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<table cellpadding="0" cellspacing="0" border="0" width="100%"> <tr> <td><a href="/web/20060901071236/http://www.iom.edu/"> <img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/Header/iom_sub_4.gif" width="546" height="83" border="0" alt="Institute of Medicine."/></a> </td> <td width="100%"> <a href="/web/20060901071236/http://www.iom.edu/"><img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/Header/iom_sub_repeater.gif" width="100%" height="83" border="0"/></a> </td> <td> <a href="/web/20060901071236/http://www.iom.edu/"><img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/Header/iom_sub_endcap.gif" width="32" height="83" border="0"/></a> </td> </tr> </table> <img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/pixel_clear.gif" width="1" height="5" border="0" alt=""/><br/> </td></tr></table> </td> </tr> <tr> <td><div id="Breadcrumb"> <span style="position:relative;top:0px;">Focus On Combating Cancer</span> </div> </td> </tr> <tr> <td class="Default_Header"> <span id="Body__ctl0__ctl0_sectionheader_DefaultHeader"> <table cellspacing="0" cellpadding="0" border="0" width="100%"> <tr> <td><img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/misc/arrowbox_neither_turquoise.gif" width="25" height="18" border="0"/> </td> <td><img id="Body__ctl0__ctl0_sectionheader_SectionImage" src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/section_banners/focusonindex.gif" alt="" border="0"/> </td> <td width="100%"> <img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/Section_banners/SectionRepeater.gif" height="18" width="100%"/> </td> <td><img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/Section_banners/SectionEnd.gif" height="18" width="5" border="0"/> </td> </tr> </table> </span> <span style="font-size:2px;"><br/></span> </td> </tr> <tr> <td> <table cellspacing="0" cellpadding="0" border="0" width="100%"> <tr> <td width="100%" valign="top"> <table cellspacing="5" cellpadding="0" border="0" width="100%"> <tr> <td width="18" nowrap></td> </td> <td width="100%"> <table width="100%" cellpadding="0" cellspacing="0"> <tr> <td style="width:100%;" valign="top"> <span class="Default_Title">Focus On Combating Cancer</span> </td> <td style="white-space:nowrap;">   <a href="/web/20060901071236/http://www.iom.edu/CMS/31496.aspx?printfriendly=true" target="_blank"><img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/icons/icon_print.gif" alt="Print" border="0"/></a>   <a href="https://web.archive.org/web/20060901071236/mailto:/?subject=Institute Of Medicine: Focus On Combating Cancer&body=I thought you might find this link of interest. %0D%0DFocus On Combating Cancer %0Dhttp://www.iom.edu/Default.aspx?id=31496 %0D%0DExcerpt from the page: %0D%22Cancer ranks second only to heart disease as the nation's leading cause of death and is the leading cause of death for those under age 85. The Institute of Medicine (IOM) has addressed a variety of broad issues related to cancer and recommended ways to advance the nation's effort against cancer. Cancer Prevention and Early DetectionFulfilling the Potential of Cancer Prevention ...%22 "><img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/icons/icon_email.gif" alt="Email" border="0"/></a> </td> </tr> <tr> <td style="width:100%;padding-bottom:10px;" colspan="2"> <img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/pixel_darkgray.gif" width="100%" height="1" border="0" alt=""/><br/> <img src="/web/20060901071236im_/http://www.iom.edu/Layouts/iom_may_2005/Images/spacer.gif" width="1" height="9" border="0"/><br/> </td> </tr> </table> <span id="Body__ctl0__ctl0_loader__ctl0_Content"> <table border="0" cellpadding="0" cellspacing="0" width="100%"> <tr> <td> <p class="MsoNormal">Cancer ranks second only to heart disease as the nation's leading cause of death and is the leading cause of death for those under age 85.  The Institute of Medicine (IOM) has addressed a variety of broad issues related to cancer and recommended ways to advance the nation's effort against cancer. <p class="MsoNormal"> <hr> <p> <p class="MsoNormal"> <p> <p class="MsoNormal"> <p class="MsoNormal"><b>Cancer Prevention and Early Detection</b> <p class="MsoNormal"><i><b><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31500">Fulfilling the Potential of Cancer Prevention and Early Detection</a></b></i> (2003) outlines a national strategy to achieve such gains.  The report concludes that in order to save the most lives, health care providers, health plans, insurers, employers, policymakers, and researchers should concentrate on helping people to <ul type="square"> <li>stop smoking, <li>maintain a healthy weight and diet, <li>exercise regularly, <li>moderate alcohol consumption, and <li>get screened for breast, cervical, and colorectal cancer.  </li></ul> <p class="MsoNormal">In June 2003, the IOM and the American Cancer Society jointly sponsored a <a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31501">symposium to discuss ways to implement these ideas.  </a> <p class="MsoNormal"> <hr> <p> <p class="MsoNormal"> <b>Breast Cancer Detection</b> <p class="MsoNormal">Breast cancer strikes more than 200,000 women, and kills more than 40,000 women, in the United States each year.  <b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31502">Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis</a></i></b> (2004) builds on earlier IOM reports in this area and concludes that improving and increasing the use of current mammography technology--which is good, if not perfect--offers the best immediate way to reduce the toll of this disease.  However, women today are threatened with limited access to mammography screening by a looming shortage of breast-imaging specialists.  <p class="MsoNormal">Each year, more than 1.2 million U.S. women turn 40 when first mammograms are recommended, and, as the population ages, this number, and thus demand, will grow much larger. The supply of breast imaging specialists is expected to decline due to heavy regulation, fear of lawsuits, and relatively low pay compared to other specialties, and mammography facilities are closing faster than new ones are being opened.  <p class="MsoNormal">The report offers recommendations to optimize the productivity of radiologists who interpret mammograms and, at the same time, improve their accuracy, and to train nonphysician personnel to perform some of the basic screening tasks (although diagnosis still would be left to breast-imaging specialists) as occurs in several European countries. <p class="MsoNormal"> <hr> <p> <p class="MsoNormal"> <b>Mammography Quality Standards Act</b> <p class="MsoNormal">Given the central role that mammography now plays in breast cancer detection, it is important to ensure its good performance.  The Mammography Quality Standards Act (MQSA) of 1992 established comprehensive and standardized regulation of mammography and led to improvements in the quality of the x-ray image, but questions remain regarding the quality of image interpretation, which depends on human factors and is difficult to measure in practice.  <p class="MsoNormal">In preparation for reauthorizing MQSA, Congress asked the IOM to determine additional steps that could be taken to ensure the accuracy of mammography interpretation. <b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31503">Improving Breast Imaging Quality Standards</a></i></b> (2005) proposes mandatory and voluntary ways to enhance how facilities assess their performance in interpreting mammograms, including three new standardized performance measurements that will provide a better picture of how well their breast imagers perform.  <p class="MsoNormal"> <hr> <p> <p class="MsoNormal"> <b>Psychosocial Needs of Women with Breast Cancer </b> <p class="MsoNormal">Most women diagnosed with breast cancer are cured by surgery, generally in combination with other forms of therapy, but the disease often brings problems beyond the physical.  Women faced with a diagnosis of breast cancer may variously experience fear, shock, sadness, or other feelings of psychosocial distress.  Although, most women will successfully adjust to such feelings and effectively manage their disease, perhaps as many as 30 percent, however, will experience episodes of severe, even disabling, psychological distress.  <p class="MsoNormal"><b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31504">Meeting Psychosocial Needs of Women with Breast Cancer</a></i></b> (2004) provides a comprehensive look at the psychological consequences of the cancer experience using breast cancer as the most studied example.  In particular, the report describes the various types and delivery methods of psychosocial services, evaluates their effectiveness, and identifies barriers that prevent women from getting needed interventions. <p class="MsoNormal"> <hr> <p> <p class="MsoNormal"> <b>Colorectal Cancer</b> <p class="MsoNormal">Colorectal cancer is the second leading cause of death from cancer in the United States.  To reduce incidence and mortality, there is general consensus that periodic screening of adults over age 50 to reduce early cancers or their precursor lesions is a valuable preventive intervention, and today most health plans cover such screening.  Yet, there is uncertainty about the specific screening strategies that should be offered to average-risk individuals.  <p class="MsoNormal">Cost-effectiveness models offer a means of evaluating screening strategies, but current models differ on how alternative strategies compare.  Understanding the reasons for such differences is therefore an important step in building confidence among policymakers and the public that the models can provide useful, objective insights into the consequences of health policy choices.  <p class="MsoNormal"><b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31505">Economic Models of Colorectal Cancer Screening in Average-Risk Adults: Workshop Summary</a></i></b> (2005) explores the reasons for differences among the leading models.  After running their models with a variety of standardized inputs, workshop participants examined differences among their structures and assumptions and possible explanations for their varied results.  <p class="MsoNormal"> <hr> <p> <p> <p class="MsoNormal"> <b>Cancer Care</b> <p class="MsoNormal"><b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31506">Ensuring Quality Cancer Care</a></i></b> (1999) provided a comprehensive exploration of the quality of cancer care and concluded that for many Americans there is a wide gulf between what could be construed as the ideal and the reality of their experience with cancer. This report, which became the foundation for many subsequent reports on the quality of cancer care, examined quality: <ul type="square"> <li>for initial treatment, <li>for survivors, <li>in prevention and palliation, and <li>in relation to volume of services, among others. </li></ul> <p class="MsoNormal"><b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31507">Enhancing Data Systems to Improve the Quality of Cancer Care</a></i></b> (2000) and <b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31508">Interpreting the Volume-Outcome Relationship in the Context of Cancer Care: A White Paper</a></i></b> (2001) also helped strengthen the foundation for subsequent work on quality and cancer care. <p class="MsoNormal">When Americans get cancer, and particularly when they die from it, they are likely to be in pain and suffer from a host of other symptoms because the available palliative care (care designed to keep them comfortable) is inadequate. The report <i><b><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31509">Improving Palliative Care for Cancer</a></b></i> (2001), examined the reasons why people suffer needlessly without such care and offered steps that society and individuals can take to improve access to palliative care. <p class="MsoNormal"> <hr> <p> <p class="MsoNormal"><b>Measuring the Quality of Cancer Care</b> <p class="MsoNormal">Shortly after the tobacco industry鈥檚 Master Settlement Agreement with the states in 1998, Georgia began considering ways to use some of its $5 billion settlement to benefit state residents.  <p class="MsoNormal">Given tobacco鈥檚 role in causing cancer, Georgia decided to create an entity and a program, called the Georgia Cancer Coalition, with the mission of making the state a national leader in cancer prevention, treatment, and research.  The Coalition, contracted with the IOM to identify a set of measures that could be used to gauge the state鈥檚 progress in improving the quality of its cancer services and in reducing cancer-related morbidity and mortality.  <p class="MsoNormal"><b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31510">Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia</a></i></b> (2005) describes a set of 52 quality indicators to measure progress.  The indicators apply to cancer prevention, early detection, diagnosis, and treatment and focus on breast, colorectal, prostate, and lung cancers.  <p class="MsoNormal">This is the first such collection of indicators to enable a state to gauge the progress of its programs in reducing the burden of cancer, and it could fulfill much of the untapped potential of cancer care and prevention by closing the gap between what is known and what is practiced in the everyday routines of the home, workplace, and physicians' offices.  <p class="MsoNormal">Importantly, while the quality measures were developed for Georgia, they also are suited to other states that choose to develop comprehensive programs aimed at improving cancer prevention and care for their citizens. <p class="MsoNormal"> <hr> <p> <p class="MsoNormal"><b>Surviving Cancer</b> <p class="MsoNormal">The treatment of childhood cancer is one of oncology's great success stories.  Most children and young adults under 20 years of age had little hope of cure prior to 1970.  Since then, five-year survival rates have increased to 78 percent, largely as a result of intensive multimodal treatments. However, perhaps two-thirds of childhood cancer survivors experience late effects--that is, complications, disabilities, or adverse outcomes--as a result of their disease, its treatment, or both.  <p class="MsoNormal">Continued surveillance and a variety of interventions may, in many cases, be needed to identify and care for late effects, which may appear even several decades after treatment.  But general agreement has been lacking about the details of such systematic follow-up.  <p class="MsoNormal"><b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31511">Childhood Cancer Survivorship: Improving Care and Quality of Life</a></i></b> (2003) outlines a comprehensive policy agenda that links improved health care delivery and follow-up, investments in education and training for health care providers, and expanded research to improve the long-term outlook for this growing population of cancer survivors.  <p class="MsoNormal">The report calls for evidence-based clinical practice guidelines for the care of childhood cancer survivors, as its highest priority, and also a minimum set of standards for systems of multidisciplinary follow-up care that link specialty and primary care providers and ensure the presence of such on-going care within institutions treating children with cancer. In response to the report, the Children鈥檚 Oncology Group quickly issued the recommended guidelines. <p class="MsoNormal">In a complementary effort, the IOM completed a study focused on adult cancer survivors, <b><i><a class="linkTextBlock" href="/web/20060901071236/http://www.iom.edu/?id=31512">From Cancer Patient to Cancer Survivor: Lost in Transition</a></i></b> (2005). The study assessed the quality of care for cancer survivors and explored social and economic hardships facing cancer survivors related to, for example, uninsurance and employment discrimination.  Policies to improve the care and quality of life for cancer survivors and their families were recommended, in particular the provision of a survivorship care plan to all survivors on completion of primary treatment for cancer. <p class="MsoNormal">In 2006, the IOM and the American Society of Clinical Oncology will be sposoring a symposium to discuss the findings from this report. </td> </tr> </table> </span> <br/><br/>  <table cellpadding="2" cellspacing="0" border="0" width="100%"> <tr> <td colspan="4" height="1" class="ListSection"> <span id="Body__ctl0__ctl0_loader__ctl0_reports_ReportListTitle">Released Reports</span> </td> </tr> <tr valign="top"> <td width="20"> </td> <td> <a href="/web/20060901071236/http://www.iom.edu/CMS/28312/4931/30869.aspx">From Cancer Patient to Cancer Survivor: Lost in Transition</a> </td> <td width="10"> </td> <td nowrap="true" align="right"> Nov 07,2005 </td> </tr> <tr valign="top"> <td width="20"> </td> <td class="altRow"> <a href="/web/20060901071236/http://www.iom.edu/CMS/3798/20443/27028.aspx">Improving Breast Imaging Quality Standards</a> </td> <td width="10" class="altRow"> </td> <td class="altRow" nowrap="true" align="right"> May 23,2005 </td> </tr> <tr valign="top"> <td width="20"> </td> <td> <a href="/web/20060901071236/http://www.iom.edu/CMS/28312/4935/26453.aspx">Making Better Drugs for Children with Cancer</a> </td> <td width="10"> </td> <td nowrap="true" align="right"> Apr 18,2005 </td> </tr> <tr valign="top"> <td width="20"> </td> <td class="altRow"> <a href="/web/20060901071236/http://www.iom.edu/CMS/3798/16410/26263.aspx">Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia</a> </td> <td width="10" class="altRow"> </td> <td class="altRow" nowrap="true" align="right"> Apr 07,2005 </td> </tr> <tr valign="top"> <td width="20"> </td> <td> <a href="/web/20060901071236/http://www.iom.edu/CMS/28312/4935/26182.aspx">Federal Agency Roles in Cancer Drug Development </a> </td> <td width="10"> </td> <td nowrap="true" align="right"> Mar 30,2005 </td> </tr> <tr valign="top"> <td width="20"> </td> <td class="altRow"> <a href="/web/20060901071236/http://www.iom.edu/CMS/3798/15652/25197.aspx">Economic Models of Colorectal Cancer Screening in Average-Risk Adults: Workshop Summary</a> </td> <td width="10" class="altRow"> </td> <td class="altRow" nowrap="true" align="right"> Feb 22,2005 </td> </tr> <tr valign="top"> <td width="20"> </td> <td> <a href="/web/20060901071236/http://www.iom.edu/CMS/3798/4933/25560.aspx">Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis--A Breast Cancer Research Foundation and Institute of Medicine Symposium</a> </td> <td width="10"> </td> <td nowrap="true" align="right"> Nov 15,2004 </td> </tr> <tr valign="top"> <td width="20"> </td> <td class="altRow"> <a href="/web/20060901071236/http://www.iom.edu/CMS/3798/4933/20721.aspx">Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis</a> </td> <td width="10" class="altRow"> </td> <td class="altRow" nowrap="true" align="right"> Jun 10,2004 </td> </tr> <tr valign="top"> <td width="20"> </td> <td> <a href="/web/20060901071236/http://www.iom.edu/CMS/3798/19213.aspx">Fulfilling the Potential of Cancer Prevention and Early Detection: An American Cancer Society and Institute of Medicine Symposium</a> </td> <td width="10"> </td> <td nowrap="true" align="right"> Mar 12,2004 </td> </tr> <tr valign="top"> <td width="20"> </td> <td class="altRow"> <a href="/web/20060901071236/http://www.iom.edu/CMS/3798/18136.aspx">Meeting the Psychosocial Needs of Women with Breast Cancer</a> </td> <td width="10" class="altRow"> </td> <td class="altRow" nowrap="true" align="right"> Jan 28,2004 </td> </tr> <tr valign="top"> <td width="20"> </td> <td> <a href="/web/20060901071236/http://www.iom.edu/CMS/28312/4931/14782.aspx">Childhood Cancer Survivorship: Improving Care and Quality of Life</a> </td> <td width="10"> </td> <td nowrap="true" align="right"> Aug 26,2003 </td> </tr> <tr valign="top"> <td width="20"> </td> <td class="altRow"> <a href="/web/20060901071236/http://www.iom.edu/CMS/3798/14958.aspx">Como Mejorar el Cuidado Paliativo: Podemos mejorar el cuidado de personas con cancer </a> </td> <td width="10" class="altRow"> </td> <td class="altRow" nowrap="true" align="right"> Aug 19,2003 </td> </tr> <tr valign="top"> <td width="20"> </td> <td> <a 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