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2007Strategic PlanProgress Report

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Table of Contents

Leadership Message .............................................................................. 3

Introduction ............................................................................................ 5

Cancer – All Sites .................................................................................... 15

Leadership Roles .................................................................................... 25

Information and Quality of Life ........................................................ 27

Research .............................................................................................. 35

Prevention and Early Detection.......................................................... 39

Colorectal Cancer ........................................................................ 41

Lung Cancer ................................................................................ 47

Breast Cancer .............................................................................. 57

Collaborative Roles ................................................................................ 63

Prostate Cancer ............................................................................ 65

Nutrition and Physical Activity.................................................... 69

Skin Cancer .................................................................................. 75

Comprehensive School Health Education .................................. 77

Global Cancer Control ............................................................................ 81

Income Development ............................................................................ 87

Historical Change .................................................................................. 99

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Leadership Message

“I find the great thing in this world is not so much where we stand, as in what directionwe are moving.” – Johann Wolfgang von Goethe

As it has throughout its 94-year history, the American Cancer Society is moving aggressively forward in its fightagainst cancer. As 2007 draws to a close, our organization has every reason to be proud. We have achieved measurableprogress toward our 2015 challenge goals for the nation and toward fulfilling our leadership roles, and we haveundertaken a bold new initiative that our studies show has lifesaving potential. And – as always – our everyaccomplishment is making a lasting and tangible difference for people touched by cancer worldwide.

Of course, success for the American Cancer Society is ultimately measured in terms of lives saved. This year again gaveus cause for celebration as cancer mortality rates continued to measurably drop, and as we achieved a secondconsecutive annual decline in the actual number of cancer deaths – a particularly challenging feat given our growingand aging population. Nearly 11 million cancer survivors are living proof that we are indeed making life-affirmingprogress.

We achieve this ultimate bottom line through our continued global leadership in the areas of cancer information,quality of life, research, prevention and early detection. This report chronicles many milestones as well as challengesthat demand additional attention.

We are justly proud of the Society’s many accomplishments, but this is not the time to rest on our laurels. As long aspeople are still needlessly suffering and dying from cancer and as long as there are disparities in the cancer burden, westill have much work to do. As long as our nation’s broken health care system remains a critical barrier to achievingour goals, we must not rest. That’s why we have launched a bold and innovative new initiative designed to educate thepublic about our nation’s health care crisis, give them the tools they need to make informed decisions, and encouragethem to work with their lawmakers to find solutions that work.

As you will read within the pages of this report, 2007 has been a year characterized by positive change and measurableprogress. Thank you for all that you do to ensure that your American Cancer Society continues moving forwardtoward achieving its worthy mission.

Anna Johnson-Winegar, PhD Richard C. Wender, MD John R. Seffrin, PhDChair, National Board of Directors President Chief Executive Officer

This progress report shows themany ways our dedicatedvolunteers and staff and ourgenerous donors are making alifesaving difference in the fightagainst cancer.

volunteers and staff nationwide, and it sets forth aframework within which the American Cancer Societywill both lead and act. The plan consists of severalconnected but discrete elements and integrates missiondelivery, income development, and global cancer control.It serves not only as a reference and guide for decision-making and the development of operational plans, butalso as an organizer for measuring and reportingprogress.

It presents significant achievements by theSociety and by the larger cancer community, as

well as areas of challenge where future improvementsare critical. It clearly shows that if we do the right things,cancer is potentially the most preventable and the mostcurable of the chronic, life-threatening diseases facingAmericans.

The National Board of Directors develops and approves astrategic plan annually. It is developed with input from

The 2007 American Cancer Society Progress Report is

organized around and illustrates progress toward the

outcome statements described in the Society’s 2007

Strategic Plan.

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Introduction

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Introduction

Mission StatementAll elements of the strategic plan are driven by theSociety’s mission: The American Cancer Society is thenationwide community-based voluntary organizationdedicated to eliminating cancer as a major health problem bypreventing cancer, saving lives, and diminishing suffering fromcancer, through research, education, advocacy, and service.

2015 GoalsOur challenge goals for the nation include reducingcancer incidence and mortality and improving quality oflife for people touched by cancer. These goals articulatethe aspirations of the entire cancer community andcannot be achieved by the American Cancer Societyalone.

Nationwide ObjectivesThese specific targets for the cancer community addressareas designed to impact the 2015 goals for incidence,mortality, and quality of life.

American Cancer Society Leadership RolesThe leadership roles identify the Society’s chosen areasof focus in support of the 2015 goals and nationwideobjectives. They define our optimal role in the fightagainst cancer and are based on our unique capabilities.The four leadership roles and two supporting pillarsdirect the strategies we pursue to accelerate progresstoward the 2015 goals.

Global Cancer ControlBy 2010, the World Health Organization estimates thatcancer will become the leading cause of death globally,followed by heart disease and then stroke. Its control isdifficult and complex, requiring shared knowledgeand experience. The Society’s international programleverages our institutional knowledge, assets, andinfrastructure to develop and implement uniqueevidence-based cancer control programming andresponds to global trends that are rapidly changing theNGO sector throughout the world.

Income Development Fundraising is the foundation that underpins our abilityto achieve our strategic plan. The Integrated FundraisingPlan supports and intersects with our mission activitiesto accomplish our leadership roles and contribute to thesuccess of the 2015 goals.

DisparitiesThe American Cancer Society’s executive leadership hasmade a commitment to reducing cancer disparitieswhether they occur in access to information andscreening services, quality care and treatment, or end-of-life support. In accordance with this commitment, theSociety has formed an Office of Health Disparities andhas adopted the National Cancer Institute (NCI)definition of cancer health disparities: “Cancer healthdisparities are differences in the incidence, prevalence,mortality, and burden of cancer and related adversehealth conditions that exist among specific populationgroups in the United States. These population groups maybe characterized by gender, age, race/ethnicity, education,income, social class, disability, geographic location, orsexual orientation.” Our initial focus is on the low SES,African Americans, Hispanics, Asians, Native Americans,and the rural poor. During fiscal year 2008, the Societywill establish an overarching strategic framework to setgoals for reducing cancer disparities. Specific measureswill be developed so that progress can be reported infuture editions of this report.

What to Expect in the ReportThe first chapter of the progress report lists the outcomestatements described in the strategic plan. Progresstoward these statements is measured using graphs andtext to highlight current trends and challenges thatdemand attention. Information used in the progressreport reflects data available as of September 1, 2007.

A series of chapters highlight progress being made towardthe 2015 goals and leadership roles. Progress is measuredagainst the Nationwide Mission Dashboard Metrics, theagreed upon indicators to measure nationwide progresstoward the leadership roles and focus areas. Dashboardmetrics will always be highlighted in gray and will bepresented first in a chapter, followed by any otherinformation relevant to a specific nationwide objective,cancer site, or risk factor.

The next chapters highlight progress toward nationwideobjectives that are not directly tied to the leadershiproles, as well as our global cancer control and incomedevelopment efforts. Progress in income development ismeasured against indicators outlined in the NationwideIncome Development Dashboard.

The final chapter illustrates the historical change in ouroutcome statements from 1996 to November 2006.

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Outcome Statements

2015 Goalsw 50% reduction in age-

adjusted cancer mortalityrates by 2015

w 25% reduction in age-adjusted cancer incidencerates by 2015

w Measurable improvementin the quality of life(physical, psychological,social, and spiritual) fromthe time of diagnosis andfor the balance of life of allcancer survivors by 2015

PrinciplesInformation

BY 2015:By 2015, state-of-the-art information on issues related to incidence,mortality, risk factors, treatment, survivorship, and quality of life(physical, social, psychological, and spiritual) will be available andaccessible through all appropriate channels to all people.

Measurement

Monitoring systems that track relevant incidence, mortality, riskfactor and screening prevalence, and quality of life dimensionsshould be available nationwide.

BY 2008:By 2008, all states will have cancer registries that meet NAACRsilver or gold certification standards.

Disparities

BY 2015:By 2015, disparities in the cancer burden among population groupswill be eliminated by reducing age-adjusted cancer incidence andmortality rates and by improving quality of life in the poor andmedically underserved.

Collaboration

Efforts should be increased at all levels of the American CancerSociety for working with other organizations and agencies toachieve our common cancer control goals and objectives.

Access to Quality Treatment

BY 2015:By 2015, assure that all people diagnosed with cancer have accessto appropriate, quality treatment and follow up, achieving 0%disparities in treatment outcomes.

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Outcome Statements

BY 2015:Incidence: By 2015, reduce the age-adjusted incidence rate of colorectal cancer by 40%.

Mortality: By 2015, reduce the age-adjusted mortality rate of colorectal cancer by 50%.

Early Detection: By 2015, increase to 75% the proportion of people aged 50 and older who have colorectal screening consistent with American Cancer Society guidelines.

BY 2010:Incidence: By 2010, reduce the age-adjusted incidence rate of colorectal cancer by 30%.

Mortality: By 2010, reduce the age-adjusted mortality rate of colorectal cancer by 40%.

Behavior Change: By 2010, 60% of people aged 50 and older will have received colorectal screening consistentwith American Cancer Society guidelines.

Lung Cancer/Adult and Youth Tobacco Use

BY 2015:Incidence: By 2015, reduce the age-adjusted incidence rate of lung cancer by 45%.

Mortality: By 2015, reduce the age-adjusted mortality rate of lung cancer by 50%.

Adult Tobacco Use: By 2015, reduce to 12% the proportion of adults aged 18 and older who are current cigarettesmokers.

Adult Smokeless Tobacco Use: By 2015, reduce to 0.4% the proportion of adults aged 18 and older who arecurrent users of smokeless tobacco.

Youth Tobacco Use: By 2015, reduce to 10% the proportion of high school students (younger than 18) who arecurrent cigarette smokers.

Youth Smokeless Tobacco Use: By 2015, reduce to 1% the proportion of high school students (younger than 18)who are current users of smokeless tobacco.

BY 2010:Adult Tobacco Use: By 2010, reduce to 18.5% the proportion of adults aged 18 and older who are current cigarettesmokers.

Adult Tobacco Use: By 2010, reduce by 25% (from 2000 baseline prevalence rate) the proportion of lowsocioeconomic status adults aged 18 and older who are current cigarette smokers.

Youth Tobacco Use: By 2010, reduce to 15% the proportion of high school students (younger than 18) who arecurrent cigarette smokers.

Colorectal Cancer

Nationwide Objectives

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Outcome Statements


Breast Cancer

BY 2015:Incidence: By 2015, reduce the age-adjusted incidence rate of breast cancer by 15%.

Mortality: By 2015, reduce the age-adjusted mortality rate of breast cancer by 50%.

BY 2010:Early Detection: By 2010, increase to 90% the proportion of women aged 40 and older who have breast screeningconsistent with American Cancer Society guidelines.

Prostate Cancer

BY 2015:Incidence: By 2015, reduce the age-adjusted incidence rate of prostate cancer by 15%.

Mortality: By 2015, reduce the age-adjusted mortality rate of prostate cancer by 50%.

Early Detection: By 2015, increase to 90% the proportion of men who follow age-appropriate American CancerSociety detection guidelines for prostate cancer.

BY 2010:Mortality: By 2010, reduce the age-adjusted mortality rate of prostate cancer by 40%.

Behavior Change: By 2010, increase the percentage of men who have been offered age-appropriate prostatespecific antigen (PSA) screening to 75%.

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Outcome Statements

Nutrition and Physical Activity

BY 2015:Overweight/Obesity: By 2015, the trend of increasing prevalence of overweight and obesity among US adults andyouth will have been reversed and by 2015, the prevalence of overweight and obesity will be no higher than in 2005.

Behavior Change: By 2015, increase to 70% the proportion of adults and youth who follow American CancerSociety guidelines with respect to the appropriate level of physical activity, as published in the American CancerSociety Guidelines on Nutrition and Physical Activity for Cancer Prevention.

Behavior Change: By 2015, increase to 75% the proportion of persons who follow American Cancer Societyguidelines with respect to consumption of fruits and vegetables, as published in the American Cancer SocietyGuidelines on Nutrition and Physical Activity for Cancer Prevention.

BY 2010:Overweight/Obesity: By 2010, the increasing trends in overweight and obesity for both US adults and youth willhave stopped.

Behavior Change: By 2010, increase to 60% the proportion of adults and youth who meet American CancerSociety guidelines for physical activity, as published in the American Cancer Society Guidelines on Nutrition andPhysical Activity for Cancer Prevention.

Behavior Change: By 2010, increase to 45% the proportion of adults and youth who meet American CancerSociety guidelines for fruit and vegetable consumption, as published in the American Cancer Society Guidelines onNutrition and Physical Activity for Cancer Prevention.

Skin Cancer

BY 2015:Behavior Change: By 2015, increase to 75% the proportion of people of all ages who use at least two or more of thefollowing protective measures which may reduce the risk of skin cancer: avoiding the sun between 10:00 a.m. and4:00 p.m., wearing sun-protective clothing when exposed to sunlight, properly applying sunscreen (SPF-15 orhigher), and avoiding artificial sources of ultraviolet light (e.g., sun lamps, tanning booths).


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Outcome Statements


Comprehensive School Health Education

BY 2015:Comprehensive School Health Education: By 2015, increase to 50% the proportion of school districts thatprovide a comprehensive or coordinated school health education program.

BY 2010:Comprehensive School Health Education: By 2010, 35% of school districts will provide comprehensive orcoordinated school health education.

School Health Councils: By 2010, 75% of school districts will have active school health councils.

School Health Coordinators: By 2010, 50% of school districts will have school health coordinators.

Quality of Life

BY 2015:Access to Care: By 2015, the proportion of individuals without any type of health care coverage will decrease to 0%.

Out-of-Pocket Costs: By 2015, the proportion of individuals diagnosed with cancer who report difficulties inobtaining medical care due to high out-of-pocket costs will decrease to 2%.

Pain Control: By 2015, all 50 states and the District of Columbia will have received a grade of B or higher on thePain Policy Report Card, and 10 states will have received a grade of A.

Measurement: By 2015, there will be national surveillance systems to monitor quality of life for those affected bycancer.

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Outcome Statements

Leadership Roles, Supporting Pillars, Focus Areas

Leadership Role – Information

“Support better decisions by making available high-quality, timely, understandable information, especially to newlydiagnosed cancer patients and their caregivers.”

Focus Areas: w “Being a trusted provider of unbiased, general information”

w “Being a trusted provider of interactive, personal information and guidance”

Leadership Role – Research

“Leverage the Society’s scientific credibility and unique position to support innovative, high-impact research – throughboth direct funding and the ability to influence the amount and direction of research funding from other sources.”

Focus Areas: w “Extramural funding of innovative and high-impact research”

w “Intramural funding to conduct, collaborate, and publish high-impact research, assisting both internal and externalcancer control strategies”

w “Influence the amount and direction of funding and policy changes that support research.”

Leadership Role – Quality of Life

“Improve quality of life of cancer patients, caregivers, and survivors by assisting primarily with service referral,community mobilization, collaboration, advocacy, and, where appropriate, directly providing services.”

Focus Areas: w “Refer patients and caregivers to optimal local services via multiple channels.”

w “Influence investment by local communities in high-impact quality of life services and policies through communitymobilization, collaboration, and advocacy.”

w “Where necessary, directly provide services where the Society is uniquely able to do so.”

