Lisa C. Richardson, MD, MPHDirector, Division of Cancer Prevention and Control,
Centers for Disease Control and Prevention
Where Do We Go From Here?
Michigan Cancer ConsortiumNovember 9, 2016
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The Golden Circle
WHAT
HOW
WHY
Simon Sinek, 2009 TedTalkAll slides in this presentation are the property of the presenter. Please do not duplicate slides without the written permission of the presenter.
CDC’s Cancer Prevention and Control Appropriations
CANCERREGISTRIES
OVARIAN & JOHANNA’S
LAW
BREAST CANCER IN YOUNGWOMEN
COMPREHENSIVECANCER
PROSTATE BREAST AND CERVICAL
CANCERSURVIVORSHIP and
SKIN CANCER
COLORECTAL
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What Is Driving the Future?
Health MarketTransformation
Growth of Exponential Technology
Changes in Populations and Cancers
Consumer Preferences and Expectations
Kaiser Family Foundation (2016); Deloitte Healthcare Convergence (2015); Deloitte Healthcare Consumer Engagement (2015); Deloitte Healthcare Current (2015); Deloitte Global Mobile Consumer Survey (2015); CDC (2015); Congressional Budget Office (2015)
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Why CDC for Cancer Prevention and Control?
Uniquely Positioned toDrive Outcomes
Data
Translation and Evaluation
Partnerships
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Our Guiding Principles
Address Health DisparitiesConsider populations facing health inequities and how to reach them and improve their outcomes. Who might get left out of a program? How do we address and overcome barriers?
Define Expected Outcomes UpfrontConsider the purpose and expected outcomes during the initial planning phases. How will you know when you’ve been successful? What data do we need and how will we get it?
Collaborate Consider each partner’s strengths, capabilities, and assets as they relate to the strategic priorities. How might they add value to the work? How might they derive value from it?
Communicate: Tailor to a Specific Audience Consider who is the recipient of the work and who is impacted by the messaging. What do they value? How do they receive and use information?
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CDC has an active and growing presence on social mediaSharing the message about Cancer Prevention and Control
15,665The CDC Breast Cancer
Facebook page received more than 15k likes since
August 2014.
@CDC_Cancer has more than 90k followers and is averaging more than 1k new followers a month.
7.9M+In 2016, CDC Cancer’s web
pages had more than 14.9 million page views from
4 million unique visitors.
4,850+CDC Breast Cancer’s
Pinterest Board has more than 95 pins and more
than 4.8k followers.
1.4MThe 85 videos on the cancer playlist have been viewed
more than 5.6 million times.
91,000
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CDC’s Cancer Aspirations and Strategic Priorities
• Reduce incidence of vaccine-preventable cancers by promoting system and policy changes
Elimination of preventable cancers
• Increase the impact and return on investment (ROI) of screening programs, and scale screening best practices within and beyond DCPC
All people get the right screening at the right
time
• Improve the integration of clinical and public health data to support data-driven decisions by providers and state health department
People have the best possible cancer care
and outcomes
• Improve health outcomes for cancer survivors through the execution of a unified survivorship agenda
Cancer survivors live longer, healthier lives
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DCPC
CDC’s Framework and Priorities
• Elimination of preventable cancers
• All people get the right screening at the right time
• People have the best possible cancer care and outcomes
• Cancer survivors live longer, healthier lives
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Why DCPC?• Existing collaboration with NCIRD, NCHHSTP, and NCEZID• Enables powerful data-driven insights, reinforces messaging, and expands reach• Every Branch and OD are already working in this space, and with a more
coordinated approach, progress can be accelerated and impact can be greater • Currently fund National HPV Roundtables for ACS
• Reduce incidence of vaccine-preventable cancers by promoting system and policy changes
Elimination of preventable cancers
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HPV & COMPREHENSIVE CANCER CONTROL DCPC-NCIRD CoAgImproving HPV Vaccination Rates Together (HPV Roundtable)
NCI Supplemental HPV FundingUp to $2.7 Million for 18 Cancer Centers
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Skin Cancer Prevention
From 2009-2015, 1.3 million fewer teenagers reported using indoor tanning devices.
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Why DCPC?• Unique role and long history of funding and delivering impactful, national-level
screening programs• Established programming expertise and partner networks and relationships• Cadre of economists and evaluators with expertise in cost effectiveness research
and evaluation activities• Opportunity to measure impact and ROI to demonstrate value and importance of
programming• Opportunity to take lessons learned and scale beyond DCPC
Increase the impact and return on investment (ROI) of screening programs, and scale screening best practices within and beyond DCPC
All people get the right screening at the right
time
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Supporting Organized Approaches to Colorectal Cancer Screening: FY 2015-FY 2020
Component 1: Health System Change to improve and increase CRC Screening•All 30 grantees are partnering with health systems to
implement priority strategies
Component 2: Direct Screening• 6 grantees are also being funded to support direct
screening for low-income adults age 50-64.
