Towards a more comprehensive understanding of cancer burden in North Carolina: priorities for intervention.

OBJECTIVE: To apply 4 measures of population burden in examining cancer burden in North Carolina and to identify priorities for intervention. METHODS: Four measures were used: incidence, mortality, prevalence, and years of potential life lost (YPLL). The North Carolina Central Cancer Registry provided summary data on incidence and mortality and record-level data that were examined using SEER*Stat software to calculate prevalence. North Carolina vital statistics (mortality) data and life expectancy estimates stratified by age, race, and sex were used to calculate YPLL. Each cancer site was ranked according to burden for each of the 4 individual burden measures and summarized into an overall rank. Burden was examined overall and by sex and race. PRINCIPAL FINDINGS: Four cancers--lung/bronchus, female breast, prostate, and colon/rectum--accounted for approximately 57% of the total cancer incidence, prevalence, mortality, and YPLL in North Carolina. Patterns of burden in gender and race subgroups were similar, although non-whites often had higher mortality rates than did whites despite similar incidence rates. An estimated 207,583 people were living with cancer in 2004 Breast and prostate cancer accounted for 42% of these survivors. Lung/bronchus cancer was the most severe cancer, accounting for more deaths and years of life lost than any other 5 cancers combined. CONCLUSIONS: Each of the 4 measures provides unique insight and guidance for cancer coordination and control efforts. Lung/bronchus, female breast, prostate, and colon/rectum cancers accounted for the majority of North Carolina's cancer burden and should be priorities for intervention.

Knowledge, beliefs and barriers associated with prostate cancer prevention and screening behaviors among African-American men.

African-American men have the highest prostate cancer rates worldwide, and innovative efforts are needed to increase cancer prevention and screening behaviors among this population. Formative research was conducted to assess attitudes and behaviors linked to prostate cancer prevention activities that could be used to develop a culturally relevant intervention for an African-American church-based population. Four gender-specific focus groups were conducted with 29 men and women at two African-American churches in central North Carolina. Three primary themes emerged from the focus group discussions: culturally and gender-influenced beliefs and barriers about cancer prevention and screening; barriers related to the healthcare system: and religious influences, including the importance of spiritual beliefs and church support. These discussions revealed the importance of the black family, the positive influence of spouses/partners on promoting cancer screening and healthy behaviors, the roles of faith and church leadership, and beliefs about God's will for good health. These findings also revealed that there are still major barriers and challenges to cancer prevention among African Americans, including continued mistrust of the medical community and negative attitudes toward specific screening tests. Findings provide important insights to consider in implementing successful prostate cancer prevention interventions designed for church-based audiences.

Breast and colorectal cancer risk communication approaches with low-income African-American and Hispanic women: implications for healthcare providers.

BACKGROUND: Information on breast and colorectal cancer risk factors is widely available to women and the physicians who provide their healthcare; however, many women are unable to identify the major risk factors, continue to misperceive their personal risk of developing these cancers, and do not engage in routine early detection. METHODS: Qualitative methods were used to investigate breast and colorectal cancer risk knowledge, perceptions, behaviors, and risk communication formats with low-income African-American and Hispanic study participants in Harlem, NY, aged 40-60 years. RESULTS: Focus group results indicated strong participant interest in strategies necessary to understand and reduce the risk of developing breast and colorectal cancers. Preferred risk communication tools presented information about family history and personal risk in graphic and quantitative formats. CONCLUSIONS: Healthcare professionals who serve low-income African-American and Hispanic female populations should deliver information to them about the personal risk of developing targeted cancers and ways to reduce this risk in formats that are meaningful and effectively address the special needs of these populations.