5 51

  3. THE PROBLEM: We are ranked in the top for mortality THE GOAL: To be last.

  4. Model of Cancer Progression Invasive cancer Normal cell Malignant Cell Exposure Metastasis Proliferation Atypia In-situ Prevention Early Detection Treatment Survivorship

  5. What Has Been Done? • Prior Focus on Early Detection - Screening Programs HSCRC BCCP • Mortality rates decline with rest of nation • More to Do - Improve early detection methods/program - Expand Efforts prevention treatment survivorship

  6. PREVENTION RESEARCH PROBLEM NEEDED SOLUTION • Intervene on • contributing factors • to incidence, • treatment failures • Educate population • and providers • Provide incentives to put prevention into practice • Facilitate access to • care/identifying those at risk Why is Maryland High in Incidence + Mortality What do individuals and providers know about risk Assessment and prevention Are high risk groups identified/treated e.g., genetically susceptible group • Studies to determine • modifiable factors • Determine level of • knowledge • What is current practice • How to put prevention • into practice • Assess prevalence • of high risk groups • Evaluate access to care

  7. EARLY DETECTION RESEARCH PROBLEM NEEDED SOLUTION • Provide access to screening (CBE & mammography) and follow-up for all • Educate patients, • providers • Facilitate uptake of • new techniques • Intervene on factors • to minimize late stage diagnoses (goal: all women dx in Stage 1 with <1 cm tumors Mortality High/ Access to screening remains an issue Underutilization of minimally invasive biopsy techniques Late stage cancer dx remains too high especially for AA women Evaluate patterns of care across region/ racial groups Identify cases/controls to identify modifiable factors

  8. TREATMENT RESEARCH PROBLEM NEEDED SOLUTION Not all breast cancer patients receive optimum care for breast cancer (regional, racial, age disparities) Not all patients receive comprehensive, unbiased treatment information Some women with DCIS and early stage breast cancer are over treated • Using Registry – • evaluate patterns of • care by region, race, • age • Determine extent • of knowledge for • providers • Research required • to determine best • (least) therapy • Evaluate if risk/benefits • are adequately discussed • Educate providers • Improve access to • care • Use registry to provide • performance • evaluation to providers • Educate public and • providers on standard • of care • Develop culturally • sensitive materials • Develop methods to • convey risks, benefits, • uncertainty • Implement strategies • based on research

  9. SURVIVORSHIP RESEARCH PROBLEM NEEDED SOLUTION Treatment has long-term effects, the extent may be unknown Need to educate women/providers about long-term effects (e.g. cognitive effects of chemo, cardiac effects of radiation, etc.) No “standard of practice” for long-term care of survivors • Research to fill the gaps • in knowledge • Determine extent of • knowledge for providers • Educate patients • and providers about • long-term effects • Education strategies • Patient navigators • Develop and then • evaluate models for • long-term care • Incorporate prevention • (recurrences, other • cancers)/screening

  10. Overarching Recommendations • Maintain/Expand Cancer Registry • Cigarette Restitution Fund - Preserve for health-related issues - Use CRF funds to answer research questions - Provide open access to CRF funds for research • Ensure access to care for all • Education/outreach activities for all populations by region, race, ethnicity

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