About the Program

The Centers for Disease Control and Prevention (CDC) supports Comprehensive Cancer Control (CCC), which is an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation, and palliation. This approach encourages healthy lifestyles, promote recommended cancer screening guidelines and tests, increase access to quality cancer care, and improve the quality of life for cancer survivors through enhanced survivorship.

In 1998, CDC established the National Comprehensive Cancer Control Program, which provides seed money, structure, and support for developing and implementing CCC plans in all states, tribes and tribal organizations, as well as U.S. Associated Pacific Islands/territories. To put these plans into action, local leaders from inside and outside the cancer arena are reaching across traditional divides and making CCC a reality in communities across the nation.

	Burden of Cancer Cancer is the second leading cause of death in the United States, exceeded only by heart disease.1 Each year, cancer claims the lives of more than half a million Americans.2 In 2004, 553,880 people died of cancer in this country, according to the U.S. Cancer Statistics: 2004 Incidence and Mortality report. That same year, 1,342,126 people were diagnosed with cancer in the United States.3* In addition to its devastating personal impact, cancer cost this country an estimated $210 billion overall in 2005, including nearly $136 billion for lost productivity and more than $70 billion for direct medical costs.4 *Incidence counts cover approximately 98% of the U.S. population. Death counts cover 100% of the U.S. population. Use caution in comparing incidence and death counts.

Accomplishments

Since 1998, the number of programs participating in the National Comprehensive Cancer Control Program (NCCCP) has increased from 6 to 65. CDC now supports 50 states, the District of Columbia, 7 tribes and tribal organizations, and 7 U.S. Associated Pacific Islands/territories in developing and implementing Cancer Control Plans. Most of these programs now are putting their Plans into action.

Effective strategies for reducing cancer deaths and the number of new cases of cancer include ensuring that evidence-based screening tests and treatments are available and accessible, and reducing behavioral and environmental factors that increase people's cancer risk. Following are examples of CCC programs in action:

California: Risk Reduction
California's Skin Cancer Prevention Program is a statewide initiative that cooperates with the National Council on Skin Cancer Prevention to reduce new cases of skin cancer. An important component of the state's CCC plan, this program focuses on child care centers, elementary and high schools, parks and recreation facilities, and outdoor work sites.

Achievements include disseminating sun-safety packages to more than 500 child care centers and preschools, teaching more than 20,000 young children about sun safety, distributing more than 400 sun-safety kits to outdoor occupational venues, and working with several Hollywood filmmakers to create two skin cancer prevention videos for elementary school students.

Ohio: Early Detection
The Northwest Ohio Colorectal Cancer Task Force, a rural coalition formed to help implement the state's CCC plan, works with local hospitals and physicians to increase colorectal cancer screening in a 6-county area. The Task Force provides screening colonoscopy free of charge to residents who are uninsured. It also offers diagnostic and treatment services, if necessary.

As of March 2006, the clinics had performed approximately 1,106 screening colonoscopies. Low-income and uninsured adults received these procedures free of charge, or at a significantly reduced rate, and no one was turned away for an inability to pay. As a result of the colonoscopies,

• Doctors discovered eight colorectal cancers (patients were referred to Task Force hospitals for follow-up treatment).
• 20 cases of high-grade dysplasia (abnormal cells) were found and removed.
• Precancerous polyps were removed from 518 of the 1,106 people screened.

Delaware: Access to Quality Cancer Treatment
In Delaware, a cancer diagnosis no longer means financial ruin for people without health insurance, thanks to a new program that pays treatment costs for those who are uninsured and do not qualify for Medicaid. Delaware's cancer treatment program, which is part of the state's CCC plan, provides 1 year of free, comprehensive care to any resident who 1) was diagnosed with cancer after July 1, 2004, 2) has no health insurance, and 3) has an annual income of less than 6.5 times the federal poverty level.

Between July 2004 and February 2006, the project paid for cancer treatment for 182 cancer patients. During that same time period, the project developed and staffed cancer care coordinator programs in the state's six major health systems; expanded education to health care providers working in the area of end-of-life care; and established a system for billing and paying for cancer treatment.

Florida: Addressing Health Disparities
With grant funding from the Florida Department of Health, the Pinellas County Health Department has implemented the Growing Older Well (GrOW) Project, which is designed to reduce health disparities among county residents aged 45 years and older. Part of the state's CCC plan, the project helps provide access to education services for lung, prostate, and colorectal cancers, as well as to screening services for colorectal cancer. To make these services available to minority men and women, the GrOW Project reaches out to the places where these people live, work, worship, and relax.