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Outcome Statements

Leadership Role – Prevention and Early Detection

“Increase the prevention and early detection of cancer.”

Focus Areas: w “Prevent and detect, as early as possible, colorectal cancer through increased screening rates, including addressing

disparities.”

w “Prevent lung cancer through legislative advocacy and smoking cessation activities.”

w “Reduce disparities in the early detection of breast cancer, primarily through advocacy and partnerships.”

Leadership Roles – Supporting Pillars

Advocacy – The leadership roles will be supported by a clear focus and investment in advocacy. Advocacy will besupported at the local, state, and national level with dedicated staff, direct funding, and volunteer involvement.

Disparities – The American Cancer Society recognizes the importance of disparities in each of its leadership roles andwill focus its efforts on them. Disparities will be addressed through direct service delivery, advocacy efforts, and directoutreach to underserved communities.

Global Cancer Control

The American Cancer Society’s InternationalProgram works to:

w Empower individuals and institutions in the fight against cancer. w Strengthen regional and country-based cancer control. w Mobilize resources to fight cancer by creating awareness about the

cancer pandemic.

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Outcome Statements

Income Development

BY 2015:By 2015, increase total public revenue to $1.531 billion, annually.

By 2010:By 2010, increase total public revenue to $1.242 billion, annually.

2010 Target 2015 Target

Relay For Life® $488 million $643 million

Other Community-Based Events $90 million $116 million (Making Strides Against Breast Cancer®, Daffodil Days®, Others)

Distinguished Events $81 million $114 million (Gala and Golf)

Direct Response Strategies $74 million $83 million (Direct Mail, Telemarketing, E-Revenue)

Employer-Based Strategies $56 million $76 million(Workplace Giving, Corporate Promotions)Cause Marketing $8 million $9 million(not included in public support)

Major Gifts/Campaigns* $118 million $109 million

Planned Giving $208 million $245 million(Legacies, Bequests, & Other Planned Gifts)

Other $127 million $145 million(Memorials, Cars, Discovery Shops, Unsolicited, Team ACS, Other)

Total Public Support per Division Plans $1.242 billion $1.531 billion

*Growth rates are likely to be higher than 4% through 2015, but many Divisions have not built their major campaigns out beyond 2010.

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Cancer – All Sites

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Trends:w Death rates are declining in measurable, inspiring

numbers.w The actual number of cancer deaths has declined for

the second consecutive year. w Cancer incidence rates have been relatively stable since

the mid-1990s. w The probability that a person with cancer will survive

at least five years after diagnosis has improved steadilyover the last several decades.

Challenges:w Eliminating disparities in the cancer burden by race,

ethnicity, and socioeconomic status remains achallenge.

w There are no population-based surveillance data toadequately measure elements directly related to qualityof life.

Bottom Line:Between now and 2015, many more new cancers andcancer deaths can be averted by concerted action tocontrol tobacco and obesity, by redoubling efforts inmammography and colorectal screening, and by enactingpolicies to close gaps in access to cancer prevention, earlydetection, and treatment services.

Progress toward the Nationwide Goals at a Glance

2015 Goals

By 2015 Progress 2015 Trends

How successful we are at transferringexisting knowledge into everyday,community-level practice will make all thedifference in the number of lives savedfrom cancer in the years to come.

Unlikely to meet goal Dashboard MetricLikely to meet goal Possible to meet goal

•

? Unknown

Despite remarkable advances in prevention, early

detection, and treatment, cancer remains the second

leading cause of death in the United States.


Incidence: 25% reduction

Mortality: 50% reduction

Quality of Life: Measurable improvement forall cancer survivors

Baseline 1992 to 2004: 10.2% reduction


No population-based surveillance data sets currentlyexist to provide reliable baseline measurements andongoing assessments of progress toward this goal.

?

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w Age-adjusted incidence rates havebeen slightly declining since 1992,showing a 0.3% annual percentdecrease.

w About 1,444,920 new cases areexpected to be diagnosed in 2007.

w Given the current trends in overallcancer incidence, and inconsideration of trends in majorcancer risk factors, it is unlikely thatwe will meet the 2015 goal.

• • • • • • • • • • • • • • •

Overall

By Gender

Age-Adjusted Incidence Rates2015 Goal – 25% Reduction

w Cancer incidence rates areconsistently higher in men thanin women.

w In the United States, men have aslightly less than one in twolifetime risk of developingcancer; for women, the risk is alittle more than one in three.

Our work to expandaccess to health care forall Americans has never

been more urgent. Forty-seven million Americans

are uninsured, andmillions more have

inadequate insurance andlimited access to medical

care, includingprevention, early

detection, andappropriate treatment.

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By Gender and Race/Ethnicity

• • • • • • • • • • • • • • •

By Race/Ethnicity

w African Americans have the highestcancer incidence rate. In 2004,incidence rates among AfricanAmericans were approximately 6%higher than those in whites.

w Asian Americans/Pacific Islandershave the lowest cancer incidence rates.

w Cancer incidence rates areconsistently higher in AfricanAmerican men than in white menand have widened over the pastthirty years.

w Cancer incidence rates are generallyhigher in white women than inAfrican American women.

Overall, racial and ethnic minorities facenumerous obstacles in receiving healthcare services, including cancer prevention,early detection, and quality treatment.Factors that contribute to disparities inhealth care access include low income; loweducation; inadequate health insurance;geographic, cultural, and languagebarriers; racial bias; and stereotyping.

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w More than 1,500 people die ofcancer every day.

w From 1993-2002, cancer mortalityrates declined 1.1% annually. Thelatest joinpoint trend shows anacceleration of the decline to 2.1%per year from 2002-2004.

w Fully reaching the 2015 goal willrequire substantial breakthroughsin early detection and/or in cancertherapy.

w Current trends will achieve a 36.8%reduction by 2015.

• • • • • • • • • • • • • • •

Overall

By Gender

Age-Adjusted Mortality Rates2015 Objective – 50% Reduction

w The declines in death rates weregreater in men than in women, duein large part to the substantialdecrease in tobacco-related canceramong men.

w Death rates decreased for 12 of the15 most common cancers in menand for 10 of the 15 most commoncancers in women.

The Society’s sister advocacy organization,the American Cancer Society Cancer ActionNetworkSM (ACS CAN), launched a historicaccess to health care collaboration with theAmerican Association of Retired Persons,the American Heart Association, theAlzheimer’s Association, and the AmericanDiabetes Association. The “Are YouCovered” campaign will educate politicalcandidates and the public about theimportance of access to care and healthinsurance reform.

The National Institutes ofHealth estimate overallcosts for cancer in 2007

at $219.2 billion: $89billion for direct medical

costs; $18.2 billion forlost productivity due to

illness; and $112 billionfor lost productivity due

to premature death.

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Age-Adjusted Mortality Rates

By Gender and Race/Ethnicity

• • • • • • • • • • • • • • •

By Race/Ethnicity

w Overall, cancer death rates arehigher in African American menthan in white men and in AfricanAmerican women than in whitewomen.

w African Americans have asubstantially higher death rate thanall other races or ethnicities.

w In 1992, the mortality rates forAfrican Americans were 31% higherthan for whites; in 2004, thisdisparity was 24%.

w Asian Americans/Pacific Islandershave the lowest cancer death rates,about half the rate of AfricanAmericans.

The American Cancer Society MissionDelivery Council awarded $8 million to the Society’s Divisions throughmission integration grants, of which60% addressed disparities.

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w The probability that a person withcancer will survive has improvedconsiderably over time.

w This improvement reflects progressin diagnosing certain cancers at anearlier stage, as well as advances intreatment.

• • • • • • • • • • • • • • •

Overall

By Race/Ethnicity

Survival Rates

w The five-year relative survivalrate for African Americansremains lower than that ofwhites, although significantprogress has been made overthe past 25 years.

By Site

• • • • • • • • • • • • • • •

w Among the four major cancer sites,the five-year relative survival rateis highest for prostate cancer(99%), and lowest for lung cancer(16%).

w Most of the leading cancer siteshave experienced significantincreases in patient survival.

w Approximately 10.76 millionAmericans with a history of cancerwere alive in 2004 according to theNCI. Some of these individualswere cancer-free, while others stillhad evidence of cancer and mayhave been undergoing treatment.

Continued increases in cancer survival are expected as a resultof improvements in treatment, as well as advanced methods for– and better participation in – early detection.

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Leading Causes of Death in the United States

• • • • • • • • • • • • • • •

w Cancer, the second leadingcause of death, wasresponsible for approximately19% of all deaths in 1975 and23% of all deaths in 2004.

w The most prominent contributors toall causes of death in 2000 weretobacco (18%), diet and activitypatterns (17%), and alcohol use (4%).

The overall number of persons inthe United States living after acancer diagnosis can be expectedto increase greatly over the nextdecade due to the aging andgrowth of the population.

Leading Causes of Death and Life Years Lost

Actual Causes of Death in the United States, 2000

As of 2007, all 50 states, 10 US territories,five tribes, and the District of Columbiahave published comprehensive cancercontrol plans. This is a substantialincrease from just five states and one tribalconsortium with comprehensive cancercontrol plans in 2000.

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w Of the major causes of death, can-cer has the most significant impacton person-years of life lost.

• • • • • • • • • • • • • • •

Person-Years of Life Lost, 2004

Person-Years of Life Lost Due to Cancer, 2004

Leading Causes of Death and Life Years Lost

w It is estimated that moreperson-years of life are lostdue to lung and bronchuscancer than breast, colorectal,prostate, and skin cancerscombined.

Average Years of Life Lost, 2004

• • • • • • • • • • • • • • •

w The estimated average number ofyears of life lost per person for allcancers combined is approximately15.5 years.


Every day, in more than3,400 communities nation-wide, the American CancerSociety is a beacon of hope

for cancer survivors andtheir loved ones.

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Leadership Roles

w Information

w Quality of Life

w Research

w Prevention and Detection

n Colorectal Cancer

n Lung Cancer

n Breast Cancer

In June 2004, the National Board of Directors,Division Board Chairs, Division Chief ExecutiveOfficers, and the National Home Office ExecutiveTeam adopted four leadership roles, 11 focusareas, and two overarching pillars where, on anationwide basis, we believe we can have thegreatest degree of impact. These leadership roles,focus areas, and pillars define the areas within the 2015challenge goals where the American Cancer Society willexplicitly and specifically focus its efforts over the nextthree to five years.

The leadership roles commit the American Cancer

Society to a broad-based effort to prevent and search

for cures for cancer and advocate effectively at all levels

of government for policies that will help advance the

fight against cancer, and to work to eliminate disparities

in the cancer burden.

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Information and Quality of Life

Information Leadership Role:

Support better decisions by making availablehigh-quality, timely, understandable information,especially to newly diagnosed cancer patients andtheir caregivers. Informed decision making is criticalto cancer prevention, early detection, treatment, andimproved quality of life. The American Cancer Society,through emphasis on information as a leadership role,strives to deliver accurate, unbiased information in atimely fashion and in a form that is easily accessed andunderstood. This is a fundamental service of theAmerican Cancer Society.

Leadership Roles – Informationand Quality of Life

Quality of Life Leadership Role:

Improve quality of life of cancer patients,caregivers, and survivors by assisting primarilywith service referral, community mobilization,collaboration, advocacy, and where appropriate,directly providing services. The tremendous growth inthe number of cancer survivors expected by 2015underscores the need to improve quality of life for allsurvivors throughout the survival continuum. Attendingto the lifelong needs of cancer survivors and their lovedones has been a central focus of the American CancerSociety for many years, and its designation as a leadershiprole ensures that it will remain so.

The American Cancer Society CancerResource Network was launchednationwide in 2006. It encompassesmultiple delivery channels that allowcancer patients, survivors, andcaregivers to reach the Society andreceive help with managing theircancer experience.

In 2006, American CancerSociety researchers publishedmore than 835 articles in peer-reviewed journals.

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Leadership Roles – Information and Quality of Life

l Constituents Served with Patient-RelatedInformation* by Channel

l Constituents Served with Patient-Related Information*w The American Cancer Society served

more than 330,000 uniqueconstituents with patient-relatedinformation and patient programreferrals in fiscal year 2006, anincrease of approximately 6,000constituents from 2005.

w The number of newly diagnosedconstituents and uninsured orMedicaid constituents increased evenmore dramatically – by 34,000 and16,000, respectively.

w This reflects a combination ofimprovements in outreach and indata capture for diagnosis date andinsurance status.

w All channels except the NationalCancer Information Center (NCIC)increased during the year, with theDivision Patient Service Centerchannel experiencing the mostgrowth.

w The decrease in NCIC volumereflects a change in callmanagement scripts givingconstituents an option to contacttheir local office, with growth in thelocal office channel as a result.

w It appears that constituents may alsobe shifting toward the Web as aresource for their cancerinformation.

This year, the Society continues its collaborationwith the National Cancer Institute to providetraining to approximately 200 patient navigatorsnationwide. Targeted donations enable the launchof 50 new American Cancer Society PatientNavigator sites throughout the country over thenext five years. The Society continues to work withCongress to secure sufficient funding for thepatient navigator bill that was signed into law in2005. This important legislation will help reducedisparities in care by improving access to cancertreatment and programs among the medicallyunderserved.

The Society continues todevelop and publish low-literacy documents in avariety of languages thataddress prevention, earlydetection, treatment, andsurvivorship issues.

l Dashboard metrics

w The Cancer Reference Informationsection on cancer.org received morethan 18 million unique views, and900,000 unique constituents viewedonline American Cancer SocietyCancer Survivors Network® contentduring fiscal year 2006. (This activityis not included in the totalconstituents served with informationand program referrals shownpreviously.)

w Fiscal year 2005 content-specific dataare not available, but overall Webvolume has increased dramatically.

l Unique Views of Cancer Information and PatientSupport Online

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The Health InsuranceAssistance Serviceexpanded to 27 states in2006, up from 11 states in2005, and has answeredcalls from more than 10,000constituents.

The Personal Health Managerlaunched in 2006. This important newconstituent tool helps newly-diagnosedcancer patients and their caregiversmanage and organize the informationabout diagnosis and treatment thatthey receive from various sources.

The American Cancer SocietyBehavioral Research Center isdedicated to preventing ordecreasing suffering andenhancing the quality of life of allindividuals affected by cancerthrough interventions research.

• • • • • • • • • • • • • • •

l Dashboard metrics

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l Number and Percent of Constituents with Needsthat Could Not Be Met when First Requestedw The number of constituents

who could not be provided witha referral to an AmericanCancer Society or communitypatient program at the time oftheir initial request declined in2006, reflecting nationwidefocus on improving the qualityof resources in the CancerResource Connection.

• • • • • • • • • • • • • • •

So far this fiscal year,cancer.org has received

nearly 24 million visits, withmore than14 million visits

coming from search enginesand four million from

referring sites.

The Society continues to publish the mostcurrent cancer statistics and trendinformation in a variety of Cancer Facts &Figures publications. These publications arethe most widely cited source for cancerstatistics.

This year, there were 11.8 million hits tothe Look Good…Feel Better® Web siteand more than 8,000 calls to their toll-free number.

