Missouri updated its Cancer Action Plan 2021-2025 this month.
Health officials created the plan to serve as a guide to cancer control and prevention for all Missourians.
"It reflects priorities to reduce the human and economic burden of cancer on Missourians through the promotion of collaborative, innovative and effective programs and policies," it states.
It is oftentimes unclear what triggers cells inside a person's body and causes them to grow uncontrollably.
A person may get cancer because of factors occurring as early as before birth through early childhood.
They may receive a cancer diagnosis because of something that occurred while they were adults.
A lifestyle factor, such as smoking, high-fat diet or working with toxic chemicals may increase a person's risk of cancer.
Cancer is a group of more than 100 different diseases -- essentially divided into two main categories, hematologic (blood) cancers affecting blood cells, and solid tumor cancers, which affect any other organs or tissues, according to the American Cancer Society website.
The action plan is to be enhanced with additional metrics and new objectives during the next few years, using input from organizations, medical care experts, public health agencies, pharmaceutical/biotechnology companies and more. The Missouri Cancer Consortium, made up of community organizations trying to eliminate the burden of cancer in Missouri, is refining the action plan.
The consortium intends to reduce the disparities in cancer screening, treatment and survival by paying attention to those with higher cancer burdens, such as the uninsured, Blacks and people living in rural parts of the state, according to the plan. For example, Black Missourians experience cancer-related deaths at a rate of 239.8 per 100,000 compared to 197.3 deaths per 100,000 for white Missourians. Only 59 percent of rural cancer survivors -- compared to 76 percent of urban survivors -- receive advice and follow-up care, according to the action plan. The plan attributes its data on survivors to the "2016 County-Level Study."
The plan's first goal, it states, is to diagnose cancer early. To do so, Missourians must have "access to high-quality screening, genetic counseling and clinical services for early detection and diagnosis of cancer."
A challenge is that cancer takes many forms and each requires different screenings.
Breast cancer is the most common cancer among women in the United States. Its five-year survival rate is 90 percent, if diagnosed early and it has not spread to other parts of the body.
Breast cancer often has no symptoms in its early stages. The best way to detect breast cancer early is through mammography screening -- an X-ray of the breast tissue. Breast cancer risk is higher for Black women and transgender individuals. Transgender females are at an increased risk of breast cancer compared to males due to hormone use. Current health recommendations suggest women over the age of 50 should receive annual mammograms.
Lung cancer is the second most common cancer, but is the leading cause of cancer deaths in the United States, with a five-year survival rate of just 21 percent. The National Lung Screening Trial compared two methods of detecting lung cancer: low-dose spiral computed tomography (LDCT) and standard chest X-rays. Both techniques have been used as a means to find lung cancer early, but the effects of these techniques on lung cancer mortality rates had not been determined definitively. This study found the LDCT significantly reduced lung cancer mortality by 20 percent among high-risk individuals. It is recommended that people who have a history of smoking 30 or more packs of cigarettes a day, are currently smoking or have quit within the past 15 years receive annual screenings for lung cancer.
Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. Screenings can prevent colorectal cancer by detecting and removing precancerous polyps or by catching cancer at an early stage. The five-year survival rate for colorectal cancer is 65 percent, but it is often not found early. When screening finds colorectal cancer early, the five-year survival rate is 90 percent. Adults ages 45-75 should be screened for colorectal cancer. Colonoscopy is the standard screening for colon cancer.
The plan includes five objectives surrounding screenings and early diagnosis:
• Increase the percentage of colorectal cancer screenings for adults 45 and older.
• Increase the percentage of women who receive regular breast cancer screenings.
• Increase number of lung, melanoma, ovarian, cervical and prostate cancer cases identified at early stages.
• Increase informed decision-making about and access to genetic testing and counseling among moderate- and high-risk individuals.
• Increase insurance coverage and benefits that provide adequate/comprehensive access to evidence-based early detection services/technologies.
A second goal is to ensure all Missourians have access to and use high-quality medical and palliative care that is appropriate and personalized to meet patient preferences and needs.
