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Cancer 101 Learning Objectives

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Cancer 101 Learning Objectives

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  1. Aging and Cancer:A Cancer 101 Adaptation to Educate Elders and Their Caregivers on the Importance of Cancer Screening and Early Detection7th National Changing Patterns of Cancer in Native Communities:The Power of PartnershipsMarie J. Lavigne, LMSW NCI’s Cancer Information Service - Northwest RegionSeptember 7, 2007

  2. Cancer 101 Learning Objectives Participants will learn why cancer is a growing concern for elder Alaskans by: • Identifying the top five most commonly diagnosed cancers in Alaskans, • Describing screening recommendations for cancer prevention and early detection, • Discussing three or more factors contributing to improved cancer survival for elders, and • Stating where to find the latest, most accurate information on cancer.

  3. Cancer is a Disease of Aging • The risk of cancer increases with age. • Close to 60% of all new cancers and 70% of deaths are in elders over 65. • Increases in life expectancy means more older adults will experience cancer. • Cancer is emerging as a chronic disease, rather than a terminal diagnosis. • Advances in research and medical care have increased the length of time and quality of life of cancer survivors.

  4. Cancer Burden in the Elderly • Those diagnosed at age 60 or older compromise the majority of cancer survivors. Understanding elders needs and concerns is critical in reducing the cancer burden. • Many older survivors have one or more chronic medical conditions that can mask the signs of cancer recurrence, or the late effects of cancer. • Elders may live alone, or they may lack adequate social and caregiver support to support recovery. • Limitations on Medicare reimbursement, along with out of pocket costs for treatment, medication and transportation, are a significant burden for those on fixed incomes. Source: The NCI Strategic Plan, January 2006 www.cancer.gov

  5. Elders face unique cancer challenges Cancer survivors over age 65: • Tend to be in poorer health (30% vs. 10% general population), • Have two or more chronic conditions (12% vs. 5%), • Experience greater functional limitations (60% vs. 30%), • Are more likely to experience other serious illnesses: Alzheimer’s disease, arthritis, diabetes, previous cancers, heart-related diseases, strokes and hypertension. • Experience lengthier hospitalizations and treatment complications, • Face unique caregiver issues when their primary caregivers (spouses, older adult children) have serious health problems. Source: National Institute on Aging Cancer Survivorship: Pathways to Health After Treatment

  6. Improved Cancer Longevity in Elders Potential factors include: • Early detection • Access to quality cancer care • Compliance with recommended treatment • Overall health status prior to cancer • Nutrition and physical activity • Family history and genetics • Social support

  7. Decreased Cancer Survival in the Elderly Potential factors include: • Late detection and advanced stage of cancer • Inability to comply with recommended treatment • Difficulty accessing care • Existing chronic health conditions • Advanced age and frailty • Genetic risk factors • Type of cancer

  8. Cancer Rates In Alaska

  9. Cancer In Alaska All AlaskaAlaska Natives Estimated New Cases in 2006 2,010 300 Estimated Cancer Deaths in 2006 810 134 Cancer Prevalence 21,000 * 2,325 ** Source: Cancer Facts and Figures, 2006 * Based on NCI estimates for US ** Alaska Native Tumor Registry

  10. Five Leading CancersMen and Women Combined Alaska NativeAlaska WhiteUS White • Colorectal 1. Prostate 1. Breast • Lung 2. Breast 2. Prostate • Breast 3. Lung 3. Lung • Prostate 4. Colorectal 4. Colorectal • Stomach 5. Bladder 5. Bladder Alaska Native Tumor Registry, 1999-2003 Alaska Cancer Registry, 1999-2002 US SEER, 1999-2002 http://seer.cancer.gov/

  11. Age Distribution of Cancers in Alaska 1997-2001 Age at first diagnosis Ages 0-19 1% Ages 20-44 13% Ages 45-64 44% Ages 65 + 42% (n=9,652) 86% cancers are diagnosed in adults ages 45 and older Source: Alaska Cancer Registry