In 2006, the Societyprovided transportationservices to approximately26,000 constituents,including 14,000 who werenewly diagnosed and 3,200who were uninsured or onMedicaid. Theseconstituents received acombined total of 371,000trips.

l Dashboard metric

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• • • • • • • • • • • • • • •

l Call Back Initiative – Number of ConstituentsContacted

l Number and Percent of Constituents with Needsthat Were Ultimately Left Unmet

w Most constituents with requeststhat were initially unmet wereeventually served. Only 2.3% ofconstituents requesting a servicehad needs that were never met bythe Society or by referral to acommunity organization.

w Fiscal year 2005 data are notavailable.

w The Call Back Initiative is part ofthe Society’s strategy to strengthenits relationship with key audiences,especially newly diagnosedpatients, by monitoring theconsistency and quality of serviceprovided and to generate demandby offering additional services.

w The total number of constituentscontacted as a result of the CallBack Initiative more than doubled,from 21,285 in fiscal year 2005 to49,639 in fiscal year 2006.

w Average satisfaction scores forconstituents completing each typeof Call Back survey were strong andconsistent across strategies.

The National CancerInformation Center handlesapproximately one millioncalls annually, or about3,000 calls per day. NCICservices are now available in91 languages.

An individual doesn’t get cancer – a familydoes. While the American Cancer Societycannot hope to directly provide all the servicesneeded by cancer patients and their families,we can become experts on community cancerresources, information, and guidance.

l Dashboard metrics

32

Nationwide Objectives Related to Leadership Roles

Access to Care

w The percentage of persons in theUnited States between the ages of 18and 64 who report being uninsuredcontinues to rise and is now at20.02%.

w Reversing this trend will requirecoordinated efforts across thepublic, private, and nonprofitsectors.

Percent Reporting No Health Care Coverage

Percent Report High Out of Pocket Costs

w The percentage of persons in theUnited States who report problemswith out-of-pocket health care costscontinues to rise and is now at7.62%.

w At least 17 million adults areunderinsured, meaning theirinsurance does not adequatelyprotect them against catastrophichealth care expenditures.

2015 Objective – Proportion of individuals without any type of health insurance will decrease to 0%.

2015 Objective: Proportion of individuals diagnosedwith cancer who report difficulties obtaining care due tohigh out-of-pocket costs will decrease to 2%.

The Society defines meaningfulhealth insurance as being:• Adequate – Access is timely

and coverage offers the fullrange of health care services,including prevention and earlydetection.

• Affordable – Costs are notexcessive and are based on thepatient’s ability to pay.

• Available – Coverage isavailable regardless of healthstatus or claims history.

• Administratively simple –Processes are easy tounderstand and systems areeasy to navigate.

Patients and families who stayed at a HopeLodge® in 2006 saved more than $18 million.Twenty-two Hope Lodges are currentlyoperating, with 12 new facilities in development.The average occupancy rate for all Hope Lodgesis 85%-90%, although many operate at 100%occupancy and have waiting lists.

Out-of-Pocket Costs

33

Nationwide Objectives Related to Leadership Roles

Pain Policy Report Card

w In 2007, 32 states received a grade ofB or higher on the Pain PolicyReport Card; only 12 states receiveda grade of B or higher in 2000.

w In 2007, four states (KS, MI, VA, WI)received a grade of A; in 2000, nostates received a score of A.

w Pain policies are becoming morebalanced, even compared with lastyear. Since 2006, 23 states hadpolicy change, and in eight of thosestates the change was sufficient toimprove the grade.

w No state’s grade decreased in thelast year or even since 2000, and86% of states now have a grade of atleast C+.

Measurement2015 Objective: There will be national surveillance systems to monitor quality oflife for those affected by cancer.

Progress: Quality of life is an increasingly important outcome amongpersons affected by cancer. However, measurement andsurveillance of quality of life remains a challenging area, as aresult of inadequate systems, poor consensus on measurementtools, and limited funding and national attention. Despite thesechallenges, the Society continues to lead the charge in exploringways to maximize both the quantity and quality of relevant data.

At the present time, there are no national cancer surveillancesystems that include both subjective outcomes collected directlyfrom cancer survivors and verified clinical data regarding cancerdiagnosis, treatment, and disease status.

State policies aimed atpreventing drug abuse,regulating professionalpractice, and improvingpatient care can eitherenhance or interfere with painmanagement. It is clear thatarbitrary or outdatedstandards can create policyrequirements that restrictpatients’ access to treatment.

2015 Objective: All 50 states and the District of Columbia will receive a grade of Bor higher on the Pain Policy Report Card, and 10 states will receive an A.

An estimated 30% of newly diagnosedcancer patients, 30%-50% of patientsundergoing treatment, and 70%-90%of patients with advanced diseaseexperience pain.

Pain Control

35

Research Leadership Role:

Leverage the Society’s scientific credibility andunique position to support innovative, high-impactresearch – both through direct funding and theability to influence the amount and direction ofresearch funding from other sources.

In 2006, the Society spent an estimated $136 million onresearch and health professional training and has investedapproximately $3.1 billion in cancer research since theprogram began in 1946. The Society’s comprehensiveresearch program consists of extramural grants, as well asintramural programs in epidemiology and surveillanceresearch, behavioral research, and statistics andevaluation. Intramural programs are led by the Society’sown staff scientists.

The aim of the American Cancer Society’s research

program is to determine the causes of cancer and to

support efforts to prevent, detect, and cure the disease.

The Society is the largest source of private, nonprofit

cancer research funds in the United States, second only to

the federal government in dollars spent.

Leadership Roles – Research

36


American Cancer Society researchershave concluded that there is a directcorrelation between insurance status anddisease severity. Their studies find thatuninsured and Medicaid patients aresignificantly more likely to be diagnosedwith more advanced cancer, whichrequires harsher treatment and is morelikely to be fatal.

w The research leadership role alsofocuses on influencing the amountand direction of funding for cancerresearch, with research advocacybeing one of the Society’s keystrategies.

w Federal funding for research wascut by $34 million and $32 million,respectively, at the NationalInstitutes of Health and theNational Cancer Institute.

The American CancerSociety concentrates on

funding a niche ofbeginning researchers and

innovative researchopportunities.

The American Cancer Societyprovides targeted researchfunding in areas of specialneed, such as cancer in thepoor and underserved, healthpolicy outcomes, andpalliative care research, inboth the extramural andintramural programs.Awards for cancer in the poorand underserved represented10.3% of the total grantsexpenditures last year.

l Federal Research Budgets

• • • • • • • • • • • • • • • l Dashboard metric

37


The American Cancer Society continues tolaunch Cancer Prevention Study-3 (CPS-3), alarge cohort study that will further ourunderstanding of factors that cause or preventcancer. The Society’s epidemiologists arerecruiting volunteers for a study of lifestyle,behavioral, environmental, and genetic factorsthat cause or prevent cancer in partnershipwith Relay For Life events across the country.More than 20,000 volunteers have been enrolledin the study to date.

As of October 2007, the AmericanCancer Society is supporting 938current multi-year grantstotaling more than $457 million.

In 2006, 12,681 constituentscreated profiles to search fortreatment and prevention/detection clinical trials as partof our Clinical Trials MatchingService. Clinical TrialsSpecialists helped 5,482constituents explore options forclinical trial enrollment. Eighty-four constituents enrolled inclinical trials.

In fiscal year 2006, 32 pay-ifs werefunded at $10,902,043; of those, 17were funded with special gifts thatwere restricted to pay grants thatwould not have been funded otherwise,adding $3,653,500 to the researchoperations budget, an increase of 41%over the previous year.

39

Current knowledge indicates that up to 70% of allcancers may be prevented through widespreadimplementation of effective interventions. Tobacco use,physical inactivity, obesity, and poor nutrition are majorpreventable causes of cancer and other diseases in theUnited States. Current scientific evidence indicates thatthe wider application of available screening and earlydetection techniques can significantly reduce thenumber of deaths from breast, cervical, and colorectalcancers. Aside from avoiding tobacco and maintaining ahealthy weight, getting recommended cancer screeningsis the most important thing people can do to reducetheir risk of dying from cancer.

n Colorectal Cancer

n Lung Cancer

n Breast Cancer

Prevention and Early Detection Leadership Role:

Increase the prevention and early detection of cancer.

Leadership Role – Preventionand Early Detection

41

Colorectal cancer is the thirdmost common cancer in both

men and women and accounts foralmost 10% of all cancer deaths.

Trends: w Incidence rates continue to decline, currently

at a rate of 2.3% annually. w Mortality rates continue to decline, currently at a rate

of 4.7% annually.

Challenges:w Screening for colorectal cancer among all populations

remains low, despite its proven effectiveness. w The disparity in both incidence and mortality rates

between African Americans and other groups hasincreased substantially since the early 1990s and doesnot appear to be lessening.

Bottom Line: People who follow recommended screening guidelines,maintain a healthy weight, engage in regular physicalactivity, and consume a healthy diet can reduce their riskof developing colorectal cancer. As more people followthe Society’s prevention and early detection guidelines,colorectal cancer incidence and mortality will continueto drop.

Progress toward Nationwide Objectives at a Glance

Colorectal Cancer

BY 2010:

•

•

Leadership Role Focus Area:

Prevent and detect, as early as possible, colorectal cancer through

increased screening rates, including addressing disparities.

Colorectal Cancer


Incidence: Reduce by 40%

Mortality: Reduce by 50%

Early Detection: 75% of people aged50 and older have colorectal screening



Behavior Change: 60% of people aged50 and older have colorectal screening



2006 screening rate: 55.1%



2006 screening rate: 55.1%

Unlikely to meet goal Dashboard MetricLikely to meet goal Possible to meet goal •? Unknown

(BRFSS: Combined FOBT or endoscopy – Adult 50+)

(BRFSS: Combined FOBT or endoscopy – Adult 50+)

Providing insurance coverage of the full range of colorectal cancerscreening tests has been shown to increase screening rates.Improving insurance coverage for the full range of colorectalscreening tests is a high priority for the Society. This year, threemore states joined 19 states and the District of Columbia, inpassing legislation to ensure insurance coverage of colon cancerscreening. In addition, eight states now have programs to providecolorectal cancer screening for low-income, uninsured, andunderinsured men and women.

42

Colorectal Cancer

w While screening rates haveincreased over the past severalyears, they still remain around 50%,even though screening tests areproven effective in preventing anddetecting colon cancer early.

w Recent increases in colorectalcancer screening may be related toincreased awareness efforts,expansions in health care coverageby states and Medicare, and theestablishment of screeningprograms in certain states.

w There is significant need forimprovement in rates amonguninsured adults; this populationsegment is being screened at lessthan half the rate of the generalpopulation.

w Trend to 2010: Likely to meetobjective

w Trend to 2015: Possible to meetobjective

• • • • • • • • • • • • • • •

l Colorectal Screening*

l Number of States Achieving ColorectalScreening Coverage Advocacy Ratings*w The number of states receiving a

gold, silver, or bronze rating foradvocacy in support of colorectalcancer screening coverageincreased in 2006.

w This increase primarily reflectsmore accurate reporting, butseveral states passed additionallegislation in 2006.

Early Detection 2015 Objective – 75% Screened2010 Objective – 60% Screened

l Dashboard metrics

Colorectal Cancer

• • • • • • • • • • • • • • •

By Race/Ethnicity

w The more rapid decrease in themost recent time period (2.3% peryear from 1998-2004) partly reflectsan increase in screening, which candetect and remove colorectal polypsbefore they progress to cancer.

w If recent decreases continue, it islikely that we will meet our 2010and 2015 goals.

w African Americans have a greaterrisk of developing colorectal cancerthan any other racial or ethnicgroup in the United States, and thegap is widening.

w In 1992, the gap between incidencerates for African Americans andwhites was 13%; this gap increasedto 24% in 2004.

Age-Adjusted Incidence Rates

43

2015 Objective – 40% Reduction2010 Objective – 30% Reduction

Other Nationwide Objectives Related to the Leadership Role

The Society and ACS CAN worked tointroduce legislation – known asMichelle’s Law, after college studentMichelle Morse – that would protectvulnerable college students fromlosing their health insurance whenthey take medical leave from school.

Overall

w Colorectal cancer death ratesdecreased 25.4% from 1991-2004.This decrease reflects decliningincidence rates and improvementsin early detection and treatment.

w If recent decreases continue, we willexceed the 2010 and 2015 goals.

Overall

By Race/Ethnicityw As with other major cancer sites,

colorectal cancer mortality ratesamong African Americans remainconsistently higher than mortalityrates for other racial and ethnicgroups.

w In 1991, the mortality rate forAfrican Americans was 27% higherthan whites; in 2004, this disparitygrew to 43%.

44

Colorectal Cancer


The Society’s 2007 colorectal cancer publicawareness campaign targeting women aged50-64 was extremely successful at generatingincreased awareness. Sixty-one percent ofrespondents who saw the campaign –particularly African American women –showed significant, positive changes in theirbeliefs and knowledge about testing andprevention.

• • • • • • • • • • • • • • •


Preserving existing coverageand avoiding the creation of

barriers to screening willensure that consumers haveaccess to the screenings that

could save their lives. Sixstates currently have laws

allowing insurance policiesto circumvent stateinsurance coverage

requirements.

Overall

w While survival rates for bothwhites and African Americanshave increased in the past twodecades, the disparity betweenthese two groups has increased.

w African Americans are less likelyto be diagnosed at the localizedstage and have lower survivalrates than whites at all stages ofthe disease.

Colorectal Cancer

Three new evidence-based initiatives thatcan be implemented at the community levelsupport the Society’s colorectal cancerobjectives. The purpose of these initiatives isto identify and enhance strategicrelationships through targeted collaborationwith health care professionals, health plans,and communities.

Survival Rates

45


Prevent lung cancer through legislative advocacy

and smoking cessation activities.

47

Lung cancer is the leading causeof cancer death in both men and

women, accounting for about 29% ofall cancer deaths and 15% of all cancer

diagnoses. Since 87% of cases are linked totobacco use, lung cancer is one of the most

preventable of all cancers.

Trends: w Incidence and death rates continue to decline

significantly in men.w Incidence and death rates in women are approaching

a plateau after continuously increasing for severaldecades.

w Advocacy efforts continue to be successful inincreasing the number of smoke-free laws, increasingstate excise taxes, and fighting tobacco industryadvertising and promotion efforts.

Challenges:w Progress in reducing smoking among adults and high

school students has slowed considerably in the lastfew years.

w There is still a disproportionately high level of tobaccouse among less educated adults.

w Average funding levels by state for comprehensivetobacco control remains less than half the minimumlevels recommended by the CDC.

w Smokeless tobacco products are increasing inpopularity among both adults and youth.

Bottom Line:Stopping tobacco use, or not starting, is the single mostimportant action that can be taken to reduce cancersuffering and premature death in the United States.


