Cancer Prevention / News

Implementing Cancer Prevention to Eliminate Disparities

Dr. Graham Colditz

Implementing cancer prevention to eliminate disparities

Public Health Challenge

Focus on the majority of cancers, breast, prostate, colon, and lung, is highly oriented to secondary prevention and the use of screening in healthy populations (breast and colon), clinical care (prostate), or high risk populations (lung). Low rates of cervical cancer is a screening success story.

To address racial disparities, we need a public health approach, a community based participatory research based strategy, and attention to implementing known to be effective interventions. Importantly, “achieving equity may do more for health than perfecting technology.” (Woolf and Satcher 2004)

Research Findings

Public Health Approach Racial disparities in cancer mortality and incidence are evidenced in Missouri and thus a concern of the Siteman Cancer Center. In addition, there are broad geographic differences in cancer screening levels. Community involvement helped determine the needs in the primary area served by the cancer center.

Research Based Strategy 

The Siteman Cancer Center constructed a logic diagram of the steps of care in cancer screening from getting to testing to the outcome, in order to begin the process of implementing interventions that will address disparities. Basic and epidemiological research provides information about the problem, while clinical and social/behavioral research assists with solving the problem.

Implementation of Effective Interventions  

At Siteman, several interventions were instituted and evaluated based on this framework. Breast diagnosis and treatment navigation; cancer screening education campaigns; and an energetics program that is multidisciplinary and inclusive of many campus departments.

Possible Directions

There is more work to be done in Missouri and expansion of current interventions to additional geographic areas is the first step. Each new geographic area may indicate new populations at risk, different messaging about cancer, and new or differently tailored interventions to be rolled out.

Future Directions

Applying systematically implementation science, whose goal is “to identify the factors, processes, and methods that can successfully embed evidence based intervention in policy and practice to achieve population health” is the challenge and the future for improved cancer prevention.

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