  12. Age Specific Cancer Incidence Rates, Alaska Natives and US Whites*, 1999-2003 • US White rates for years 1998-2002 • Source: Alaska Native Tumor Registry

  13. Five Leading Cancers By AgeAlaska Natives, Men and Women Combined, 1989-2003 50-59 Years60-69 Years70+ Years Breast 21.0% Lung 23.0% Colorectal 25% Colorectal 19.5% Colorectal 19.1% Lung 22.4% Lung 15.6% Breast 11.9% Prostate 8.8% Oral 5.4% Prostate 8.8% Breast 7.4% Prostate 5.3% Stomach 5.0% Stomach 4.4% (n=789) (n=964) (n=1158) Source: Cancer in Alaska Natives, 1969-2003

  14. Cancer Risk By AgeUS Men and Women, All Races Age Cancer Risk 0-9 1 in 6,250 10-19 1 in 6,054 20-29 1 in 2,361 30-39 1 in 983 40-49 1 in 375 50-59 1 in 145 60-69 1 in 65 70+ 1 in 43 Source: NCI SEER Program Data, 1994-1998

  15. Lifetime Probability of Developing Cancer - Men Site Risk All sites1 in 2 Prostate 1 in 6 Lung and Bronchus 1 in 13 Colon and Rectum 1 in 17 Non-Hodgkin Lymphoma 1 in 46 Melanoma 1 in 52 Kidney 1 in 64 Leukemia 1 in 67 Oral Cavity 1 in 73 Stomach 1 in 82 2000-2002 Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.0 Statistical Research and Applications Branch, NCI, 2005. http://srab.cancer.gov/devcan

  16. Lifetime Probability of Developing Cancer - Women Site Risk All sites1 in 3 Breast 1 in 8 Lung and Bronchus 1 in 17 Colon and Rectum 1 in 18 Uterine Corpus 1 in 38 Non-Hodgkin Lymphoma 1 in 55 Ovary 1 in 68 Melanoma 1 in 77 Pancreas 1 in 79 Urinary Bladder 1 in 88 Uterine Cervix 1 in 135 2000-2002 Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.0 Statistical Research and Applications Branch, NCI, 2005. http://srab.cancer.gov/devcan

  17. Age Distribution of Cancers Deaths in Alaska1997-2001 Cancer Mortality (n=3,270) Ages 0-19 <1% Ages 20-44 7% Ages 45-64 35% Ages 65 + 58% 92% of cancers deaths are in adults over 45 Source: Alaska Cancer Registry

  18. Deaths Due to Chronic Disease in AlaskaCancer is the leading cause of death in Alaska since 1993 1,755 deaths combined, or 58% of all Alaska deaths in 2004 * Any mention Source: Alaska Bureau of Vital Statistics

  19. Reducing Your Cancer Risk

  20. Leading Causes of Cancer Source: The Harvard Report on Cancer Prevention

  21. Reducing Your Cancer Risk Research is ongoing and early findings suggest healthy lifestyles may reduce your cancer risk: • A diet rich in natural foods, fruits and vegetables, • Maintain a healthy weight, • Daily physical activity, • Abstain from tobacco use, • Moderate alcohol use, • Limit sun exposure, • Avoid known carcinogens, • Protect yourself and your partner from sexually transmitted diseases, • Screening and early detection for cancer.

  22. What Is Cancer?

  23. What is Cancer? Cancer is a disease characterized by: • A series of changes in the cells and genes leading to abnormal cell proliferation (growth). • Unchecked local growth (tumor formation) and invasion of surrounding tissue. • Ability to spread (metastasize). The term cancer refers to a group of more than 100 different diseases that begin in cells, the body’s basic unit of life.

  24. How cancer cells develop Cancer develops when changes occur within cells that effect the DNA. DNA contains genes that are programmed to perform specific tasks. Changes or “mutations” in the DNA lead to the development of cancer.