Lung Cancer/Adult and Youth Tobacco Use

•

•

••

Lung Cancer




Adult Tobacco Use: Reduce to 12%

Adult Smokeless Tobacco Use: Reduce to 0.4%

Youth Tobacco Use: Reduce to 10%

Youth Smokeless Tobacco Use: Reduce to 1%

Adult Tobacco Use: Reduce to 18.5%

Adult Tobacco Use: Reduce by 25% from 2000baseline for low socioeconomic status adults

Youth Tobacco Use: Reduce to 15%

By 2010



2005 prevalence rate: 20.9% (NHIS)


2005 prevalence rate: 23% (YRBS)

2005 prevalence rate: 8.0% (YRBS)



2005 prevalence rate: 23% (YRBS)


48

Lung Cancer

w In 1965, 42.4% of adults smoked; by2005 that number had dropped to20.9%. However, progress in ratereduction has essentially stalled, likelyreflecting increased tobacco industryexpenditures on marketing andpromotion and declines in funding forcomprehensive tobacco controlprograms.

w In 2005, more adults with lowereducation smoked (32.6%) comparedto all adults.

w While 2006 National Health InterviewSurvey data are not yet available, 2006Behavioral Risk Factor SurveillanceSystem data show that 19.7% of adultsare current smokers and 27.7% ofadults with low education aresmokers.

w Trends to 2010/2015: Possible tomeet objective

w Significant progress has been madesince the early 1990s, but rates ofyouth who are current smokers maybe rising once again based on mostrecent data.

w Trends to 2010/2015: Unlikely tomeet objectives

Tobacco Use

w Funding levels for comprehensivetobacco control increased, but werestill less than half the minimumlevels recommended by the Centersfor Disease Control and Prevention(CDC).

w On average in 2006, states funded39.5% of the minimum for tobaccocontrol established by CDC, up from33.6% in 2005.

• • • • • • • • • • • • • • • • • • •

• • • • • • • • • •

l Adults – Current Smokers

l Youth – Current Smokers

l Tobacco Control Funding*

Adult Prevalence Objectives Youth Prevalence Objectives2015 – 12% (Current smokers) 2015 – 10% (current smokers)2010 – 18.5% (Current smokers) 2010 – 15% (current smokers)2010 – Reduce by 25% (low socioeconomic status)

l Dashboard metrics

49

Lung Cancer

w The number of states reporting fullMedicaid smoking cessationcoverage increased slightly, from 11states in 2002 to 14 states in 2003.

w In 2003, 24 states and the District ofColumbia had partial coverage and13 states had no coverage.

• • • • • • • • • •

l Medicaid Coverage for Smoking Cessation

l State Smoke-Free Laws Grade

• • • • • • • • • • • • • • •

w A 100% increase in the number ofstates receiving an A grade wasaccompanied by a decrease in Band F ratings.

w One state’s “Incomplete” rankingwill convert to an A in 2007 whenlegislation is implemented.

w As of July 2007, 23 states, theDistrict of Columbia, Puerto Rico,and 2,617 municipalities havesmoke-free laws in effect thatrequire 100% smoke-freeworkplaces and/or restaurantsand/or bars.

l Dashboard metrics

w The percentage of the populationprotected by smoking restrictions inbars, restaurants, and workplaces,as well as comprehensive smoke-free laws, showed significantincreases in the past two years.

w Thirty-five states have nopreemption laws, up from 29 statesin 2005.

w The Society and ACS CAN haveadvocated vigorously for smoke-freelaws to reduce the incidence of lungcancer and other smoking-attributable diseases.

l Percent of Population Covered by Smoke-Free Laws

50

Lung Cancer

Among current adult smokers, 70% reportthat they want to quit smoking. In 2005, anestimated 19.2 million adult smokers (42.5%)had stopped smoking for at least one dayduring the preceding 12 months because theywere trying to quit. More than 54% of currenthigh school smokers tried to quit within thepreceding year.

The American CancerSociety has 12 stateQuitline® contracts plus theDistrict of Columbiarepresenting 37% of the USpopulation. The Societyconducts approximately64,000 Quitline sessions peryear. Forty new employercontracts were added in2007 for a total of 77contracts.

l Tobacco Excise Taxes, 2007w In 2007, 22 states and the District of

Columbia have tobacco tax greaterthan or equal to $1.00, up slightlyfrom 21 in 2006.

w The Society and ACS CAN lobbiedsuccessfully for increases in tobaccoexcise taxes, resulting in 11 statesincreasing their excise taxes thisyear; however nearly all of theseoccurred in states already above the$1.00 tax threshold.

w The Society and ACS CAN continueto urge Congress to substantiallyincrease the federal tobacco tax.

Quitting smoking, or not starting at all, is by farthe best way to prevent lung cancer.

Raising tobacco taxes is one of the mosteffective measures to stop children from

starting to smoke, as well as to reduceoverall tobacco consumption. A 10%

increase in the price of a pack ofcigarettes will reduce youth smoking by

7% and overall consumption byapproximately 4%.

l Dashboard metrics

51

Lung Cancer

Other Nationwide Objectives Related to the Leadership RoleAge-Adjusted Incidence Rates2015 Objective – 45% Reduction

w Lung cancer incidence ratesdecreased 13.5% from 1992-2004.

w Trend to 2015: Unlikely to meetobjective

Overall

On the 30 th anniversary of theGreat American Smokeout®, theSociety’s Quitline® broke anintake call volume record for asingle day with 1,441 calls.

The per capita yearly consumption of cigarettes foradults has changed dramatically over the last fourdecades – from a high of 4,345 cigarettes per capitain 1963 to 1,814 cigarettes per capita in 2004.

Smoke-free laws reduce cigaretteconsumption and save healthcare dollars. They encouragesmokers to quit, increase thenumber of successful quitattempts, and reduce the totalnumber of cigarettes smoked.

The tobacco industry heavilymarkets smokeless tobacco

products as harm-reductionagents, although there is no

evidence that smokers are able tofully switch to smokeless tobacco

and not return to smoking.

52

Other Nationwide Objectives Related to Leadership Role

By Gender

w Among men, lung cancerincidence has been declining sincethe early 1980s; among women,the rates have been essentiallystable since 1998 after a longperiod of increase. The downwardtrend in men is on track to meetthe 45% reduction goal, but thetrend among women is not.

w In 2004, rates were approximately1.7 times higher in men than inwomen.

w The primary cause (87%) of lungcancer is tobacco use, soincidence trends are largely areflection of tobacco use trendsover the preceding 20-year period.

By Race/Ethnicity

• • • • • • • • • • • • • • •

w Incidence rates for AfricanAmericans remain consistentlyhigher than for other racialgroups; however, a steeper declinehas been observed for AfricanAmericans as compared to whitesin recent years, likely due tohistorical changes in tobaccoconsumption.

w In 2004, the lung cancer incidencerate for African Americans wasapproximately 20% higher thanthe rate for whites, due to higherrates in African American men.

Lung Cancer

Age-Adjusted Incidence Rates2015 Objective – 45% Reduction

In 2005, cigarette companies spent $13.11 billionon advertising and promotional expenses, downfrom $15.12 billion in 2003, but nearly doublewhat was spent in 1998. This amounted to morethan $36 million per day, more than $45 for everyperson in the United States, and more than $290for each US adult smoker. Additionally, certaintobacco products are advertised and promoteddisproportionately to racial and ethnic minoritycommunities.

53

By Gender

• • • • • • • • • • • • • • •

w Lung cancer death rates among mendecreased 21.8% between1991-2004.

w Death rates for women appear to beplateauing, although the most recentstatistical trend shows a slight increase.

w Lung cancer death rates decreased9.7% from 1991-2004.


w African Americans have a higher lungcancer death rate than any other racialor ethnic group, but the gap hasnarrowed.

w In 1991, the mortality rate for AfricanAmericans was 23% higher than forwhites; in 2004, the gap was 12%.

By Race/Ethnicity

Lung Cancer

Age-Adjusted Mortality Rates2015 Objective – 50% Reduction

Overall

• • • • • • • • • • • • • • •

During 2005, the five largesttobacco manufacturers spent anew record of $250.79 millionon smokeless tobaccoadvertising and promotion.

54

w Survival rates for both AfricanAmericans and whites remainlow; most lung cancers are notdetected at an early stage, whenchances of survival are greatest.

w The five-year relative survivalrate is 49% for cases detected inthe localized stage; however, only16% of lung cancers arediagnosed this early.

Overall

Lung Cancer

Tobacco preventionworks. By even themost conservative

estimate, more than40% of the reduction in

male cancer deathrates between 1991

and 2003 can beattributed to declinesin smoking in the last

half century.

The Society and ACS CAN are urgingCongress to grant the US Food and DrugAdministration the authority to regulatetobacco products and their marketing.This legislation is essential to stop tobaccomanufacturers from marketing theirproducts to children or making false ormisleading claims that their products arelow-risk or safer, and would force thedisclosure of the ingredients in tobaccoproducts.

Survival Rates

We now know with certainty thatconsistent efforts and focused resources

can make a difference in saving livesfrom cancer.

Grassroots advocacy efforts continue to protectmillions of dollars in funds from state tobaccosettlements from being diverted away fromtobacco control programs.

w Smokeless tobacco use amongadults in the United States hasremained essentially flat for morethan a decade.


• • • • • • • • • • • • • • •

55

Lung Cancer

Youth – Smokeless Tobacco Use

12th Graders – Smokeless Tobacco Use

Adult Prevalence Objectives Youth Prevalence Objectives2015 – 0.4% (Smokeless) 2015 – 1% (Smokeless)

Adults – Smokeless Tobacco Use

Tobacco Use

• • • • • • • • • • • • • • •

w While there is progress comparedto the mid-1990s, smokelesstobacco use among youth wasessentially flat between 1999 -2005.


w Daily use of smokeless tobaccoamong 12th grade students hasdecreased significantly from 4.3%in 1992 to 2.5% in 2005.

w While the percentages are small,this is still a significant concern asadolescents who use smokelesstobacco are more likely to becomecigarette smokers.

The smokeless tobaccoindustry has recentlyreported a sharp upturnin US sales, possiblyreflecting an increase inuse due to the increasingnumber of smoke-freeenvironments and a lagin prevalence survey datareporting.

57


Reduce disparities in the early detection of breast cancer,

primarily through advocacy and partnerships.

Breast cancer affects more women in theUnited States than any other cancer except

skin cancer. And only lung cancer kills morewomen than breast cancer.

Trends:w Incidence rates have started to decline after

continuously increasing for more than two decades.w Mortality rates continue to decrease by more than 2%

per year.w According to Behavioral Risk Factor Surveillance

Survey (BRFSS) data, mammography screening rateshave been essentially flat since 2000.

Challenges:w A substantial number of women are still not getting

recommended mammograms.w Overweight and obesity rates are not improving.w Disparities in the breast cancer burden continue to

exist.

Bottom Line: The greatest opportunity to save lives from breast cancercontinues to be timely, high-quality mammographyscreening by all eligible women. Nearly all breast cancerscan be treated successfully if detected early.


Breast Cancer

BY 2010:

•

Breast Cancer




Early Detection: Increase to 90% women aged40 and older who have breast screening.



2006 Screening rate: 61.2%(BRFSS: mammography within the past year)


w Mammography rates have remainedstable at around 60% over the past fiveyears.

w There is a screening disparity betweenwomen who have health insurance andthose who don’t. Uninsured womenhave substantially lower rates ofmammography use than women withinsurance.

w Screening rates among women ages40-64 was 60.5% in 2002; 56.8% in 2004;and 59.7% in 2006.


• • • • • • • • •

The National Breast and Cervical Cancer EarlyDetection Program (NBCCEDP) provides low-income, uninsured, and underinsured womenaccess to lifesaving breast and cervical cancerscreening tests and follow-up services. To date,NBCCEDP has provided more than 6.9 millionscreening exams to underserved women. However,because of a lack of funding, four out of every fiveeligible women are still not being screened andtreated.

58

Breast Cancer

Early Detection2010 Objective – Screening Rates at 90%

On April 20, 2007,representatives from the

American Cancer Society andits sister advocacy

organization, ACS CAN,joined President Bush as he

signed the NBCCEDPReauthorization Act into law.

The legislation allows forgreater flexibility in the

program so it can reach moreeligible women and also sets

increased funding targetsover the next five years.

w CDC funding for the NBCCEDP instates, tribes, and territoriesincreased only slightly (by $3 million)in 2006. Generally, flat funding levelshave significantly affected theprogram’s ability to enroll neweligible women.

w Flat funding rates typically allowmaintenance for screening womencurrently enrolled in the program.Administrative costs continue toincrease during the same period.

l Mammography*

l NBCCEDP Funding Levels – CDC Award

l Dashboard metrics

Overall

By Race/Ethnicity

w Breast cancer incidence rates increasedby 0.5% per year between 1987-2001.However, in the most recent time period,(2001-2004) incidence rates have beendeclining by 3.5% annually.

w The steep recent decline may be due tothe combined effects of decreasedmammography screening rates and thesudden decline in the use of hormonetherapy following the publication ofresults from the Women’s HealthInitiative for combined estrogen andprogestin.

w While it is too early to determinewhether the recent decline is real orrandom, if the trend continues, we wouldfar exceed the 2015 goal of a 15%decrease.

w Although breast cancer incidencerates are lower among AfricanAmericans compared to whites,African American women havesignificantly higher mortality rates.

59

The American Cancer Society continues to be astrong community partner in supporting outreachfor NBCCEDP in states. To date, 35 state programretreats, composed of both American CancerSociety and state and local health departmentrepresentatives, have been held across thecountry.

• • • • • • • • • • • • • • •

Other Nationwide Objectives Related to the Leadership RoleAge-Adjusted Incidence Rates2015 Objective – 15% Reduction

Breast Cancer

w Breast cancer death ratesdecreased 25.4% from 1991-2004.The decline can largely beattributed to earlier detection andmore effective treatment.

w The decline is approximately 2.2%per year; if this trend continues, weare likely to meet the 2015 goal.

w African American women havesubstantially higher death ratescompared to other racial andethnic groups.

w In 1991, African Americanmortality rates were 18% higherthan rates for whites; in 2004 theywere 36% higher.

60

By Race/Ethnicity


2015 Objective – 50% Reduction

Overall

Breast Cancer

• • • • • • • • • • • • • • •

Increasing the proportion of womenwho receive annual mammographyscreening can further reduce breastcancer death rates.

61

“Team Up” is a pilot project in which theAmerican Cancer Society, the Centersfor Disease Control and Prevention, theNational Cancer Institute, and the USDepartment of Agriculture have joinedforces to determine the effectiveness ofadapting and using evidence-basedoutreach interventions to serve rarely ornever screened populations with breastand cervical cancer screening. The pilotis finishing up its fourth and final yearof work in six states. As of June 2007, allsix states successfully implemented theintervention.

w Survival rates among both AfricanAmerican women and whitewomen significantly increasedfrom 1975-2003; nonetheless thereremains a substantial gap.

Survival Rates

Overall

Breast Cancer

63

Collaborative Roles

n Prostate Cancer

n Nutrition and Physical Activity

n Skin Cancer

n Comprehensive School Health Education

The American Cancer Society cannot achieve the2015 challenge goals and nationwide objectivesentirely on its own. Instead, we must collaborate withothers in productive ways. Even though the recentnationwide prioritization process, which resulted in ourleadership roles and focus areas, did not establish specificprograms of work for each site and/or risk factor, theSociety still has a responsibility to be a catalyst, primarilythrough collaboration, to ensure that the resources of ourcancer control partners address any gaps.

Prostate cancer is the most frequently diagnosed cancer

in American men and the second deadliest.

65

Trends:w The long-term incidence trend

is difficult to interpret because it issubstantially influenced by PSA

testing. The mortality trend shows a4.1% annual reduction for 1994-2004.

Challenges:w For reasons that remain unclear, prostate cancer

incidence rates are significantly higher in AfricanAmerican men than in white men.

w Mortality rates in African American men remain morethan twice as high as those of white men.

w There is presently not sufficient data to recommendfor or against prostate cancer testing in men ataverage risk of developing the disease.

