Oklahoma state cancer plan sets ambitious goals for reducing deaths
Oklahoma City — Oklahoma's new state cancer plan lays out ambitious goals to screen more people for disease, reduce long-term risk factors and hopefully save lives.
The plan, unveiled last week, sets a goal of reducing the cancer mortality rate by 2022 by more than 6 percent from the 2016 baseline. It also sets goals to cut deaths due to some specific cancers even further — in the case of lung cancer, by 16 percent.
About one-third of cancers can't be cured now, even if the people who have them get the best medical care possible, said Dr. Robert Mannel, director of Stephenson Cancer Center.
The plan focuses on four cancers: breast and cervical cancers in women, and colorectal and lung cancers in all adults. Unlike some cancers, those types can be prevented or detected early, when the odds of successful treatment are higher.
Joy Fugett, cancer control coordinator at the Oklahoma State Department of Health, said many of the strategies to reduce cancer will sound familiar, since it has many of the same risk factors as heart disease. Learning more about how risk factors like smoking and obesity affect cancer may motivate change, she said.
“Cancer is so personal,” she said.
Some of the strategies the plan leans on would require legislative action. It calls for another tax increase to raise the price of cigarettes, and for a ban on smoking on all indoor public spaces. Oklahoma law currently exempts bars and some other locations.
The plan also calls for the state to launch an anti-smoking advertising campaign and to track sales of electronic cigarettes to minors.
The hope is that those strategies would reduce the smoking rate among adults from about 20 percent to about 16 percent, and among high school students from about 12.5 percent to about 11 percent. Not all people who develop lung cancer used tobacco, but cigarette smoking is the biggest risk factor for tumors in the lungs and several other organs.
Those are achievable goals, but the tobacco industry will lobby hard against any efforts to toughen state laws, said Doug Matheny, programs and initiatives manager for policy at the Oklahoma Tobacco Research Center.
“It's clear what works to reduce smoking deaths. The real challenge is overcoming tobacco industry efforts to maintain the status quo,” he said. “They aggressively market to young Oklahomans to replace smokers who quit or die.”
More shots on the schedule
Another piece of the plan, targeted at cervical cancer, likely also depends on state action. The plan set a goal for at least 80 percent of teens to get vaccinated against human papillomavirus by 2022.
Most people contract HPV at some point, and in the majority of cases the body eliminates it without symptoms. For an unlucky minority of people, however, it can cause cancer in the cervix, vagina, penis, anus, or throat.
The plan calls for the Legislature to pass a bill adding HPV to the list of vaccines that school children must have. Studies of other diseases, like hepatitis B, have found that vaccination rates go up dramatically when schools require the shot, said Dr. Amy Middleman, chief of adolescent medicine at OU Medicine.
“The way to get rates up the fastest is to implement a school requirement,” she said.
Even if the Legislature doesn't pass a requirement, doctors can increase the odds parents will agree to the vaccine for their teen patients, Middleman said. Providers can increase acceptance by emphasizing that HPV can cause cancer, rather than that it's most commonly spread through sex.
“We've been waiting for a long time for something that can prevent cancer,” she said. “If we can save lives, why would we not move forward?”
Doctors, patients have to change
Other goals rely almost totally on providers. The plan sets goals of increasing the number of at-risk patients screened for four cancers, but it doesn't lay out specific plans to address some of the barriers to screening, such as lack of transportation to appointments or the state's high uninsured rate.
Soonercare has programs to cover screening and treatment for breast and cervical cancer in low-income women who wouldn't normally qualify for state insurance coverage, but that doesn't exist for colon or lung cancer screening, said Jo Stainsby, spokeswoman for the Oklahoma Health Care Authority. Some patients can find that type of care through hospital charitable care programs, she said.
Oklahoma hasn't elected to expand Soonercare to more low- and middle-income adults, as allowed under the Affordable Care Act.
The goals related to obesity could be even more difficult to reach. The plan calls for the percentage of adults who are obese to fall from about 33 percent to about 30 percent by 2022. It also sets a goal of reducing teen obesity from about 17 percent to about 15 percent.
To reach those goals, the state will need to continue engaging schools, local communities and workplaces to make small changes that offer people the chance to make healthier choices, said Julie Bisbee, spokeswoman for the Tobacco Settlement Endowment Trust.
“It's going to take a team effort to address this very complex problem,” she said. “Behavior change is hard.”
Oklahoma has succeeded in slowing down the growth in obesity, because predictions the state was going to be the nation's most-obese by now haven't come to pass, Bisbee said. The obesity rate even appeared to fall slightly last year, though it's too early to be sure that wasn't a blip, she said.
“When you're looking at public health, you have to be a little ambitious, because those are lives,” she said.
To view the plan, visit https://www.ok.gov/health2/documents/State%20Cancer%20Plan%202017-2022.pdf.
Risk reduction goals
Among proposals for cancer reduction efforts from a baseline with 2016 numbers to 2022 are:
• Adolescent females vaccinated: Increase from 43.6 percent to 80.6 percent
• Adolescent males vaccinated: Increase from 35.0 percent to 87.0 percent
Obesity (Physical Activity and Nutrition)
• Adolescent obesity: Reduce from 17.1 percent to 15.3 percent
• Adult obesity: Reduce from 32.8 percent to 29.5 percent
• Adolescent smoking: Cut from 12.5 percent to 11 percent
• Adult smoking: Cut from 19.6 percent to 15.8 percent
Priority cancer areas
• Increase screenings from 75.5 percent to 78.1 percent
• Increase screenings from 78.8 percent to 82.7 percent
• Increase screenings from 59.4 percent to 62 percent
• In addition to reducing adult smoking, promote at least four lung cancer screenings