Despite the availability of treatment options for cancer, there are many cases in which a cure is not possible, so the goal becomes reversing, slowing or stopping its progression. The type of treatment one receives is based on multiple factors, Such as the type of cancer or its stage, the general health of the patient and the patient's personal preference.
Conventional treatments may include surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, hormone therapy, stem cell transplant and others. There are also palliative treatment options available.
The plan includes nine objectives surrounding treatments:
• Increase the proportion of Missourians who receive accurate, evidence-based information about cancer treatment options.
• Increase adherence to evidence-based standards of care.
• Increase regular assessment of, and health care provider support for, mental health needs.
• Increase capacity of cancer care navigation services available for all ages.
• Increase diversity and participation in clinical trials.
• Increase access to guideline-indicated bio-marker testing and precision medicine treatments, especially for people living in rural communities.
• Increase the number of programs led by community-based organizations to address local needs for cancer prevention, treatment or survivorship.
• Increase the number of updated advance care planning documents.
• Increase use of public health surveillance and health system medical record data to inform decision-making about cancer service locations and quality improvement.
The plan's third goal is to improve the quality of life for cancer survivors. Advances have improved early detection and treatment of cancer, and allow people receiving diagnoses to live many years.
However, disparities in health care affect survival rates, according to the plan. Low-income people who have inadequate or no health insurance coverage are more likely to be diagnosed with cancer at a later stage, often reducing survival time," the plan states. "For the over 500,000 adult cancer survivors living in Missouri, access to resources and supports that address physical, emotional, social, spiritual and financial challenges due to a cancer diagnosis and treatment is critical to long-term recovery and quality of life."
Public health professionals strive to address survivorship and quality of life issues, such as the coordination of care, patient-provider communication, palliative care, pain management and fertility preservation, the plan states.
"... Every person with cancer should receive written care plans and summaries that follow them from the time they are diagnosed through all the years of survivorship," it states.
Objectives associated with improving quality of life for survivors include:
• Increase the delivery of comprehensive, individualized survivorship care plans including use of peer-support groups to include children cancer survivors.
• Increase patient satisfaction with physical and mental health symptom-management during and after treatment.
• Increase resources and services that equip patients to direct end-of-life care.
• Increase the proportion of cancer patients who use rehabilitation services to reduce or prevent long-term and late effects.
• Increase capacity to collect, analyze and report data related to quality of life of cancer survivors.
The fourth goal of the plan is to reduce Missourians' risk of cancers associated with health behaviors and environmental carcinogens.
About 42 percent of cancer cases and 45 percent of cancer deaths in the United States are linked to modifiable risk factors, making them preventable, according to the action plan. Risk factors may include tobacco use, poor diet, alcohol use, excess body weight, cancer-associated infections, ultraviolet radiation and lack of exercise.
"Furthermore," the plan states, "the risk of getting cancer can be reduced in a variety of ways, including eating healthy and keeping a healthy weight, avoiding tobacco, limiting alcohol consumption, protecting your skin from the sun, and getting recommended screenings."
Skin cancer is the most common form of cancer in the United States. Exposure to ultraviolet rays appears to be the most important environmental factor involved with developing skin cancer. To help prevent skin cancer while still having fun outdoors, seek shade, apply sunscreen regularly, and wear sun-protective clothing, a hat and sunglasses.
The action plan sets these objectives to reduce the risk of residents getting cancer associated with their behaviors:
• Increase the percentage of Missourians at healthy weight.
• Increase the percentage of Missourians who exercise regularly.
• Reduce the proportion of Missourians who use tobacco products, including electronic smoking products.
• Reduce exposure to ultraviolet rays.
• Reduce exposure to radon gas.
• Increase the percentage of individuals ages 11-17 who receive the human papillomavirus vaccine.
• Increase the number of adults who know their family history of cancer.
• Increase capacity to collect data and measure impact of digital media strategies on prevention-related health behaviors.
• Increase funding for community health education, peer support services, and tobacco prevention and cessation services.