Bottom Line: The only well-established risk factors for prostate cancerare age, ethnicity, and family history of the disease. Earlydetection may increase survival and treatment options.High-risk men (African Americans or men with a strongfamily history) should begin screening at age 45. All menaged 50 and older should be offered annual digital rectalexam (DRE) and prostate specific antigen (PSA) testing,and should talk with their doctors about the benefits andlimitations of prostate cancer screening so they can makeinformed decisions.


Prostate Cancer

BY 2010:

Prostate Cancer




Early Detection: 90% follow detectionguidelines


Behavior Change: 75% offered age-appropriate PSA screening



2006 prevalence rate: 53.8%(BRFSS: men 50+ with recent PSA)

Baseline to 2004: 35.4% reduction

2006 prevalence rate: 53.8%(BRFSS: men 50+ with recent PSA)

?


66

Prostate Cancer

w Prostate cancer incidence ratesdecreased 32.7% from 1992-2004.

w Prostate cancer incidence has beenextremely variable in the past 20years, largely due to the advent ofPSA screening.

w Declining prostate cancer incidencetrends will be largely dependent onthe rates of PSA testing in the yearsto come.

w The long-term trend is unknown.

• • • • • • • • • • • • • • •

Overall

By Race/Ethnicity

w African American men have one ofthe highest documented prostatecancer incidence rates in theworld.

w In 2004, the incidence rate forAfrican American men was 53%higher than the incidence rate forwhite men; the reasons for thissubstantial gap remain unclear.

Age-Adjusted Incidence Rates2015 Objective – 15% Reduction

Prostate cancer accounts forapproximately 37% of all

cancers diagnosed in AfricanAmerican men.

Twenty states have laws requiringinsurers to cover clinical trials, andfour states have special agreementswith insurers to voluntarily coverclinical trials.

67

Overall

• • • • • • • • • • • • • • •

By Race/Ethnicity

w Prostate cancer mortality ratesdecreased 35.4% from 1991-2004.

w The latest joinpoint trend (1994-2004) shows a 4.1% annual decrease;if this trend continues, we will farexceed the 2015 goal.

w The reasons for this trend areuncertain, but the measured timeperiod closely followed theintroduction of PSA screening in theUnited States and the advent ofmore effective treatments.

w Although indirect evidence suggeststhere will be mortality benefits fromPSA screening, no trials have beencompleted yet to demonstrate thescale of the benefit.

w Although death rates have beendeclining among white men andAfrican American men since the early1990s, rates in African American menremain more than twice as high asthose in white men.

The huge difference in prostate cancermortality rates between African Americanmen and white men accounts for about 40%of the overall cancer mortality disparitybetween African American men and whitemen.



Prostate Cancer

68

w The five-year relative survival rate is99% for white men and 95% forAfrican American men.

w More than 90% of all prostatecancers are discovered in the localand regional stages; the five-yearrelative survival rate for patientswhose tumors are diagnosed atthese stages approaches 100%.

w The dramatic improvements insurvival are partly attributable toearlier diagnosis and improvementsin treatment.

w Although not conclusive, there isevidence that early detection hasresulted in men being diagnosed atearlier stages and at younger ages,which could ultimately decreasemortality rates and improve theopportunity for successful treat-ment.

w PSA screening rates have remainedessentially flat over the last fiveyears at just above 50%.

w However, screening rates amongmen without insurance are almosthalf those of men with insurance.



Screening*

Survival Rates

Early Detection2015 Objective – 90% follow guidelines2010 Objective – 75% offered PSA

American Cancer Society-funded researchdiscovered the prostate-specific antigen(PSA) test for prostate cancer screening.

Prostate Cancer

Overall

• • • • • • • • • • • • • • •

69

Each year, roughly one-third of all cancer deaths in the

United States are due to nutrition and physical activity

factors, including excess weight. For the majority of

Americans who do not smoke, maintaining a healthy

weight, increasing physical activity, and eating a healthy

diet are the most important ways to reduce cancer risk.

Trends:w Overweight and obesity are increasing among

all ages, both genders, and all ethnic groups. w Currently, two-thirds of adults are overweight,

including one-third who are obese.w Currently, approximately 16% of youth aged 6 to 19 are

overweight, and one-third are at risk of becomingoverweight; obesity rates have doubled in children andtripled in teens over the last 20 years.

Challenges:w It is difficult to combat perceptions that eating and

exercise behaviors are only “individual” concerns andthat environments in which we live, work, play, and goto school do not affect individual behavior.



By 2010:



Overweight/Obesity: Trends reversed andprevalence no higher than in 2005

Nutrition: 75% of population follow guidelinesfor fruit and vegetable consumption

Physical Activity: 70% of population followguidelines

Overweight/Obesity: Increasing trends stopped

Nutrition: 45% of population follow guidelinesfor fruit and vegetable consumption

Physical Activity: 60% of population followguidelines

2006 adult rate: 61.3% (BRFSS)2005 youth rate: 16% (YRBS)

2005 adult rate: 24.3% (BRFSS)2005 youth rate: 20.1% (YRBS)


2006 adult rate: 61.3% (BRFSS)2005 youth rate: 16% (YRBS)


2005 adult rate: 48.3% (BRFSS)2005 youth rate: 68.7%(YRBS)

w Translation of research to support practical applicationof science into policies and programs is limited.

Bottom Line: The obesity epidemic threatens to jeopardize theincidence and mortality decreases seen for many cancerssince the early 1990s. The tobacco control experience hastaught us that policy and environmental changes arehighly effective in deterring tobacco use. To avert anepidemic of obesity-related disease, similar purposefulchanges in public policy and in the communityenvironment will be required to help individuals maintaina healthy body weight and remain physically activethroughout life.


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w Obesity is the nation’s fastest risingpublic health problem. Obesity ratesamong US adults increased by morethan 75% between 1991-2006, and ratesdoubled in children and tripled inteens over the past 20 years.

w One in seven young people is obeseand one in three is overweight.

w The prevalence of overweight/obesityamong ethnic/racial groups does notdiffer significantly for men; in women,prevalence is highest among AfricanAmericans (more than half of AfricanAmerican women aged 40 and olderare obese and 80% are overweight).

w Trends to 2010 and 2015: Unlikely tomeet objectives

w By 2015, it is projected that overall, theprevalence of overweight adults will be75% and obese adults will be 41%,compared to 66% and 32%,respectively, in 2006.

w By 2015, it is projected that forchildren aged 6-11, the prevalence ofoverweight will be 23%, and foradolescents aged 12-19 it will be 24%.In 2006, 16% of adolescents wereoverweight.

Obesity Trends Among US Adults – 1991

Obesity Trends Among Adults – 1995

Overweight and Obesity

More than half the adultpopulation in every stateis overweight; thepercentage of adults whoare overweight exceeds60% in 28 states.

Obesity Trends Among Adults – 2006

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Overweight and Obesity

Current patterns of overweight and obesityin the United States could account for up to14% of cancer deaths in men and 20% inwomen, and contribute to 90,000 cancerdeaths each year.

Twenty two states have taken legislativeaction to set nutrition standards on foodssold outside the school meal program.

About half of youth who areoverweight as children andabout 70% of those who areoverweight by adolescence willremain overweight as adults.

Twenty six states have takenlegislative action to limit when andwhere foods that are not part of theschool meal program can be soldduring school hours.

Through the Preventive HealthPartnership between AmericanCancer Society, AmericanDiabetes Association, and theAmerican Heart Association, theSociety is working collaborativelyto increase the public’sawareness and utilization ofpreventive services andscreenings for chronic disease.

The Preventive HealthPartnership will provide aplatform for exploring the newand better models for thedelivery of preventive servicesthat would improve the quality oflife and other health outcomesfor millions of people over timewhile simultaneously makingmore efficient use of our nation’shealth care resources by avoidingexpenses for preventable chronicconditions.

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Nutrition2015 Adult and Youth Objective – 75% consume five fruits and vegetables daily2010 Adult and Youth Objective – 45% consume five fruits and vegetables daily

Fruits and Vegetables – Adults

• • • • • • • • • • • • • • •

Fruits and Vegetables – Youth

w In 2005, fewer than one in fouradults (24.3%) reported eating fiveor more servings of fruits andvegetables a day; this percentagehas remained essentially the samefor the last decade.

w Trend to 2010 and 2015: Unlikelyto meet objectives

w The 2005 Youth Risk BehaviorSurveillance System (YRBSS)showed that only 20.1% of US highschool students ate five or morefruits and vegetables per day; again,like adults, this percentage hasremained essentially unchanged foryears

w Trend to 2010 and 2015: Unlikelyto meet objectives

Most urban and rural areas have limitedaccess to supermarkets with nutritious foods.Low-income zip codes tend to have fewer andsmaller grocery stores than higher-income zipcodes.

Seventeen states have taken legislative actionto require higher nutritional standards onschool meals than minimum USDArequirements.

People in low-income areasoften pay more for nutritiousfoods such as fresh fruits andvegetables.


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Physical Activity2015 Adult and Youth Objective – 70% follow guidelines2010 Adult and Youth Objective – 60% follow guidelines

w Based on the 2005 Behavioral RiskFactor Surveillance System, 48.3% ofadults met moderate physicalactivity recommendations.

w The state median for vigorousphysical activity is 27.6%.


w Trend to 2010: Likely to meetobjective

Physical Activity – Youth

• • • • • • • • • • • • • • •

In 2005, 37% of high school studentsreported watching three or morehours of television each day, andonly 33% attended physicaleducation daily.

Physical Activity – Adults

w The 2005 YRBSS data showed moderatephysical activity is 68.7%.

w This percentage has increased very littleover the past five years.

w Trend to 2015: Likely to meet objective w Trend to 2010: Objective already met

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More than one million cases of skin cancer are

diagnosed each year. Most are basal and squamous

cell cancers that are highly curable if detected early.

Overall, there was rather limitedprogress in improving sun protectionpractices and reducing sunburns amongUS youth between 1998-2004, despitewidespread sun protection campaigns.

However, about 59,940 skin cancercases in 2007 will be malignant

melanoma – the most serious skin cancer.While melanoma is also highly curable if

detected early (the five-year relative survival rate is91%), it will cause an estimated 8,110 deaths in 2007.Melanoma affects mostly whites, who are 10 times morelikely to develop the disease than African Americans.

Trends:w During the 1970s, melanoma incidence rates

increased by about 6% per year. Between 1981-2000,however, the rate of increase slowed to 3% per year.Since 2000, rates have remained stable.

w After increasing for several decades, the death rate formelanoma has stabilized since 1990 in white men andhas been decreasing since 1988 in white women.

Challenges:w Adults and adolescents do not regularly protect

themselves from ultraviolet (UV) exposure whenoutside on sunny days.

Bottom Line: Nearly all skin cancers are caused by excessive exposureto ultraviolet (UV) radiation. Reducing sun exposure,wearing protective clothing, and properly using adequatesunscreen are the best ways to reduce skin cancer risk.This is especially true for children, as childhood sunburnscan increase the risk of skin cancer later in life.


Skin Cancer

Skin Cancer


Behavior Change: 75% of people useat least two protective measures


Adult: 2005 HINTS – 19% to 50%Youth: 2005 YRBS – 9% to 18%

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Skin Cancer

Most governmental andnongovernmental efforts toprevent skin cancer in theUnited States have sought tochange the individualbehaviors of parents andchildren, without aconcomitant emphasis onsun protection policies, suchas those used effectively inAustralia.

Progress

w The 2005 Youth Risk Behavior Survey (YRBS) found that only 9% ofhigh school students used sunscreen of SPF-15 or higher “most ofthe time” or “always” when they were outdoors in the sun for morethan an hour; this was down from 14% reported in the 2001 YRBS.

w Nationwide, according to the 2005 YRBS, 18% of high schoolstudents most of the time or always stayed in the shade, wore longpants, wore a long-sleeved shirt, or wore a hat that shaded theirface, ears, and neck when outside for more than one hour on asunny day.

w According to the 2005 Health Information National Trends Survey(HINTS), adults reported engaging in the following sun protectionmeasures: 50.4% used sunscreen always or often; 46.3% used a hatalways or often; 19.2% used shade always or often; 61.9% usedlong-sleeved shirts always or often; 28.3% used long pants alwaysor often.

w According to the 2005 BRFSS, the percentage of adults who weresunburned during the past 12 months was 41.2%, an increase from34.5% in 1999.

w In 2004, 69% of youth aged 11-18 reported having been sunburnedduring the summer, not significantly less than in 1998 (72%) basedon Society surveys. There was a significant decrease in thepercentage of those aged 11-15 who reported sunburns and a non-significant increase among 16-18 year-olds.

w The proportion of youth who reported regular sunscreen use inthe past summer increased significantly from 31% in 1998 to 39%in 2004.

w The School Health Policies and Programs Study (SHPPS)conducted by CDC in 2000 indicates that policies for sun safetyprograms do not exist in the majority of elementary,junior/middle, or senior high schools in the United States. Twelvestates and the District of Columbia have policies that require sunsafety or skin cancer prevention in elementary schools. Fifteenstates and the District of Columbia have policies that require sunsafety or skin cancer prevention in middle or high schools. 2006SHPPS data is not yet available.

w If these current trends continue, we are unlikely to meet the 2015objective.

Skin Protection – Behavior Change2015 Objective – 75% of people use at least two protective measures

New American CancerSociety guidelines onskin cancer preventionand early detection willbe released in 2007.

Much of the progress against cancer that we see today

is the result of interventions begun 30 to 40 years ago.

77

The present generation of youngpeople exhibit behaviors that are

linked to increased cancer risk in thefuture, including tobacco use, poor diet,

lack of physical activity, drug and alcohol use,and certain sexual behaviors. If these young people

can be influenced to change their behaviors, more than60% of cancers known to be preventable and caused byhabits formed in childhood could potentially beeliminated. The effort to improve youth health choicescould yield additional health benefits, since many of thebehaviors that increase cancer risk also increase the riskof heart disease, diabetes, and stroke later in life.

Trends:w While the percentage of schools that require health

education increases by grade from 33% in kindergartento 44% in grade five, the percentage decreases to 27%in grade six and only 2% in grade 12. Thus, during thegrades when the prevalence of health risk behaviorsincreases among students, schools progressivelyprovide less health education.

Challenges:w Lack of curriculum and lack of understanding what

works are not the main barriers to comprehensiveschool health education. Instead, the primary obstaclesare a lack of resources, trained personnel, and policiesin school systems that address health in a coordinatedand comprehensive way.

w At the local level, few required health education classesor courses are taught by a teacher who majored orminored in health education or health and physicaleducation combined.

Bottom Line: More than 53 million young people are enrolled in 14,000school districts across the United States. Comprehensiveschool health education in grades K-12 can providestudents the knowledge and skills necessary to help themadopt and maintain healthy lifestyles. If adopted andimplemented nationwide, comprehensive school healtheducation, coordinated with other health enhancingschool programs and policies, could shape the futurehealth of the nation.


Comprehensive School Health Education (CHSE)

BY 2010:

?

?

?

?