  25. Abnormal Cell Growth: Increasing number of dividing cells  Growing mass of tissues (Tumor)   BenignMalignant

  26. Benign vs Malignant Tumors The gradual increase in the number of dividing cells creates growing mass of tissue called a “tumor.” Tumors can be benign (non-cancerous) or malignant (cancer). • Benign tumors do not spread to other parts of the body, are usually not a threat to life and are labeled by adding the suffix –oma to the tissue of origin (e.g. lipoma, adenoma) • Malignant tumors are cancerous cells that grow without control and invade or damage other parts of the body.

  27. When Cancer Spreads Metastasisis the spread of a malignant tumor from its primary (original) site to another part of the body. Cancer cells may spread by blood capillaries and veins (most common route), seeding throughout body, or the lymphatic system. The most common sites are: • Bone • Lung • Liver • Central nervous system

  28. Metastasis: How cancer spreads If melanoma, a type of skin cancer, metastasizes (spreads) to the liver, the cancer cells in the liver are melanoma cells. The disease is called metastatic melanoma (not liver cancer).

  29. Screening & Early Detection

  30. The Importance of Cancer Screening • Checking for cancer in a person who does not have symptoms of the disease is called screening. • The goal of screening is to improve outcomes – to reduce cancer deaths and enhance quality of life. • Cancer survival can be improved by screening and early detection for cancers of the breast, cervix, colon and rectum. • For other types of cancer, such as the lung, no reliable screening test currently exists.

  31. Cancer Early Detection • The chances cancer will be detected early are greatly improved by having regular health check ups and being aware of changes in your body. • During a physical exam, the provider will look for anything unusual, feel for lumps or growths, inquire about any cancer warning signs you may be experiencing, recommend tests needed and answer your questions. • The goal is to discover a cancerous tumor early before it grows and spreads.

  32. Possible Symptoms of Cancer: Pay Attention To Your Body If There Is: • Change in bowel or bladder habits • A sore that does not heal • Unusual bleeding or discharge • Thickening, lump, or swelling in the breast or any other part of the body • Indigestion or difficulty swallowing • Recent change in wart or mole • Nagging cough or hoarseness • … along with unexplained weight loss, fever, fatigue and pain that is present for several weeks or longer.

  33. Screening Rates in Older Alaskans

  34. Screening Rates in Older Adults Older women having pap tests within past three years: AlaskaUS Ages 55-64 * 86.1% 87.8% Ages 65+ N/A 69.9% Older women having mammography within past two years: AlaskaUS Ages 50-59 * 76.5% 79.7% Ages 60-64 * N/A 80.0% Ages 65+ 67.8% 75.1% Source: Behavioral Risk Factor Surveillance System, 2004 * The Alaska Breast & Cervical Health Check offers free health screenings for women ages 18-64

  35. Screening Rates in Older Adults Older men and women ever having a sigmoidoscopy or colonoscopy for colorectal cancer screening: AlaskaUS Ages 50-59 41.8% 42.3% Ages 60-64 N/A 55.7% Ages 65+ 69.6% 63.2% Source: Behavioral Risk Factor Surveillance System, 2004

  36. Barriers to Cancer Screening and Early Detection in Elders • Fear of cancer • Lack of knowledge • Modesty • Communication • Illness beliefs • Access

  37. Breast Cancer Screening

  38. Breast Cancer Screening • Screening for breast cancer has been shown to reduce the risk of dying from the disease. • A high quality mammogram with a clinical breast exam is the most effective way to detect breast cancer early. • NCI recommends women in their 40s and older should have mammograms every 1 to 2 years. • Women at higher than average risk should talk with their health care providers about how often to be screened.

