Opportunities and Challenges

Current progress has been the result of activities implemented by a wide range of public- and private-sector organizations at the national, State, and local levels. Further progress depends on increasing coordination of these activities and implementation of evidence-based cancer prevention and control strategies nationwide.

In 1998, CDC initiated a program that provides Federal support to State health departments for CCC coalitions. These coalitions of community groups, research centers, and other organizations working against cancer develop and implement plans for risk reduction, early detection, better treatment, and improved survival at the State and local levels. By sharing expertise and integrating their efforts, CCC coalitions reduce duplication of efforts and maximize the use of limited resources. All 50 States, the District of Columbia, 6 Tribal organizations, and 6 U.S. Territories have active CCC coalitions that collaborate with Federal agencies, the American Cancer Society, the Intercultural Council, the Lance Armstrong Foundation, C-Change, and other organizations.

By sharing their expertise and integrating their efforts, national and State coalition partners increase the effectiveness of their cancer prevention and control efforts by reducing duplication and maximizing the use of limited resources. For example, in one State, coalition efforts to implement a plan led to the passage of legislation to fund colorectal cancer screening, and in another State, coalition efforts resulted in a legislation amendment, which generated additional funding allocated for prevention, early detection, and treatment of cancer and cardiovascular, pulmonary, and other chronic diseases.^{4, 26}

Cancer prevention and control efforts have benefited from the guidance on evidence-based practice from USPSTF⁶ and the Task Force on Community Preventive Services (TFCPS).²² USPSTF conducts systematic reviews of evidence on the effectiveness of cancer screening, chemoprevention, and provider counseling services and makes recommendations for clinical practitioners.⁶ TFCPS conducts evidence-based reviews and reports recommendations on the effectiveness of community interventions related to cancer prevention and control, including interventions for cancer screening, tobacco use, and physical activity.²² These independent task forces provide critical guidance to CCC coalitions, health professionals, health plans, and other organizations on effective services and programs to prevent and control cancer.

A number of other collaborative efforts are important in attaining the targets. Several Federal agencies, State and local health departments, primary care associations, and other organizations are working to implement Health Disparities Collaboratives to improve cancer care in underserved communities and to reduce disparities.³³ Opportunities for progress are created by continued collaboration among large employers, health care companies, benefits consultants, vendors, and Federal agencies to promote business support for cancer-related clinical preventive services recommended by USPSTF.³⁴ Most health care profession associations have cancer prevention guidelines for their members, and an increasingly large number of well-organized community organizations and cancer advocacy groups promote prevention and control.⁴ For example, the National Committee for Quality Assurance cooperates with employers and insurers to monitor performance of cancer screening in managed care organizations, thereby increasing the screening of enrolled members.³⁵ C-Change, which comprises many of the Nation's leaders from government, business, and nonprofit organizations, has a number of efforts to increase prevention and improve cancer treatment.³⁶

Success in reaching breast and cervical cancer screening targets increasingly depends on Federal and State partnerships, such as the National Breast and Cervical Cancer Early Detection Program,³ to increase screening among women who are least likely to be screened, including low-income, uninsured women.⁴ All 50 States, the District of Columbia, 13 Tribal organizations, and 4 Territories are collaborating with a range of partners to implement this program. Since 2000, the program has provided 2.7 million screening examinations to almost 1.5 million women who otherwise would unlikely be screened.¹⁴ However, the program reaches only a small proportion of women needing the services.³⁷

To help support organizations active in cancer prevention and control, several HHS agencies, led by NCI and in collaboration with the American Cancer Society developed the Cancer Control PLANET Web portal.^{25, 38} The PLANET, launched in 2003, is an interactive five-step "lens" to help cancer prevention and control professionals and organizations find a comprehensive set of evidence-based cancer control program planning, implementation, and evaluation resources, such as those developed by USPSTF. PLANET provides a "one-stop shop" for research-tested intervention approaches, evidence-based guidelines, national and State data, and other resources. Achieving the cancer targets requires increased use of PLANET and similar efforts to better disseminate evidence-based resources.^{25, 38}

Attaining the cancer targets also depends on progress in other focus areas, including Access to Quality Health Services (Focus Area 1), Educational and Community-Based Programs (Focus Area 7), Health Communication (Focus Area 11), Nutrition and Overweight (Focus Area 19), Physical Activity and Fitness (Focus Area 22), Public Health Infrastructure (Focus Area 23), and Tobacco Use (Focus Area 27).^{6, 18, 22} Many cancer prevention activities also contribute to the reduction of the risk of heart disease and stroke (Focus Area 12) and other chronic diseases (Focus Areas 4, 5, 24, and 26).^{6, 22} An ongoing challenge, particularly for CCC coalitions, is how to integrate related objectives and improve coordination with organizations working on them.

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