CSHE: 50% of school districts provide CSHE

CSHE: 35% of school districts provide CSHE

School Health Councils: 75% of schooldistricts have active school health councils

School Health Coordinators: 50% of schooldistricts have school health coordinators

2000 SHPPS data: 14.9%

2000 SHPPS data: 14.9%

2000 SHPPS data: 88% have sometype of council

No data point until 2006 SHPPSdata is released



78


Comprehensive School HealthEducation2015 Objective – 50% of school districts2010 Objective – 35% of school districts

Progress

w The American Cancer Society collaborated with the CDC to definea measure for Comprehensive School Health Education (CSHE)from the 2000 School Health Policies and Programs Study (SHPPS)data. The SHPPS data showed that 14.9% of school districtsconduct CSHE according to the Society’s definition.

w The Society worked with CDC’s Division of Adolescent and SchoolHealth (DASH) to further refine SHPPS measures for the 2006survey to more accurately capture CSHE at the school districtlevel. The 2006 data will be released in October 2007.

w The Society supported the recent review and revision of theNational Health Education Standards released in February 2007.The National Health Education Standards, originally developed in1995 with the Society’s support, have significantly influenced thequality and quantity of health education taught in US schools inthe past 12 years. The standards are now the recognized healtheducation reference in the United States and have been referencedinternationally. This is a significant contribution by the AmericanCancer Society to school health nationwide.

w Thirty-eight states have adopted or adapted the standards as aframework for K-12 health education. With renewed commitment,the Society continues to work with other national youth andschool health organizations to promote the use and adoption ofthe National Health Education Standards.

w Trend to 2010 and 2015: Unknown until 2006 data is availableSHHPS 2006 data will be released by the Centers for DiseaseControl and Prevention Division of Adolescent and School Healthin October 2007.

Comprehensive school healtheducation refers to K-12 classroominstruction – just one component ofthe larger school health program thatincludes food services, the schoolenvironment, student services, staffwellness, student counseling, andcommunity and parent involvement.

The American Cancer Societyis in the final year of a five-year initiative to implementthe Urban School HealthLeadership Institute within sixlarge urban school districts.This initiative is designed tostrengthen school healthprograms and policies withinthese urban school districts.

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School Health Councils

2010 Objective – 75% of school districtswith active councils

Progress

w Based on data from the 2000 SHPPS survey, some typeof council exists in 88% of school districts.

w Recent federal regulations associated with the FederalFree and Reduced School Meal Authorization requiredthat all school districts use representatives from bothschool and the community to develop School WellnessPolicies related to nutrition and physical activity.Schools with school health councils, many formed dueto the Society’s advocacy efforts, were well positionedto develop policies outlined in the regulations. Thosethat did not have councils had to create them to servethe district. The expectation is that 2006 SHPPS datawill show significant growth for school health councils.

w Trend to 2010: Unknown until 2006 data is availableSHHPS 2006 data will be released by the Centers forDisease Control and Prevention Division of Adolescentand School Health in October 2007.

School Health Coordinators

2010 Objective – 50% of school districtswith coordinators

Progress

w The Society worked with CDC DASH to include newquestions on the 2006 SHPPS in order to capture thepercentage of school districts with school healthcoordinators. Previous SHPPS data captured theprevalence of coordinators nationwide, but thequestion did not distinguish between district andschool building-level coordinators.

w In addition, the Society worked with CDC DASH toinclude questions to capture the impact of leadershiptraining targeting school health coordinatorsnationwide. Since the inception of the AmericanCancer Society School Health Leadership Institutes in1999, many Society Divisions and state departments ofhealth and/or education have sponsored trainingstargeting school health coordinators and other schooland community members who share and influencedecisions that impact school health programs.

w School Health Leadership Institutes conducted at thenational, state, and regional levels over the past eightyears have reached school health leadership teams inmore than 250 school districts that represent somefive million K-12 students – just fewer than 10% of thetotal US student population.

w Trend to 2010: Unknown

The present generation of adolescentsis heavier, less physically active, and,especially among girls, smokes morethan its parents did at the same age.This backslide in the status of ournational health has tremendousnegative implications for society.

81


83

Cancer is potentially the most preventable and the most

curable of all chronic, life-threatening diseases facing

the world today.


In the United States and many otherdeveloped countries, the last century has witnessed

incredible advances in the fight against cancer. Forthe first time in history, age-adjusted mortality rateshave been on the decline for more than a decade inthe United States. We have seen a 1% to 1.2% per yearreduction in cancer mortality since this downturnfirst began in the early 1990s, which has resulted inhundreds of thousands of lives being saved.

However, globally, the story is far different. This year,cancer will claim some seven million lives worldwide,and another 11 million new cases will be diagnosed.Cancer accounts for one in eight deaths worldwide –more than HIV-AIDS, tuberculosis, and malariacombined. Already, 70 percent of all cancer deaths occurin low-and middle-income countries, and withoutimmediate intervention, the situation will grow muchworse. The World Health Organization (WHO) estimatesthat cancer will become the leading cause of deathglobally by 2010.

Projected Global Deaths for Selected Causes of Death, 2002-203015

Cancers

Ischaemicheart disease

Stroke

HIV/AIDS

Other infectiousdiseases

Road trafficaccidents

TuberculosisMalaria

2000 2010 2020 2030

Year

12

10

8

6

4

2

0

Pro

ject

ed g

lob

al d

eath

s (m

illio

ns)

84


Without intervention, more than onebillion people will die unnecessarilyfrom cancer this century – most ofthem in low- and middle-incomecountries. In the last 50 years, sciencehas made remarkable progress towardunraveling the mystery of cancer, yetso much of what we know aboutcancer is not being adequatelytranslated into what we do.

Through its international programs,the American Cancer Society supportsthe efforts of our global public healthpartners in their efforts to controlcancer. We collaborate actively withthe World Health Organization, whichhas set a goal for reducing cancerdeaths by 7.7 million between 2005-2015. This is the equivalent of anentire year free of cancer.

The American Cancer Society’sinternational program works toempower individuals and institutionsin the fight against cancer, tostrengthen regional and country-based cancer control, and to mobilizeresources to fight cancer by creatingawareness about the cancer pandemicthrough several programs.

Cancer.org and Cancer Information Translations

The American Cancer Society’s Web site, www.cancer.org, servesmillions of individuals throughout the world. Cancer information iscurrently available in English, Spanish, Mandarin, and several otherAsian languages. Approximately 21% of Web traffic to cancer.orgcomes from outside the United States.

Worksite Initiatives

The American Cancer Society collaborates with multinationalbusiness partners to deliver cancer information and wellnessprograms to employees throughout the world. The Society’sQuitline will be launched internationally in the near future.

The American Cancer Society University

The American Cancer Society University (ACSU) is an intensivetraining and development program designed to enhance nonprofitmanagement practices and public health skills among cancercontrol leaders around the world. To date, more than 500 scholarsfrom over 80 countries have graduated from the American CancerSociety University.

International Relay For Life®

International Relay For Life enables cancer organizations to raisetheir profiles and increase income and capacity throughsurvivorship programs, volunteerism, and advocacy. More than 20countries have implemented Relay programs, with more than 525events annually.

Framework Convention on Tobacco Control

The American Cancer Society plays a significant role in globaltobacco control by supporting the adoption and implementation ofthe Framework Convention on Tobacco Control (FCTC). Incollaboration with Cancer Research UK, Research in TobaccoControl, the Society has funded more than 200 grants in more than70 countries to support tobacco control advocates. To date, morethan three-fourths of the world’s countries have ratified the treaty.

Global Smokefree Partnership

In 2007, the Society became the co-host, along with the FrameworkConvention Alliance, of the Global Smokefree Partnership (GSP) – amulti-partner initiative dedicated to promoting smoke-free policiesworldwide. GSP leads efforts to secure strong global guidelines forsmoke-free policies and to ensure their implementation.

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The American Cancer Society’s international programadvances our mission globally and allows us to be morecompetitive in the nonprofit marketplace in a number ofimportant ways:w It allows us to better serve the worksite needs of

multinational corporate partners. As we expand ourportfolio of worksite options, the Society willincreasingly be seen as a solutions enterprise.

w It positions us to receive grants and partnerships fromindividuals and corporations in the United States thathave global interests or aspirations, and fromindividuals and corporations in regions of the worldwhere we implement our programs.

w It allows us to more completely address problems thatcan only be solved globally, such as the multinationaltobacco industry.

w It resonates with immigrant populations here in theUnited States and helps us build trust through acommon interest.

w It speaks to immigrant populations in the UnitedStates. Our market data shows that ethnic populationsrespond positively to knowledge that the Society isworking in their countries of origin.

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One of the most effectivemeasures we can take toreverse the toll that cancer istaking on the most vulnerablenations in our society is toeliminate the global scourge oftobacco, which is the singlemost preventable cause ofcancer worldwide.

At current rates, 650 millionpeople alive today, including325 million children, willeventually die of tobacco-related disease.

Challenges:

w Cancer is absent or low on the health agendas of low- andmiddle-income countries and is minimally represented in globalhealth efforts in those countries.

w In all regions of the world, aging populations are a factor incancer’s growth. But it is the preventable causes of cancer –tobacco, infection, obesity, and disparities in access to high-quality cancer prevention and treatment programs – thatprovide us with a uniquely transformative opportunity to savelives through global advocacy, leadership, and action.

w Despite global successes such as the WHO FrameworkConvention on Tobacco Control, the first legal instrumentdesigned to reduce tobacco-related death and disease aroundthe world, chronic diseases have generally been neglected ininternational health and development work.

w Despite the recognition from international organizations likeWHO that well-designed, comprehensive cancer control plansand programs can save and improve lives, most countries andstates – both well-developed and developing – do not havesuch plans.

w The role of international partners is crucial for achievingdesired cancer control goals, particularly on transnationalissues, where the actions of a single country are insufficient.Coordinated work is needed among organizations of the UnitedNations System, intergovernmental bodies, nongovernmentalorganizations, professional associations, patient groups,corporations and foundations, and other key stakeholders.

Income Development

87

The Society’s IntegratedFundraising Plan, implemented

through several strategicinitiatives, supports and

intersects with our missionactivities to accomplish our

leadership roles and contribute to thesuccess of the 2015 goals.

Trends:w Rise in disaster relief funding in recent yearsw Increase in large gifts, with emergence of new “social

investor” mega-donorsw Declining direct marketing campaigns industry-wide w Legislative changes affecting donations of merchandisew Double-digit growth in Internet contributions

(although they still represent a small proportion ofoverall giving)

89

Fundraising is the foundation on which the American

Cancer Society’s strategic plan for mission delivery is built.

Income Development

2006 Data 2010 Target 2015 Target

Total Public Support

Relay For Life

Other community based-events (Making Strides AgainstBreast Cancer®, Daffodil Days®, others)

Distinguished Events (Gala and Golf)

Direct Response Strategies(Direct Mail, Telemarketing, E-Revenue)

Employer-Based Strategies(Workplace Giving, Corporate Promotions)

(Cause Marketing – Not included in Public Support)

Major Gifts/Campaigns

Planned Giving(Legacies, Bequests, others)

Other (Memorials, Cars, Discovery Shops, Unsolicited,Team ACS, other)

$969 M

$375.4M

$73M

$53M

$69M

$46M

$3M

$62M

$171M

$120M

Challenges:w Greater collaboration with mission delivery in

persuasively communicating the highest priorityrestricted funding opportunities to major donors

w Need for creative, win-win solutions to support theexpansion of revenue strategies involving inter-Division and Division-NHO collaborations

w Greater prioritization of high-potential growth areasfor investment

w Greater public awareness of the Society’s fundraisingopportunities through expanded strategic marketing efforts

Bottom Line: The American Cancer Society is the largest health charity,double the size of its next largest peer and has grown attwice the rate of the health charity sector for the lastthree years.

$1.242 B

$488 M

$90 M

$81 M

$74 M

$56 M

$8M

$118 M

$208 M

$129 M

$1.531 B

$643M

$116 M

$114 M

$83 M

$76 M

$9M

$109 M

$245 M

$145 M

The stated objectives represent an annual average growth rate of 6% through 2010 and 4% through 2015. *Growth rates are likely to be higher than 4% through 2015, but many Divisions have not built their major giftcampaigns out beyond 2010.

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Income Development

w The Society raised close to $1 billionin total public support in 2006 andis the fifth largest charity in totalpublic support and the largesthealth charity – twice the size of thenext largest health charity.

w Growth in public support has beenstrong in each year since theIntegrated Fundraising Plan beganits phased rollout in 2003.

w Preliminary 2007 results showgrowth continuing at strong rates.

The Best Practices Initiative improvesour fundraising success in all strategyareas by analyzing and interpreting data,strengthening management capabilities,developing custom Division plans, andevaluating progress.

l Total Public Support

l Cost Per Dollar Raised

w Following an improvement in 2004,cost per dollar raised has beenrelatively steady.

l Dashboard metrics

91

Income Development

w Growth in annual giving was strongin each year since the phased rolloutof the Integrated Fundraising Planin 2003.

w Growth has been driven byimprovements in dollar per donor( from $71 in 2003 to $83 in 2006),reflecting the Society’s increasingemphasis on fundraising strategiesfor cultivating wealthy constituents,especially the Major Gifts Initiativeand Distinguished Event strategies,as a complement to traditional massmarket strategies.

w Donor retention has been generallyconsistent over time atapproximately 32%.

• • • • • • • • • • • • • • •

l Public Support Growth in Health Charity Sector

l Annual Net Income

w In 2004, 2005, and 2006, the Societygrew at approximately twice ormore the rate of its health sectorpeers.

l Dashboard metrics

Relay For LifeRelay For Life grew at robust rates eachof the last three years, including twoyears of double digit growth. The eventexpanded into an additional 829communities between 2003-2006, withoverall growth being driven bycontinued broadening of the base ofparticipation and support.

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Income Development

Relay For Life

Moving forward, mission willbe more fully incorporatedinto Relay through theframework of ‘Celebrate.Remember. Fight Back.’ Anincreasingly strong fieldoperations relationship will beneeded to sustain growth instaff and volunteer leadershipas events mature.

Strategic Initiative: Relay For Life

Relay For Life continues to grow as the Society’ssignature event and as a key strategy for engagingcommunities in the fight against cancer. Itgenerates a significant portion of the Society’s totalannual giving and creates volunteer leadershipopportunities, a platform for advocacy andsurvivor and mission related activities, and aviable community presence at thousands ofcommunity events.

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Income Development

Making Strides Against Breast Cancer

In the future, stronger corporate partnerships andbroader public awareness of the Strides event willbe needed, especially as it expands into mid-sizedurban markets and more fully incorporatesmission integration strategies.

Strategic Initiative: Fundraising Resources

Fundraising ResourcesFundraising Resources activities appealto constituents based on their personalareas of interest (cancer site, sports,social, honoring of loved ones, etc.).They build nationwide collaborativerelationships to support communicationwith special interest groups. Priorityactivities include Making Strides AgainstBreast Cancer, Distinguished Events(Gala and Golf), Daffodil Days, Coachesvs. Cancer®, and the Society’s TributeProgram.

w Making Strides Against BreastCancer grew at double digit rates in2004 and 2005, with preliminary 2007results above 25%. Growth has beendriven by a combination of increasesin market penetration and dollar perdonor, as well as the addition of 12events between 2003 and 2006.

w Galas growth has been strong ineach year of the IntegratedFundraising Plan. Growth has beendriven by an increase in dollar perdonor, reflecting access to awealthier clientele. The number ofevents has declined by 30 asDivisions transition to a smallernumber of higher-end events.