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National Colorectal Cancer Roundtable
Expand colorectal cancer screening efforts
• National Colorectal Cancer Roundtable (NCCRT)’s 80% by 2018 Initiative – American Cancer Society, CDC, NCI, HRSA, other
stakeholders
From 2013-2015, 2.9 Million more adults reported being up-to-date with colorectal cancer screening
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CDC’s Colorectal Cancer Control Program
*Of the clinics reporting an EHR-calculated screening rate, 77% reported somewhat or very confident in the accuracy of the screening rate; 15% reported not confident, and 8% did not report a confidence level
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CDC’s Colorectal Cancer Control Program
77% of clinics are Patient Centered Medical Home-recognized
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Why DCPC?
DCPC is one of the only organizations that manages a national-level data source; Expertise and ongoing analysis around registry/surveillance data
Unique position in the cancer ecosystem through its relationship with state health departments, providers, and national organizations
Ability to leverage public health data, along with other data, to demonstrate public's health value in reducing cost and improving quality and overall population health
Improve the integration and use of clinical and public health data to support data-driven decisions by providers and state health departments
People have the best possible cancer care
and outcomes
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PCORTF Collaborative Project – CDC and FDA
• Two Year Project• Project Goals:
–Develop a Natural Language Processing (NLP) Web Service for structuring and standardizing unstructured clinical information
–Pilot for use in cancer registries and safety surveillance domains
–Will be expandable to meet other domain requirements
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Literature Review and Evaluation
Engage Stakeholders, Requirement
Gathering, and Technical
Design
Prototype Development
Pilot NLP Web Service
NLP Web Service
Published
Overview of Project Activities
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Potential Challenges
Dependencies on open source software
Availability of large test datasets
Limitations of open source NLP software and tools
Inclusion of stakeholders from different domains
Prioritization of requirements
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Why DCPC? Deep expertise and capabilities across surveillance, research, and
program to identify and address emerging survivor needs Unique position to translate the science around survivors into state-level
public health programs and interventions Experience with coalitions and CBO’s that can connect survivors with a
broad array of health and social resources DCPC is embedded in NCCDPHP which provides great opportunities to
address co-morbidities
• Improve health outcomes for cancer survivors through the execution of a unified survivorship agenda
Cancer survivors live longer, healthier lives
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16.9 17.1 15.4 15.6 16.813.8 12.1
10.0
0.05.0
10.015.020.025.030.0
2009 2010 2011 2012 2013 2014 2015 2017
% w
ho sm
oke
Cancer Survivors Who Are Current Smokers
Smoking in Cancer Survivors
From 2009-2015 overall, the number of cancer survivors who are current smokers has decreased from 2.3 million people to 1.9 million people.
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Comprehensive Cancer Control Plan for Michigan, 2009–2015
Genomics GoalIncrease availability of cancer-related genetic
information to the Michigan public and decrease barriers to risk-appropriate services
Ovarian Cancer GoalImprove understanding of, and access to, genetic
counseling services for women who may be at high risk for developing ovarian cancer
michigancancer.org/
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Promoting Evidence-based Cancer Screening Polices Among Insurers
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Enhancing Breast Cancer Genomics Best Practices and Policies, 2011–2014
Goals● Promote adoption of health plan policies to increase coverage of BRCA clinical services● Increase healthcare provider knowledge and use of BRCA clinical practices● Expand surveillance of BRCA clinical practices
1. Record family and personal
history of cancer
2. Perform cancer genetic risk
evaluation referral and counseling
3. Perform BRCA testing and
interpret results
4. Provide recommended BRCA related
clinical service
BRCA counseling, testing, and clinical services
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Promoting Evidence-based Cancer Screening Policies Among Insurers
Michigan Department of Health and Human Services, unpublished data
Members from specific health plan receiving BRCA counseling and testing, October 1, 2007–September 30, 2013
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Lynch Syndrome Screening Network (LSSN)
LSSN Mission● Promote Lynch syndrome screening on all newly
diagnosed colorectal and endometrial cancers● Facilitate the ability of institutions to implement
appropriate screening through network collaboration● Investigate universal screening for other
Lynch syndrome-related malignancies Institutional membership
● Over 120 leading cancer institutions are members● Over 20,000 newly diagnosed cancers screened● Membership data assisting to measure
Healthy People 2020 Lynch syndrome objective http://www.lynchscreening.net/
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“I plan to do two things: 1) Increaseresources—both private andpublic—to fight cancer. 2) Breakdown silos and bring all the cancerfighters together —to work together,share information, and end canceras we know it. And the goal of thisinitiative is simple—to double therate of progress. To make a decade’sworth of advances in 5 years.”
Vice President Joe BidenFebruary 2016
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To make a decade worth of advances in cancer prevention, diagnosis, and treatment, in five years …
… coming together of science, technology, advocacy, social science, and big data to solve cancer’s greatest challenges.
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Free Trapped Data
Support Patients
Increase Access to Treatment
Improve Care
Help Find a Cure
Unleash New Breakthroughs
Vice President’s Cancer Moonshot To …..
