State of Florida Prostate Cancer Program

Friday September 15, 2011 Bonita Springs FL

Prostate Cancer in Florida

Florida has the second highest incidence of prostate cancer in the Nation
1 in 4 men will be diagnosed over their lifetime (1 in 6 nationally)

Significant health disparities, predominantly in rural communities Lack of systemic education and awareness regarding best practices and current guidelines Prostate cancer often portrayed as an unimportant disease of the elderly, fraught with over-diagnosis and over-treatment

Uninsured Burden by State

Uninsured Rank State Uninsured Population % Uninsured

1 2 3 4 5 6 7 8 9 10

Texas New Mexico Florida Louisiana Mississippi Arizona California Oklahoma Nevada Alaska

5,832,884 441,351 3,738,230 848,463 572,555 1,237,322 6,701,890 646,363 468,808 115,824

2,3406,068 1,938,093 18,029,897 4,196,532 2,889,110 6,308,138 36,163,342 3,491,892 2,547,075 652,846

25% 23% 21% 20% 20% 20% 19% 19% 18% 18%

Health Disparities in Florida

Significant health disparities between rural and urban populations and across ethnic and racial groups Men in rural areas are either under-diagnosed or diagnosed at later stages, receiving different management, being underinsured and having less desirable outcomes AA have mortality rates up to more than 10x other racial or ethnic groups due to more virulent disease and less likelihood to receive adequate treatment

NIH-Funded Prostate Cancer Centers

4,43 5,330 3,14 2,880 5,05 6,040 2,52 3,380 2,010

2,850 3,010

3,98 3,000 1,98 1,960 4,70 5,850

3,43 3,640

15,710

American Cancer Society, Facts & Figures 2007

Funding for Prostate Cancer in U.S.

Prostate Cancer Advisory Council

Name Angela Adams, PharmD B. Thomas Brown, MD Thomas Crawford, MBA Linda Delo, DO Edward Droste Sue Higgins, MPH Paul Hull David Most, PhD James Mul, PhD Alan Pollack, MD, PhD Julio Pow-Sang, MD Brian Rivers, PhD Michael Wehle, MD Organization Central Florida Pharmacy Council American Association of Clinical Urologists UF Prostate Disease Center Florida Osteopathic Medical Association Advanced Prostate Cancer Collaborative Florida Department of Health American Cancer Society Health Information Research, Inc. H. Lee Moffitt Cancer Center University of Miami H. Lee Moffitt Cancer Center Cancer Control & Research Advisory Council Mayo Clinic

Bill Objectives
Florida Statue 381.911 Statewide focus on reducing the incidence of prostate cancer Enhance community education and awareness Reduce ethnic and racial disparities Reduce fragmentation of care through implementation of best practices Expand access to clinical trials.

Objective
Primary objective is to establish a communications platform to create systemic synergy between the prostate cancer stakeholders within the state and serve as a resource (versus advertisement) for patients and their advocates

Dissemination of Information
Accrual

Information

Validation

Dissemination

State Resources:

Department of Health Florida Center for Universal Research to

Eradicate Disease (FL CURED) Florida Biomedical Research Advisory Council Florida Cancer Plan Council Florida Cancer Council Florida Cancer Data Systems Comprehensive Cancer Control Program Cancer Control and Research Advisory Council

Regional cancer control collaboratives

African American Prostate Cancer Incidence

Escambia Holmes Santa Okaloosa Jackson Rosa Washington Walton Gadsden Bay Calhoun Liberty GulfFranklin Leon Wakulla Jefferson Duval Baker Union Clay Taylor Lafayette Bradford St. Johns Gilchrist Alachua Putnam Dixie Flagler Suwannee Levy Citrus Volusia Columbia Hamilton Madison Nassau

Lake Marion Seminole Sumter Hernando Orange Pasco Osceola Hillsborou gh Pinellas Polk Manatee Hardee

Brevard

Indian River Okeechobee St. Lucie Highlands Sarasota DeSoto Martin Charlotte Glades Lee Hendry Palm Beach Broward Collier Miami Dade

Monroe

= County Incidence Rate >2X Higher than A.A. Statewide Rate >416.98 per 100,000 = County Incidence Rate >2X Higher than White Statewide Rate =229.8 416.97 per 100,000

African American Prostate Cancer Mortality

Escambia Holmes Santa Okaloosa Jackson Rosa Washington Walton Gadsden Bay Calhoun Liberty Gulf Franklin Leon Wakulla Jefferson Duval Baker Union Clay Taylor Lafayette Bradford St. Johns Gilchrist Alachua Putnam Dixie Flagler Suwannee Levy Citrus Sumter Hernando Pasco Pinellas Hillsborou gh Polk Marion Lake Seminole Orange Osceola Brevard Volusia Columbia Hamilton Madison Nassau

Indian River Okeechobee Manatee Hardee St. Lucie Highlands Sarasota DeSoto Martin Charlotte Glades Lee Hendry Palm Beach Broward Collier Miami Dade

Monroe

= County Mortality Rate 2X Higher than A.A. Statewide Rate >95.56 per 100,000 = County Mortality Rate >2X Higher than White Statewide Rate =35.80 95.55 per 100,000

The Screening Controversy

Legitimate Concerns of Screening

Lifetime risk of death from PCA is 3% and the life time risk of being diagnosed with PCA is 17% Screening will result in over-diagnosis of cancers that do not require therapy Over-diagnosis is estimated approx. 30-50% and increases directly with age Cost of screening may not be justified if harm caused by treatment and diagnosis outweighs the health benefits obtained

The Screening Controversy

Due to PSA testing, approximately 90% of all
PCA are currently diagnosed at an early stage, and, consequently, men are surviving longer after diagnosis Does PSA screening actually saves lives? 27 % relative risk reduction in PCA deaths, but it takes 1410 men to screen, 48 men to treat to prevent 1 cancer death. Rate of over-diagnosis: Approximately 50%

If We Would not Screen.

60% of non-palpable cancers detected at screening are low-risk and may do well with active surveillance 40% of prostate cancers in the general population would not be detected without screening and are intermediate to high risk cancers requiring active treatment

Prostate Cancer Act (S.3775)

Introduced by Senator Tester (D-MT) Objective: Coordination of research to expand programs at the DoD, Health & Human Services and VA Defining better diagnostics and enabling scientists to distinguish between aggressive and indolent varieties of this cancer Data sharing Eliminating duplicate efforts
19

Summary
Introduction of new legislature to enhance
awareness, research and optimize care in Florida Establishment of Prostate Cancer Advisory Council Annual report to Governor and FL Legislature Potential for state-wide impact of prostate cancer awareness, care and research Potential to serve as a template for national efforts (Prostate Cancer Act)