Balls and Galas

Over time, greater integration of galaswith the Society’s major gifts program

will create fluid opportunities forconstituents to move to higher levels of

giving and engagement with theorganization’s mission.

Memorials

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Income Development

Golf

w Growth in golf and Daffodil Dayshas been relatively modest, asnationwide focus has been ongrowing priority strategies. Golf hastransitioned toward a greateremphasis on reaching a high-endclientele, as seen in a growingdollar per donor.

w Memorials growth was strong in2004 and 2005 as the Societyexpanded its strategic relationshipwith the National Funeral DirectorsAssociation, although revenuedeclined slightly in 2006.

w The Society is also working todevelop new special eventstrategies, especially those thatleverage technology, such asendurance events that cultivateestablished athletic communities ofinterest.

Daffodil Days

Other Fundraising Resources Strategies

Strategic Initiative: Major Gifts

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Income Development

• • • • • • • • • • • • • • • •

Major Gifts/Campaigns

Major GiftsMajor Gifts develops meaningful long-term relationships with high net worthindividuals and foundations, andprovides them a platform for realizingtheir personal vision of the fight againstcancer while investing in the Society’smost compelling mission opportunities.

w Major Gifts and Campaigns grewsignificantly since the initiativekicked off in 2004, with more than30% growth each year, andcontinued growth at that rateexpected in 2007. Gifts of $100,000and more rose from 78 in fiscal year2004 to 108 in fiscal year 2006; Giftsof $1 million and more rose fromone in fiscal year 2004 to 13 in fiscalyear 2006.

Moving forward, close collaboration withMission Delivery will be needed to identify andcommunicate the Society’s most compellingrestricted giving opportunities in a way that ispersuasive and motivating to major donors.

Strategic Initiative: Employer Initiative Employer Initiative

The Employer Initiative develops cross-Division relationships with major USemployers (e.g., Fortune 1000 companies)and creates mutually beneficialpartnerships through a coordinatedaccount management process. It offersthose companies customized mission andincome offerings to stimulate payrolldeduction programs, event sponsorships,matching gifts, cause marketingrelationships, and corporate philanthropy.

w Independent payroll deduction hasshown moderate growth, reflecting atwo- to four-year cultivation cycle.Several major cultivation wins in 2006will generate significant revenuegrowth, with 2007 preliminary resultsup more than 50%.

In fiscal year 2006, 3,427 workplace missionofferings (e.g. Quitline, Active For LifeSM) at 1,599

worksites affected 36.6 million people.

Independent Payroll Deduction

• • • • • • • • • • • • • • •

Strategic Initiatives: Mass Market CRM

Strategic Initiative: E-Revenue

E-Revenue

E-RevenueThe goal of E-Revenue is to build apowerful online competency thatserves as a foundation for a donor carestrategy while providing incomegrowth opportunities to all other majorIntegrated Fundraising Plan initiatives.

It creates dynamic new fundraisingopportunities using changes in socialengagement techniques resulting fromtechnological advances and leveragestechnology to access a broader groupof potential donors, achieve higherlevels of giving, increase the efficiencyof fundraising, and improve ease ofdata capture and subsequentconstituent relationship management.

w Total E-Revenue has shown tripledigit growth in 2005 and 2006,contributing to the strong growthshown in special events and otherstrategies.

96

Income Development

Direct Marketing

Mass Market CRMThrough an integrated set of directresponse strategies, Mass Market CRMstrengthens mass market constituentrelationships to improve donorretention, constituent loyalty, and giftsize and frequency. It focuses onmarket segmentation, interactiveopportunities, and net lifetime value.

w Direct Marketing revenue,including all mail andtelemarketing revenue, hasincreased slightly, but hasperformed better than other healthcharities whose revenue declinedduring the same time period.

The Society’s focus on donor segmentation anddonor lifecycles has been a key strategy in revi-talizing direct marketing growth in 2006, withlarger projected increases in 2007 and beyond.

Of online donors in fiscal year2006, 73% were first-time donorsto the American Cancer Society.

97

Income Development

Planned GivingResourcesPlanned Giving Resources developsmeaningful personal relationships withindividuals of capacity and their financialadvisors, enabling them to leverage theirassets and make ultimate gifts to the fightagainst cancer. When possible, it positionsthe American Cancer Society as aphilanthropic advisor and uses directresponse strategies to build awareness ofplanned giving opportunities among abroader audience.

w Extraordinary bequests and marketfactors cause fluctuations in PlannedGiving revenue, making the 2003-2006average growth of 7% a better indicatorthan performance in any single year.

Legacies and Bequests

Strategic Initiatives: Planned Giving Resources

The impact of the PensionProtection Act is stillunfolding, creating thepotential for significantfuture increases in IRArollover giving.

99

Historical Change

101

Since adopting the 2015 Challenge Goals in 1996-1998 and

the nationwide objectives in 1999, the American Cancer

Society National Board of Directors has annually reviewed

progress toward these established outcomes. In response to

the annual review, the Board changes or modifies outcome

statements, as appropriate. Following is a historical look at the

changes from 1996 through November 2006.

Historical Change

2015 Goals

Outcome Statement/Origination Date Rationale for Change

50% reduction in age-adjusted cancer mortality rates bythe Year 2015. (Adopted 1996)

25% reduction in age-adjusted cancer incidence ratesby the Year 2015. (Adopted 1998)

Measurable improvement in the quality of life (physical,psychological, social, and spiritual) from the time ofdiagnosis and for the balance of life of all cancersurvivors by the Year 2015. (Adopted 1998)

Note that statements outlined in blue are those currently in effect.

No change since adoption.



102

Historical Change

Information

By 2015, state of the art information on issues related toincidence, mortality, risk factors, treatment, survivorshipand quality of life (physical, social, psychological andspiritual) will be available and accessible through allappropriate channels to all people. (Adopted 2003)

By 2015, state of the art information on issues related toincidence, mortality, risk factors and quality of life(physical, social, psychological and spiritual) will beavailable and accessible through all appropriate channelsto all people. (Adopted 1999)

By 2004, objectively quantify, prioritize, and create plansto fulfill unmet cancer information needs of constituents. (Adopted 2003)

By 2002, identify the cancer-related information needsand utilization patterns of users of ACS cancerinformation services in order to prioritize and develop orassemble information to fill those identified needs. (Adopted 2000)

Added the words “treatment” and “survivorship” in 2003.

Added the words “treatment” and “survivorship” in 2003.

This objective has been completed and the work isongoing. Specific metrics related to the leadership rolesand focus areas address this objective, and NCICcontinually collects and evaluates information-relateddata.

This objective has been mostly completed and wasrestated for 2004.


Principles

103

Historical Change

Measurements


Monitoring systems that track relevant incidence,mortality, risk factor and screening prevalence, andquality of life dimensions should be availablenationwide. (Adopted 2003)

By 2008, all states will have cancer registries that meetNAACR silver or gold certification standards. (Adopted 2003)

By 2005, tracking systems will be developed or supportedto identify and monitor the disparities betweenpopulation groups in cancer incidence, mortality, riskfactor and screening prevalence, and quality of life.(Adopted 2003)

By 2005, systems will be developed or supported thattrack inputs, activities, and outputs towardsachievement of Division-specific outcomes andultimately nationwide objectives. (Adopted 2003)

By 2002, nationwide systems will be developed orsupported to gather baseline, monitoring, and programevaluation and cost data for all relevant incidence,mortality and quality of life dimensions. (Adopted 1999)

By 2002, develop internal tracking systems for theNationwide Program of Work. (Adopted 2000)

By 2002, conduct surveys to begin to track nationwideinterim objectives that are not tracked using externaldata sources. (Adopted 2000)



This objective has been mostly completed and the workis ongoing.

This objective has been mostly completed and work isongoing through the Nationwide Dashboard andDivision Scorecards.

This objective has been mostly completed and work isongoing. This objective was restated in 2003 in theoverarching measurement statement.

This objective has been partially completed and work isongoing. This objective was restated in a 2005 objective.

This objective has been mostly completed and wasrestated in a 2005 objective.

104

Historical Change

Disparities


By 2015, eliminate the disparities in cancer burdensamong population groups by reducing age-adjustedcancer incidence and mortality rates and improvingquality of life in the poor and underserved. (Adopted 2006)

By 2015, eliminate the disparities in cancer burdensamong population groups by reducing age-adjustedcancer incidence and mortality rates and improvingquality of life in the poor and underserved to thepopulation average. (Adopted 1999)

By 2005, conduct or support comprehensive assessmentsthat identify issues and needs for eliminating disparitiesto guide decisions on objectives, audiences, andinterventions. (Adopted 2003)

By 2004, ensure that appropriate programs included inthe ACS Nationwide Program of Work address cancerdisparities and the needs of the underserved. (Adopted 2003)

By 2001, develop 5-year action plans by NHO that addressthe elimination of disparities within each site/risk factorand quality of life area. (Adopted 2000)

By 2001, all charter agreements will incorporate anorganizational diversity plan. (Adopted 2000)

By 2001, diversity training for staff and volunteers will beavailable nationwide. (Adopted 2000)

By 2001, a Clearinghouse for sharing best practices andcoordination will be developed. (Adopted 2000)

Deleted the words “to the population average” toreduce ambiguity.

Wording was refined in 2006 objective to reduceambiguity.

The work in this objective is ongoing through theleadership roles and focus areas.

Addressing disparities was established as anoverarching pillar for all leadership roles and focusareas. Specific metrics in the leadership roles andfocus areas address this objective. This objective hasbeen completed and the work is ongoing.

This objective was partially completed in 2001, andrestated in a 2004 objective.

This objective was completed in 2001.



105

Historical Change

Collaboration


Efforts should be increased at all levels of the AmericanCancer Society for working with other organizations andagencies to achieve our common cancer control goals andobjectives. (Adopted 1999)

By 2004, identify, enter into, and measure specificcollaborations and partnerships with organizations andsystems, especially those related to addressing identifiedcancer disparity issues. (Adopted 2003)

By 2002, identify collaborating partners and incorporateroles, based upon collaboration guidelines, in action plansat all levels of the Society. (Adopted 2000)

By 2002, collaboration training for staff and volunteerswill be available nationwide at all levels of the Society.(Adopted 2000)


This objective has been completed and the work isongoing. Collaborative relationships continue withnumerous leadership organizations in the fightagainst cancer. A database of collaborativepartnerships is now being maintained and regularlyupdated.

This objective has been partially completed and wasrestated in a 2004 objective.

This objective was mostly completed in 2002 andwork is ongoing.

Access to Quality Treatment


By 2015, assure that all people diagnosed with cancerhave access to appropriate, quality treatment andfollow-up, achieving 0% disparities in treatmentoutcomes. (Adopted 2000)

By 2004, develop long-term action plans by NHO, incollaboration with the National Quality Forum andothers, that (a) address access to care and (b) defineindicators of quality treatment for each major cancersite. (Adopted 2001)


This objective has been partially completed and thework is ongoing. Access to care is a current focus forthe Society. Collaborative partnerships continue withnumerous leadership organizations and others onthis issue.

106

Historical Change

Colorectal Cancer


Incidence: By 2015, reduce the age-adjusted incidencerate of colorectal cancer by 40%. (Adopted 1999)

Mortality: By 2015, reduce the age-adjusted mortalityrate of colorectal cancer by 50%. (Adopted 1999)

Early Detection: By 2015, increase to 75% the proportionof people aged 50 and older who have colorectalscreening consistent with American Cancer Societyguidelines. (Adopted 1999)

Incidence: By 2010, reduce the age-adjusted incidencerate of colorectal cancer by 30%. (Adopted 2006)

Mortality: By 2010, reduce the age-adjusted mortality rateof colorectal cancer by 40%. (Adopted 2006)

Behavior Change: By 2010, 60% of people aged 50+ willhave received colorectal screening consistent withAmerican Cancer Society guidelines. (Adopted 2006)

Public Awareness: By 2005, 75% of people aged 50+ willbe aware of and have knowledge about the need forcolorectal screening. (Adopted 2000)

Behavior Change: By 2005, 50% of people aged 50+ willhave received colorectal screening following ACSguidelines as measured by the preferred tests ofsigmoidoscopy, colonoscopy, or barium enema. (Adopted 2000)

Access to Screening: By 2005, 100% of states will havecomprehensive insurance laws, which cover the costs ofcolorectal screening in fully insured and self-insuredhealth plans. (Adopted 2000)

Access to Screening: By 2005, 100% of states will havecomprehensive insurance laws or cooperative agreementsthat cover the costs of colorectal screening in fullyinsured and self-insured health plans. (Adopted 2001)




New objective established in 2006 as interim measuretoward 2015 objective.

New objective established in 2006 as interim measuretoward 2015 objective.

Updated the 2005-related objective to a 2010objective following mid-course assessment.

This objective was moved to operations in 2006 andis being monitored as a key indicator in business planactivities.

This objective was updated in 2006 to a new 2010objective.

Word change adding “or cooperative agreements” in2001.

This objective was moved to operations in 2006 andis being monitored as an existing Leadership Rolemetric.


107

Historical Change

Lung Cancer and Adult and Youth Tobacco Use


Incidence: By 2015, reduce the age-adjusted incidencerate of lung cancer by 45%. (Adopted 1999)

Mortality: By 2015, reduce the age-adjusted mortality rateof lung cancer by 45%. (Adopted 1999)

Mortality: By 2015, reduce the age-adjusted mortality rateof lung cancer by 50%. (Adopted 2005)

Adult Tobacco Use: By 2015, reduce to 12% theproportion of adults (18 and older) who use tobaccoproducts. (Adopted 1999)

Adult Tobacco Use: By 2015, reduce to 12% theproportion of adults (18 and older) who are currentcigarette smokers. (Adopted 2006)

Adult Smokeless Tobacco Use: By 2015, reduce to 0.4%the proportion of adults (18 and older) who are currentusers of smokeless tobacco. (Adopted 2006)

Youth Tobacco Use: By 2015, reduce to 10% theproportion of young people (under 18) who use tobaccoproducts. (Adopted 1999)

Youth Tobacco Use: By 2015, reduce to 10% theproportion of high school students (under 18) who arecurrent cigarette smokers. (Adopted 2006)

Youth Smokeless Tobacco Use: By 2015, reduce to 1% theproportion of high school students (under 18) who arecurrent users of smokeless tobacco. (Adopted 2006)


Restated in 2005 following mid-course assessment tomake consistent with overall 2015 goal of a 50%reduction.

Restated objective to make consistent with overall 2015goal of a 50% reduction.

Changed wording to “current cigarette smokers” in 2006to make consistent with survey questions.

Restated objective to make consistent with surveyquestions.

New objective established in 2006 following mid-courseassessment.

Changed wording to “high school students who arecurrent cigarette smokers” in 2006 to make consistentwith survey questions.

Restated objective to make consistent with surveyquestions.

New objective established in 2006 following mid-courseassessment.