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Moonshot Initiative
Federal Task Force
Deputies Working Committee
Science
Data
Therapies
Prevention & Diagnosis
Access & Care
NCI
Blue Ribbon Panel
*Blue Ribbon Panel has seven work groups not reflected in diagram: Cancer Immunology and Prevention, Tumor evolution and Progression, Precision prevention and early detection, Expanding Clinical Trials, Pediatric Cancer, Enhanced data sharing, and Implementation Sciences
Cancer Moonshot: Organization
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Cancer Moonshot: Key Activities
5/31/2016 Prevention and Diagnosis Work Group Kick-Off
January-February March-April May-June July-August September-October
1/28/16White House
MemorandumLate April:
CDC Engaged
9/7/16Blue Ribbon Panel Report Released
10/17/16Task Force
Report Released
6/29/16Moonshot Summit
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Recommendations:
– Establish a network for direct patient involvement– Create a clinical trials network devoted exclusively to
immunotherapy– Develop ways to overcome resistance to therapy– Build a national cancer data ecosystem– Intensify research on the major drivers of childhood cancers– Minimize cancer treatment’s debilitating side effects– Expand use of proven prevention and early detection strategies– Mine past patient data to predict future patient.– Develop a 3D cancer atlas– Develop new cancer technologies
Cancer Moonshot: Blue Ribbon Panel
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Cancer Moonshot: Cancer Moonshot Task Force Report Priority Areas
Catalyze New Scientific
Breakthroughs
Unleash the Power of Data
Accelerate Bringing New Therapies to
Patients
Strengthen Prevention and
Diagnosis
Improve Patient Access and Care
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FDA’s Oncology Center of Excellence
Expedite and integrated
development and evaluation of drugs,
biologics, and devices
Shift away from conventional phase
1, phase 2, and phase 3 paradigm
Use common control trials
Encourage use of large simple trials
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NCI’s Cancer Clinical Trials
• Re-design how patients and oncologists locate information about NCI-supported cancer clinical trials
• New API allows researchers and patient groups to tailor information from the site, in real time, to identify trials relevant to individual communities and specific cancers
• Easier for researchers to recruit new participants and for patients to find trials that make a difference for them
trials.cancer.gov
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Prevention and Diagnosis Work Group Priorities
Increase Outreach and Funding for Adopting Effective Prevention
Strategies
HPV vaccination
Tobacco control
Improve the Cancer Screening Continuum
Colorectal cancer screening
Colorectal Cancer Legislation
Enhance Understanding of Environmental
Determinants of Cancer
Radon risk
Screening assays of carcinogens (Tox21
Interagency Agreement)
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Prevention and Diagnosis Work Group Priorities: HPV Vaccination
Strategy: Promote HPV as Cancer Prevention
• National HPV Vaccination Roundtable– American Cancer Society, CDC (DCPC and NCIRD), and
other partners
• Expand reach of current CDC Immunization and Comprehensive Cancer Control programs
• Establish HPV Vaccination State Affinity Groups (CMS, CDC, and HRSA)
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Prevention and Diagnosis Work Group Priorities: Colorectal Cancer
Strategy: Expand colorectal cancer screening efforts
• National Colorectal Cancer Roundtable (NCCRT)’s 80% by 2018 Initiative – American Cancer Society, CDC, NCI, HRSA, other
stakeholders
Strategy: Remove barriers that limit access to colorectal cancer screening
• President’s Fiscal Year 2017 budget proposes legislation to waive co-payments when polyps removed during screening colonoscopy
• CMS to provide technical assistance as needed
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Unleash the Power of Data Work Group
Enable a seamless data environment
Unlock scientific advances with open computational
and storage platforms
Develop a workforce capable of
using the open and connected
data
…. we will come.
…. make it easy and relevant to use ….
If you build it ….
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Cancer Moonshot: Alignment
Blue Ribbon Panel Federal Task ForceResearch and Science – Network for direct patient engagement
(clinical trials)
Data – Data ecosystem– Human tumor atlas
– Genomic Data Commons– APPOLLO– Shared resources of linked clinical
data sets
Therapies – NIH Public-Private Partnership for accelerating new therapies
Prevention and Diagnosis
– Evidence-based approaches to prevention: Tobacco control Colorectal cancer HPV vaccination
– Promote tobacco control– Increase colorectal cancer
screening– Improve HPV vaccination
Access and Care – Minimize cancer treatment’s debilitating side effects
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Comprehensive Cancer Control National PartnershipAmerican Cancer Society
American College of SurgeonsCommission on Cancer
Association of State and Territorial Health Officials
American Cancer Society Cancer Action Network
Centers for Disease Control and Prevention
Health Resources Services Administration
Intercultural Cancer Council
LIVESTRONG Foundation
North American Association of Central Cancer Registries
National Association of Chronic Disease Directors
National Association of County and City Health Officials
National Cancer Institute
Susan G. Komen for the Cure
Cancer Support Community
Leukemia & Lymphoma Society
The George Washington University Cancer Center
Truth Initiative
YMCA of the USA
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For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health Promotion
Division of Cancer Prevention and Control
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