  39. Who Is At Risk for Breast Cancer? • Age - most important risk factor for breast cancer. • Personal history of breast cancer • Family history • Genetic alterations • Certain breast changes on biopsy • Reproductive and menstrual history: Age of first childbirth Early menses or late menopause No childbirth experience Hormone Therapy • Breast density • Diet and lifestyle factors • Radiation therapy

  40. Breast Cancer Screening and Medicare • In women ages 65 and older, 68% report having had a mammogram in the prior two years. • Medicare currently covers an annual screening mammogram for all eligible women over 40. • A physician’s referral is not required. • There is no Part B deductible, however a 20% co-insurance or co-payment applies. Source: Federal Interagency Forum on Age Related Statistics CMS Medicare utilization, accessed May 31, 2006 http://www.medicare.gov/

  41. Cervical Cancer Screening

  42. Cervical Cancer Screening • It is recommended women of average risk have a Pap test at least once every three years. • Women 65-70 years of age who have had at least three normal Pap tests and no abnormal tests in the last 10 years may decide, upon consultation with their health care provider, to stop cervical screening. • Women who have had a total hysterectomy do not need to undergo cervical cancer screening, unless the surgery was done to treat cervical cancer. Source:U.S. Preventative Services Task Force

  43. Common Cervical Cancer Questions • Could I have cervical cancer and not know it?YES--often cervical cancer does not cause pain or other symptoms. • If I've gone through menopause, do I still need a Pap test?Most women still need to Pap tests. This decision depends on your age and past results. Talk with your health care provider about what’s right for you. • If I'm not sexually active now do I still need a Pap test?Women who are not currently sexually active may still need a Pap test. Almost all cervical cancer is caused by a sexually transmitted virus called the (HPV) Human Papillomavirus that can live in the body for many years.

  44. Cervical Cancer Screening and Medicare • High Risk – Annual ScreeningMedicare covers one Pap test and pelvic exam for women at high risk for cervical cancer, including those with an abnormal pap during the prior three years. • Low Risk – Every Two YearsMedicare covers one Pap test and pelvic exam every two years for women at low cancer risk. • Breast Exam - A clinical breast exam is included as part of the Medicare pelvic screening benefit. • There is no Part B deductible and no cost for the Pap lab test, however a 20% co-payment applies for the pelvic and breast exams. Source: CMS Medicare http://www.medicare.gov/

  45. Colorectal Cancer Screening

  46. Colorectal Cancer Screening To find polyps or early colorectal cancer, adults of average risk in their 50s and older should be screened. A health care provider may recommend one or more of the following tests, based on age, family history and risk factors: • Sigmoidoscopy • Colonoscopy • Fecal Occult Blood Test (FOBT) • Double Contrast Barium Enema (DCBE) • Digital Rectal Exam (DRE)

  47. Colorectal Cancer Screening • The optimal interval for screening depends on the test and the provider’s assessment of cancer risk. • For the person at average risk, initial screening begins at age 50 and includes: Annual FOBT with a Colonoscopy every 10 years, or Annual FOBT with a Flexible Sigmoidoscopy every 5 years. • For individuals at high risk, screening needs to begin earlier and take place more often. Source:U.S. Preventative Services Task Force

  48. Who Is At Risk for Colorectal Cancer? Certain risk factors are associated with an increased risk of developing colorectal cancer: • Age • Polyps • Family history • Familial Adenomatous Polyposis (FAP) • Nutrition • Physical activity • Ulcerative colitis or Crohn’s colitis

  49. Colorectal Cancer Screening and Medicare • Medicare coverage for colorectal cancer screening tests is based on the U.S. Preventative Services Task Force recommendations. • Despite coverage, Medicare claims suggest only 31% beneficiaries ever had a colorectal cancer screening test (1998-2002). • The Medicare deductible and coinsurance apply to this benefit. For screenings performed on an outpatient basis, the beneficiary is responsible for 20% of the approved Medicare amount. Source: Federal Interagency Forum on Age Related Statistics CMS Medicare utilization, accessed May 31, 2006 http://www.medicare.gov

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