108

Historical Change

Lung Cancer and Adult and Youth Tobacco Use


Adult Tobacco Use: By 2010, reduce to 18.5% theproportion of adults (18 and older) who are currentcigarette smokers. (Adopted 2006)

Adult Tobacco Use: By 2010, reduce by 25% from 2000baseline prevalence rate the proportion of low SESadults (18 and older) who are current cigarette smokers.(Adopted 2006)

Youth Tobacco Use: By 2010, reduce to 15% theproportion of high school students (under 18) who arecurrent cigarette smokers. (Adopted 2006)

Adult Tobacco Use: By 2005, reduce to 19% theproportion of adults (18 and older) who use tobaccoproducts. (Adopted 2000)

Adult Tobacco Use: By 2005, reduce by 25% from 2000baseline prevalence rate the proportion of low SESadults (18 and older) who use tobacco products.(Adopted 2000)

Youth Tobacco Use: By 2005, reduce to 15% or less thefrequent use of cigarettes by young people (under 18).(Adopted 2000)

Tobacco Settlement: By 2005, 75% of states will directavailable tobacco control funds consistent with CDCguidelines. (Adopted 2000)

Clean Indoor Air: By 2005, 50% of U.S. population willreside in communities covered by comprehensive cleanindoor air laws/policies. (Adopted 2000)

Tobacco-free Schools: By 2005, 100% of schools willhave tobacco-free environments. (Adopted 2000)

Tobacco Excise Taxes: By 2005, all states will achieve astate excise tax level on cigarettes that is equal to thefederal level and 50% of states will achieve a state excisetax level on cigarettes that is equal to or greater than$1.00 per pack. (Adopted 2000)




This objective was restated in a 2010 objectivefollowing mid-course assessment.







109

Historical Change


Breast Cancer

Incidence: By 2015, reduce the age-adjusted incidencerate of breast cancer by 15%. (Adopted 1999)

Mortality: By 2015, reduce the age-adjusted mortalityrate of breast cancer by 45%. (Adopted 1999)

Mortality: By 2015, reduce the age-adjusted mortalityrate of breast cancer by 50%. (Adopted 2005)

Early Detection: By 2010, increase to 90% theproportion of women aged 40 and older who havebreast screening consistent with American CancerSociety guidelines. (Adopted 2006)

Early Detection: By 2008, increase to 90% theproportion of women aged 40 and older who havebreast screening consistent with American CancerSociety guidelines. (Adopted 1999)

Behavior Change: By 2005, the recent screening ratesof women aged 40+, women aged 65+, and low SESpopulations (200% of poverty level and below) will be70%. (Adopted 2000)

Access to Treatment: By 2005, through advocacy at allorganizational levels, 100% of women will have accessto appropriate treatment. (Adopted 2000)

Surveillance: By 2002, include in all state registriesDCIS surveillance data as a measurement forevaluating screening. (Adopted 2000)


Restated in 2005 following mid-course assessmentto make consistent with overall 2015 goal of a 50%reduction.

Restated objective to make consistent with overall2015 goal of a 50% reduction.

Updated 2008 and 2005-related objectives followingmid-course assessment.

Restated in a 2010 objective following mid-courseassessment.




110

Historical Change


Prostate Cancer

Incidence: By 2015, reduce the age-adjusted incidencerate of prostate cancer by 15%. (Adopted 1999)

Mortality: By 2015, reduce the age-adjusted mortalityrate of prostate cancer by 20%. (Adopted 1999)

Mortality: By 2015, reduce the age-adjusted mortalityrate of prostate cancer by 50%. (Adopted 2005)

Early Detection: By 2015, increase to 90% theproportion of men aged 50 and older who followAmerican Cancer Society detection guidelines forprostate cancer. (Adopted 1999)

Early Detection: By 2015, increase to 90% theproportion of men who follow age-appropriateAmerican Cancer Society detection guidelines forprostate cancer. (Adopted 2001)

Mortality: By 2010, reduce the age-adjusted mortalityrate of prostate cancer by 40% (Adopted 2006)

Behavior Change: By 2010, increase the percentage ofmen who have been offered age-appropriate PSAscreening to 75%. (Adopted 2006)

Behavior Change: By 2005, increase the percentage ofage-eligible men who have been offered PSA screeningto 75%. (Adopted 2000)

Behavior Change: By 2005, increase the percentage ofmen who have been offered age-appropriate PSAscreening to 75%. (Adopted 2001)

Surveillance: By 2002, develop data collectionsystems to accurately measure the percentage of menscreened for prostate cancer as measured by PSAtests. (Adopted 2000)


Restated in 2005 following mid-course assessmentto make consistent with overall 2015 goal of a 50%reduction.

Restated objective to make consistent with overall2015 goal of a 50% reduction.

Changed wording by adding “age-appropriate” in2001 for clarity.

Restated objective for clarity.

New objective established in 2006 as interimmeasure toward 2015 objective.

Updated 2005-related objective following mid-course assessment.

Wording change in 2001 for clarity.



111

Historical Change



Behavior Change: By 2015, increase to 75% theproportion of persons who follow American CancerSociety guidelines on diet and nutrition as measured byconsumption of fruits and vegetables. (Adopted 1999)

Behavior Change: By 2015, increase to 75% theproportion of persons who follow American CancerSociety guidelines with respect to consumption of fruitsand vegetables as published in the American CancerSociety Guidelines on Nutrition and Physical Activityfor Cancer Prevention. (Adopted 2000)

Behavior Change: By 2015, increase to 90% theproportion of youth (high school students) and to 60%the proportion of adults who follow American CancerSociety guidelines with respect to the appropriate levelof physical activity as published in the AmericanCancer Society Guidelines on Nutrition and PhysicalActivity for Cancer Prevention. (Adopted 2000)

Behavior Change: By 2015, increase to 70% theproportion of adults and youth who follow AmericanCancer Society guidelines with respect to theappropriate level of physical activity as published in theAmerican Cancer Society Guidelines on Nutrition andPhysical Activity for Cancer Prevention. (Adopted 2006)

Overweight/Obesity: By 2015, the trend of increasingprevalence of overweight and obesity among US adultsand youth will have been reversed, and by 2015, theprevalence of overweight and obesity will be no higherthan it was in 2005. (Adopted 2006)

This objective was restated in 2000 for clarity.

Restated objective for clarity.

This objective was revised in 2006 following mid-course assessment to a new target for youth andadults.

Revised objective with a new target for youth andadults.

New objective established in 2006 following mid-course review.

112

Historical Change



Behavior Change: By 2010, increase to 45% theproportion of adults and youth who meet AmericanCancer Society guidelines for vegetable and fruitconsumption, as published in the American CancerSociety Guidelines on Nutrition and Physical Activityfor Cancer Prevention. (Adopted 2006)

Behavior Change: By 2010, increase to 60% theproportion of adults and youth who meet AmericanCancer Society guidelines for physical activity, aspublished in the American Cancer Society Guidelineson Nutrition and Physical Activity for CancerPrevention. (Adopted 2006)

Overweight/Obesity: By 2010, the increasing trends inoverweight/obesity for both US adults and youth willhave stopped. (Adopted 2006)

Public Awareness: By 2005, 90% of the public will beaware of and have knowledge about the role of ahealthy diet and physical activity in preventing cancer.(Adopted 2000)

Behavior Change: By 2005, 45% of the population willconsume 5 servings of fruits and vegetables daily.(Adopted 2000)

Behavior Change: By 2005, increase to 72% theproportion of youth (high school students) and to 30%the proportion of adults who follow American CancerSociety guidelines with respect to the appropriate levelof physical activity as published in the AmericanCancer Society Guidelines on Nutrition and PhysicalActivity for Cancer Prevention. (Adopted 2000)

Updated from a 2005-related objective following mid-course assessment.

Updated from a 2005-related objective following mid-course assessment.

New objective established in 2006 following mid-course review.




113

Historical Change


Skin Cancer

Behavior Change: By 2015, increase to 75% theproportion of people of all ages who use at least twoor more of the following protective measures whichmay reduce the risk of skin cancer; avoid the sunbetween 10 a.m. and 4 p.m., wear sun-protectiveclothing when exposed to sunlight, use sunscreen withan SPF 15 or higher, and avoid artificial sources ofultraviolet light (e.g., sun lamps, tanning booths). (Adopted 1999)

Behavior Change: By 2015, increase to 75% theproportion of people of all ages who use at least twoor more of the following protective measures whichmay reduce the risk of skin cancer; avoid the sunbetween 10 a.m. and 4 p.m., wear sun-protectiveclothing when exposed to sunlight, properly applysunscreen with an SPF 15 or higher, and avoidartificial sources of ultraviolet light (e.g., sun lamps,tanning booths). (Adopted 2006)

Public Awareness: By 2005, 50% of parents will beaware of and have knowledge about the importance of sun protection for their children. (Adopted 2000)

Organizational Awareness: By 2005, 50% ofelementary schools, day-care centers, parks/recreation centers will be aware of and haveknowledge about the importance of sun protection.(Adopted 2000)

Organizational Policy: By 2005, 50% of elementaryschools, day-care centers, parks/recreation centerswill have policies to foster skin protection. (Adopted 2000)

Revised wording in 2006 by substituting the words“properly apply” for “use”.

Revised objective with 2006 wording change.

This objective was eliminated in 2006 as there arecurrently no existing population-based measuresof awareness and knowledge about sun protectionin the general public.

This objective was deleted in 2001 due toredundancy.

This objective was eliminated in 2006 as there arecurrently no existing measures of numbers oforganizations with policies that foster skinprotection. School-based policies will continue tobe monitored through the School Health Programand Policies Study periodically conducted by CDC.

114

Historical Change


Comprehensive School Health Education (CSHE)

CSHE: By 2015, increase to 50% the proportion ofschool districts that provide a comprehensive orcoordinated school health education program.(Adopted 1999)

CSHE: By 2010, 35% of school districts will provideCSHE. (Adopted 2006)

School Health Councils: By 2010, 75% of schooldistricts will have active school health councils.(Adopted 2006)

School Health Coordinators: By 2010, 50% of schooldistricts will have trained school health coordinators.(Adopted 2006)

CSHE: By 2005, 20% of school districts will provideCSHE. (Adopted 2000)

School Health Councils: By 2005, 50% of schooldistricts will have active school health councils.(Adopted 2000)

School Health Coordinators: By 2005, 50% of schooldistricts will have trained school health coordinators.(Adopted 2000)


Updated from 2005-related objective followingmid-course assessment.



This objective was updated to a 2010 objectivefollowing mid-course assessment.



115

Historical Change


Quality of Life

Access to Care: By 2015, the proportion of individualswithout any type of health care coverage plan willdecrease to 0%. (Adopted 2006)

Out of Pocket Costs: By 2015, the proportion ofindividuals diagnosed with cancer who reportdifficulties in obtaining medical care due to high outof pocket costs will decrease to 2%. (Adopted 2006)

Pain Control: By 2015, all 50 states and the District ofColumbia will have received a grade of B or higher and10 states will have received a grade of A on the PainPolicy Report Card. (Adopted 2006)

Measurement: By 2015, there will be nationalsurveillance systems to monitor quality of life forthose affected by cancer. (Adopted 2006)

Physical Effects: By 2015, provide appropriate carefor symptom control, emphasizing pain,rehabilitation, and side effects of treatment basedupon an appropriate care plan using uniformstandards of care for 90% of cancer survivors.(Adopted 1999)

Physical Effects: By 2015, provide appropriate carefor symptom control, emphasizing pain, fatigue,rehabilitation, and side effects of treatment basedupon an appropriate care plan using uniformstandards of care for 90% of cancer survivors.(Adopted 2001)

New objective adopted in 2006.




Changed wording in 2001 by adding “fatigue” tothe statement.

Objective deleted in 2006 as no population-basedsurveillance data sets currently exist to provideassessments of progress. New objectives wereadopted in 2006 based on a new model andavailable data.

116

Historical Change


Quality of Life

Pain Control: By 2015, provide appropriate care forthe control of pain based upon an appropriate careplan using uniform standards of care for 90% of cancersurvivors. (Adopted 1999)

Physical Appearance: By 2015, the negative impact ofcancer on physical appearance and body image will besubstantially reduced in 75% of those affected cancersurvivors. (Adopted 1999)

Social Support: By 2015, appropriate interventionsfor socio-economic needs will be received by 90% ofcancer survivors, and families and caregivers of thoseaffected by cancer. (Adopted 1999)

Support Network: By 2015, 90% of cancer survivorsand families and caregivers of those affected by cancerwill express satisfaction with the available socialsupport network. (Adopted 2001)

Social Effects: By 2015, 75% of cancer survivors andtheir families will be assisted through advocacy,referral, and education in addressing financial,employability, insurability issues, and access totreatment and follow-up care. (Adopted 1999)

Socio-Economic Support: By 2015, 75% of cancersurvivors and their families will be assisted throughadvocacy, referral, and education in addressingfinancial, employability, insurability issues, and accessto treatment and follow-up care. (Adopted 2001)

Objective deleted in 2006 as no population-based surveillance data sets currently exist toprovide assessments of progress. New objectiveswere adopted in 2006 based on a new modeland available data.





Wording was added to this objective in 2002 forclarity.

117


Quality of Life

Socio-Economic Support: By 2015, 75% of cancersurvivors and their families will be appropriatelyassisted at the community level throughprogram/service delivery, advocacy, referral, andeducation in addressing identified needs related tofinancial, employability, insurability issues, and accessto treatment and follow-up care. (Adopted 2002)

Psychological, Emotional, Spiritual Effects: By 2015,90% of cancer survivors and families and caregivers ofthose affected by cancer will receive appropriate care orappropriate referral to services for identifiedpsychological, emotional, and spiritual problemsand/or needs. (Adopted 1999)

Psychological, Emotional, Spiritual Effects: By 2015,90% of cancer survivors and families and caregivers ofthose affected by cancer will receive appropriate care orappropriate referral to services for identifiedpsychological, emotional, and spiritual distress and/orneeds. (Adopted 2001)

Provider Education: By 2015, 90% of health careproviders will assess psychological, emotional, andspiritual needs of cancer survivors and families andcaregivers of those affected by cancer and provideappropriate care or appropriate referral to services.(Adopted 1999)

Service Delivery Systems: By 2008, 100% of Divisionswill develop or have access to a comprehensive servicedelivery system that addresses the needs of cancersurvivors, their families and caregivers through ACSprograms/services, or referral to other organizationsand resource development to fill gaps in services.(Adopted 2002)


Wording was changed in 2001 for clarity.



This objective was moved to operations in 2005under the Leadership Roles.

Historical Change

118

Historical Change


Quality of Life

Public Awareness: By 2005, 60% of survivors, theirfamilies, and caregivers will be aware of and haveknowledge about American Cancer Society quality oflife education and support services. (Adopted 2000)

Health Care Provider Awareness: By 2005, 75% ofrelevant health care providers (e.g. cancer careproviders, primary care providers) will be aware of andexpress satisfaction with and willingness to refer theirpatients to American Cancer Society quality of lifeeducation and support services. (Adopted 2000)

Public Policy/System Change: By 2005, 75% of healthcare systems will have institutionalized qualitystandards for the management of pain. (Adopted 2000)

ACS Patient Support Programs: By 2005, the numberof cancer survivors, their families, and caregivers whoparticipate in appropriate ACS patient supportprograms or are referred to other communityprograms will increase by at least 50%. (Adopted 2000)

Public Policy/System Change: By 2002, all Divisionsand National will have 3-year action plans to influencepublic policy for priority issues in quality of life,including pain control. (Adopted 2000)

Assessment of Need: Every 3 years, the AmericanCancer Society will document the self-reported needsof cancer survivors, their families, and caregivers todetermine ACS roles, collaborative opportunities, andpotential ACS programs. (Adopted 2000)





This objective was mostly completed in 2002.


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