During April 2005, the GrOW Project and its partners provided health education and screening at 14 locations, and conducted a door-to-door educational campaign among the Hmong population in Pinellas County. More than 1,700 people participated in the classes and events.

The National Partnership for Comprehensive Cancer Control

Another major accomplishment is the formation of the National Partnership for Comprehensive Cancer Control—a group of national organizations that supports CCC efforts nationwide. To help coordinate comprehensive cancer control efforts taking place at federal, state, local, tribal, and territorial levels, CDC works with many national organizations, including

• American Cancer Society.
• American College of Surgeons, Commission on Cancer.
• C-Change.
• Intercultural Cancer Council.
• Lance Armstrong Foundation.
• National Association of Chronic Disease Directors.
• National Association of County and City Health Officials.
• National Cancer Institute.

Since 2000, this National Partnership for Comprehensive Cancer Control has

• Sponsored a series of 2-day seminars, called CCC Leadership Institutes, designed to help cancer-control leaders complete CCC plans and implement specific strategies in the plans.



• Conducted Planning Assistance Team Visits, which offer targeted assistance to specific states, tribes, and territories that are experiencing unique challenges in their CCC efforts.



• Created Leadership Support Teams, regional teams that offer coordinated technical assistance to CCC programs and coalitions. These teams consist of staff and volunteers representing CDC, the National Cancer Institute, the American Cancer Society, and the Intercultural Cancer Council.



• Maintained Cancer Control P.L.A.N.E.T., a Web portal that provides several tools for CCC planners, including state cancer profiles and links to all CCC plans.



• Launched CancerPlan.org,* a Web site designed to provide cancer control planners with practical information and resources, including the ability to connect with one another.

Ongoing Work

During fiscal year 2007–2008, CDC will continue to

• Provide seed money to help initiate and enhance CCC programs' activities.
• Offer ongoing technical assistance to programs that are developing and implementing CCC plans, including how to evaluate CCC to identify and measure accomplishments.
• Support partnerships that strengthen cancer control at the national, state and local levels.
• Broaden awareness of the CCC concept and its benefits.

Collectively, these accomplishments will improve the health of people in every stage of life—one of CDC's primary health-protection goals.

Future Directions

CDC plans to conduct research and surveillance activities that will develop and evaluate comprehensive approaches to cancer prevention and control. Results will guide interventions designed to address cross-cutting issues (such as health disparities and survivorship) at state, tribal, and territorial levels.

Some of the projects already planned or under way will

• Evaluate components of state cancer plans, and report on selected topics and issues covered by the plans.



• Evaluate national CCC outcomes.



• Develop specific program performance measures that reflect the outcomes being achieved through CCC.



• Assist states in determining the probable costs of implementing their cancer plans, and in defining strategies to obtain necessary resources.



• Conduct a Web-based survey of all states, 15 tribes/tribal organizations, and selected territories, to determine these communities' capacity to plan, implement, and evaluate CCC programs.

CDC will continue to strengthen the infrastructure for NCCCP grantees by hiring more epidemiologists and program evaluators, supporting strategic planning activities, and conducting demonstration-intervention projects.

	Risk Reduction and Early Detection Routine screening can reduce the number of people who die of colorectal cancer by 60% or more.5 For women aged 40 years or older, a mammogram every 1–2 years can reduce the risk of dying of breast cancer by approximately 20%–25% during a period of 10 years.6 Additionally, Pap tests can find abnormal changes in cells on the cervix before these cells turn into cancer. Researchers in many countries have found that rates of cervical cancer death dropped by 20%–60% after screening programs began.7

References

1. Heron MP, Smith BL. Deaths: leading causes for 2003. National Vital Statistics Reports Hyattsville, MD. National Center for Health Statistics.



2. Howe HL, Wu X, Ries LA, Cokkinides V, Ahmed F, Jemal A, Miller B, Williams M, Ward E, Wingo PA, Ramirez A, Edwards BK. Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations. Cancer 2006;107(8):1711–1742.



3. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2004 Incidence and Mortality. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2007.



4. National Heart, Lung and Blood Institute. Fact Book, Fiscal Year 2004. (PDF-1.6MB)



5. U.S. Preventive Services Task Force. Screening for Colorectal Cancer. Recommendations and Rationale. Rockville, MD: Agency for Healthcare Research Quality; 2002.



6. U.S. Preventive Services Task Force. Screening for Breast Cancer. Recommendations and Rationale. Rockville, MD: Agency for Healthcare Research Quality; 2002.



7. U.S. Preventive Services Task Force. Screening for Cervical Cancer. Recommendations and Rationale. Rockville, MD: Agency for Healthcare Research Quality; 2003.

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*Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.