Prostate Cancer Program

8/3/2019 Prostate Cancer Program

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State of FloridaProstate Cancer Program

Friday September 15, 2011

Bonita Springs FL


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Prostate Cancer in Florida

Florida has the second highest incidence ofprostate cancer in the Nation

1 in 4 men will be diagnosed over their lifetime (1in 6 nationally)

Significant health disparities, predominantly inrural communities

Lack of systemic education and awarenessregarding best practices and current guidelines

Prostate cancer often portrayed as anunimportant disease of the elderly, fraught

with over-diagnosis and over-treatment


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Uninsured Burden by State

Uninsured Rank State Uninsured Population % Uninsured

1 Texas 5,832,884 2,3406,068 25%

2 New Mexico 441,351 1,938,093 23%

3 Florida 3,738,230 18,029,897 21%

4 Louisiana 848,463 4,196,532 20%

5 Mississippi 572,555 2,889,110 20%

6 Arizona 1,237,322 6,308,138 20%

7 California 6,701,890 36,163,342 19%

8 Oklahoma 646,363 3,491,892 19%9 Nevada 468,808 2,547,075 18%

10 Alaska 115,824 652,846 18%


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Significant health disparities between rural andurban populations and across ethnic and racial

groups

Men in rural areas are either under-diagnosed ordiagnosed at later stages, receiving differentmanagement, being underinsured and having less

desirable outcomes

AA have mortality rates up to more than 10xother racial or ethnic groups due to more virulent

disease and less likelihood to receive adequate

treatment

Health Disparities in Florida


5/20

NIH-Funded Prostate Cancer Centers

American Cancer Society, Facts & Figures 2007

1,960

3,640

2,0103,000

6,040

3,3805,850

5,3302,880

15,710

3,010

1,980

3,430

2,0103,980

5,050

2,5204,700

4,4303,140

2,850


6/20

Funding for Prostate Cancer in U.S.


7/20

Prostate Cancer Advisory Council

Name Organization

Angela Adams, PharmD Central Florida Pharmacy Council

B. Thomas Brown, MD American Association of Clinical Urologists

Thomas Crawford, MBA UF Prostate Disease Center

Linda Delo, DO Florida Osteopathic Medical AssociationEdward Droste Advanced Prostate Cancer Collaborative

Sue Higgins, MPH Florida Department of Health

Paul Hull American Cancer Society

David Most, PhD Health Information Research, Inc.

James Mul, PhD H. Lee Moffitt Cancer Center

Alan Pollack, MD, PhD University of Miami

Julio Pow-Sang, MD H. Lee Moffitt Cancer Center

Brian Rivers, PhD Cancer Control & Research Advisory Council

Michael Wehle, MD Mayo Clinic


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Bill Objectives

Florida Statue 381.911 Statewide focus on reducing the incidence

of prostate cancer Enhance community education andawareness

Reduce ethnic and racial disparities Reduce fragmentation of care through

implementation of best practices

Expand access to clinical trials.


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Objective

Primary objective is to establish a

communications platform to create

systemic synergy between theprostate cancer stakeholders within

the state and serve as a resource

(versus advertisement) for patientsand their advocates


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Dissemination of Information

Accrual

Validation Dissemination

Information


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State Resources:

Department of HealthFlorida Center for Universal Research toEradicate Disease (FL CURED)

Florida Biomedical Research AdvisoryCouncil

Florida Cancer Plan CouncilFlorida Cancer CouncilFlorida Cancer Data SystemsComprehensive Cancer Control ProgramCancer Control and Research Advisory

CouncilRegional cancer control collaboratives


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= County Incidence Rate >2X Higher than A.A. Statewide Rate

>416.98 per 100,000

= County Incidence Rate >2X Higher than White Statewide Rate

=229.8 416.97 per 100,000

Pinellas

Hillsborou

gh Polk

Osceola Brevard

Indian

RiverManatee Hardee

DeSoto

Charlotte

Sarasota

Lee

Collier

Palm

Beach

Broward

Martin

St. LucieOkeechobee

Hendry

MonroeMiami

Dade

EscambiaSanta

RosaOkaloosa

Walton

HolmesJackson

Washington

BayCalhoun

GulfFranklin

Liberty

Gadsden

Leon

Wakulla

Jefferson

Madison

Taylor

Hamilton

Lafayette

Dixie

Levy

Suwannee

Gilchrist

Columbia

Union

Baker

Bradford

Alachua

Nassau

Duval

St. JohnsClay

PutnamFlagler

Marion

VolusiaCitrus

Sumter

Lake

Seminole

Hernando

Pasco

Orange

Highlands

Glades

African American Prostate Cancer Incidence


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= County Mortality Rate 2X Higher than A.A. Statewide Rate

>95.56 per 100,000

= County Mortality Rate >2X Higher than White Statewide Rate

=35.80 95.55 per 100,000

Pinellas

Hillsborou

gh Polk

OsceolaBrevard

Indian

RiverManatee Hardee

DeSoto

Charlotte

Sarasota

Lee

Collier

Palm

Beach

Broward

Martin

St. LucieOkeechobee

Hendry

Monroe

Miami

Dade

EscambiaSanta

RosaOkaloosa

Walton

HolmesJackson

Washington

BayCalhoun

Gulf Franklin

Liberty

GadsdenLeon

Wakulla

Jefferson

Madison

Taylor

Hamilton

Lafayette

Dixie

Levy

Suwannee

Gilchrist

Columbia

UnionBaker

Bradford

Alachua

Nassau

Duval

St. Johns

Clay

PutnamFlagler

MarionVolusia

Citrus

Sumter

Lake

Seminole

Hernando

Pasco Orange

Highlands

Glades

African American Prostate Cancer Mortality


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The Screening Controversy


16/20

Legitimate Concerns of Screening

Lifetime risk of death from PCA is 3% and thelife time risk of being diagnosed with PCA is17%

Screening will result in over-diagnosis ofcancers that do not require therapy Over-diagnosis is estimated approx. 30-50%

and increases directly with age

Cost of screening may not be justified if harmcaused by treatment and diagnosis outweighsthe health benefits obtained


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The Screening Controversy

Due to PSA testing, approximately 90% of allPCA are currently diagnosed at an early stage,

and, consequently, men are surviving longer

after diagnosis

Does PSA screening actually saves lives? 27 % relative risk reduction in PCA deaths, but

it takes 1410 men to screen, 48 men to treat toprevent 1 cancer death.

Rate of over-diagnosis: Approximately 50%


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60% of non-palpable cancers detected atscreening are low-risk and may do well

with active surveillance

40% of prostate cancers in the generalpopulation would not be detected without

screening and are intermediate to high

risk cancers requiring active treatment

If We Would not Screen.


19/20

Prostate Cancer Act (S.3775)

Introduced by Senator Tester (D-MT) Objective: Coordination of research to expand

programs at the DoD, Health & Human

Services and VA Defining better diagnostics and enabling

scientists to distinguish between aggressive

and indolent varieties of this cancer

Data sharing Eliminating duplicate efforts

19


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Summary

Introduction of new legislature to enhanceawareness, research and optimize care in

Florida

Establishment of Prostate Cancer AdvisoryCouncilAnnual report to Governor and FL LegislaturePotential for state-wide impact of prostate

cancer awareness, care and research

Potential to serve as a template for nationalefforts (Prostate Cancer Act)

Documents

Prostate Cancer Program