Amid the complex system of American health care, where progress has lagged in the prevention and early detection of cancer, a major public health project is underway in San Francisco with one ambitious goal: reducing cancer in the city where the disease is the leading cause of death.
The San Francisco Cancer Initiative (SF CAN) is targeting the five most common cancers which collectively account for half of all new cancers in San Francisco: breast, lung and other tobacco-related cancers, prostate, colorectal, and liver cancer.
Now scientists behind the initiative have published their first paper, which describes the project’s early progress, including forging collaborations with more than 40 community organizations and other key stakeholders. The paper also presents a framework for other cities on how to systematically plan and develop a similar structure for community-based health projects.
The article is published in Health Affairs.
“Cancer is a major burden for all racial and ethnic groups in San Francisco, but the impact falls disproportionately upon specific racial and socioeconomic groups, causing persistent disparities,” said first author Robert A. Hiatt, MD, PhD, professor in the UCSF Department of Epidemiology and Biostatistics and associate director of the UCSF Helen Diller Family Comprehensive Cancer Center. “By harnessing the power of collective knowledge and embodying the best of team science, we are seeking to reduce cancer in San Francisco through prevention and early detection.
“A project of this scope begins with the active engagement of a city’s political leadership,” Hiatt said. “It also requires the integration of cancer research, prevention activities, improvements in cancer health care, and community participation.”
As a city characterized by wealth and innovation but also persistent poverty, the authors said that San Francisco serves as an ideal laboratory for focusing on cancer.
Cancer strikes more than 3,800 San Francisco residents annually, and kills nearly 1,400 residents each year, according to an earlier UCSF report cataloguing the state of cancer in the city in 2013 and 2014. Cancer medical expenses cost San Franciscans about $213 million annually, not including time lost from work, the report found.
SF CAN, which launched in November 2016, brings together the San Francisco Department of Public Health and UCSF, which conceived the initiative and provides ongoing scientific expertise. The project also includes an extensive coalition of community organizations and major health systems to collectively reduce the incidence and mortality from the most common cancers in San Francisco that are known to be affected by existing prevention practices or better screening.
The new paper details the beginnings of SF CAN, starting with the groundwork laid over many years by community-based activities. Using the San Francisco Health Improvement Partnership as a model, SF CAN was developed as a separate but similar mode of community engagement.
The initiative formed five task forces to develop strategic approaches to each of the five cancers. Cancer data, including rates, trends and disparities at the population level, came primarily from the California Cancer Registry. Behaviors related to tobacco and alcohol use, poor diet, lack of physical activity, and other risk factors associated with cancer incidence, were derived from the California Health Interview Survey.
When cases and deaths were categorized by race and ethnicity, the highest numbers occurred in the white and Asian-American populations which account for the largest fractions of the population, the authors wrote in the paper. But inequities between sub-populations in San Francisco were dramatic when expressed as rates, particularly for the African-American community where men have a 63 percent higher incidence and are more than twice as likely to die from prostate cancer as white men, the authors reported.
While SF CAN focuses on San Francisco, the authors stress that it can serve as a model for other municipalities. The paper also depicts best practices for cancer prevention and suggests how to improve access to care for cancer patients.
As the project continues, SF CAN will explore the social determinants of cancer in San Francisco “that lead to unhealthy environments and give rise to the ‘causes of the causes’ of cancer,” the authors wrote. “When federal financial and political support is uncertain, local government, institutions, and citizens themselves may need to take responsibility for tackling complex problems such as cancer control.”
Co-authors on the paper are Amanda Sibley, PhD, MPH, initiatives program director at the UCSF Helen Diller Family Comprehensive Cancer Center; Laura Fejerman, PhD, associate professor in the Department of Medicine; Stanton A. Glantz, PhD, professor of medicine and director of the UCSF Center for Tobacco Control Research and Education; Tung Nguyen, MD, professor of medicine; Rena Pasick, DrPH, professor of medicine and director of community engagement at the Helen Diller Family Comprehensive Cancer Center; Nynikka Palmer, DrPH, MPH, assistant professor of medicine; Arnold Perkins, chair of the community advisory board at the Helen Diller Family Comprehensive Cancer Center and director of the Alameda County Public Health Department from 1994 through 2006; Michael Potter, MD, professor of Family and Community Medicine; Ma Somsouk, MD, MAS, associate professor of medicine; Laura van ‘t Veer, PhD, professor of laboratory medicine; Roberto Vargas, MPH, a navigator in community engagement and health policy; and senior author Alan Ashworth, PhD, FRS, president of the UCSF Helen Diller Family Comprehensive Cancer Center.
UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, transitional and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises three top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children's Hospitals in San Francisco and Oakland, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.