ACS CAN Testifies on 2019-20 Preliminary NYC Budget

Tesimony by the American Cancer Society Cancer Action Network

to the New York City Council Health Committee

March 18, 2019 • New York, NY

Chair Levine and members of the Health Committee, thank you for the opportunity to testify today.  My name is Michael Davoli and I am the New York Metro Director for Government Relations at the American Cancer Society Cancer Action Network (ACS CAN), the nonprofit, nonpartisan, advocacy affiliate of the American Cancer Society.  I am pleased to be able to speak about the 2019-2020 Preliminary Budget.

Last month ACS CAN released a report examining cancer in New York City.  The report, “Reducing the Cancer Burden in New York City,” showed that the number of people diagnosed with cancer every year in New York City could fill Madison Square Garden, twice—over 40,000 people annually.  Over 12,000 people die from the disease annually each year in New York City according to the report.

On average, approximately 771 New York City residents were diagnosed with cancer and 241 individuals died from cancer each week from 2011-2015. Imagine two packed New York City Subway cars.  That is how many people die each week from cancer.

Cancer cases and cancer deaths differ greatly among boroughs and the neighborhoods making up New York City, in part reflecting the diverse socioeconomic and demographic characteristics across New York City. Key findings in the report include:

• Four cancers - lung, prostate, breast and colorectal - account for nearly half (47.4 percent) of all cancer diagnoses and nearly half (45 percent) of all cancer deaths in New York City from 2011-2015.
• Lung and bronchus cancer are the single largest cause of cancer death, causing nearly 2668 deaths yearly from 2011-2015. Colorectal (1,240), female breast (1,027), and Pancreatic (933) cancers were the second, third and fourth most frequent causes of mortality.
• Female breast cancer is New York City's most commonly diagnosed cancer among women, with 5,887 women diagnosed annually between 2011-15, whereas prostate cancer was the most common among men (5,347 new cases annually from 2011-2015).
• Lung and bronchus cancer are New York City's most common cause of cancer death among women, with 1237 women cancer deaths caused annually between 2011-15, and men (1430 deaths annually from 2011-2015).
• Men and women living on Staten Island have the highest incidence rate of new cancer cases overall on average annually between 2011-2015.
• Men and women on Staten Island experience the highest rates of lung and bronchus cancer.
• Women in Manhattan and men in the Bronx have the highest rates of female breast and prostate cancer respectively on average annually between 2011-2015.
• Men living in PUMA “Neighborhoods” Morris Heights, Fordham South and Mount Hope, Brownsville & Ocean Hill and Tottenville, Great Kills and Annadale have the approximate highest cancer incidence rate overall among men.
• Men living in PUMA “Neighborhoods” Jackson Heights and North Corona, Sunnyside & Woodside, and Greenpoint and Williamsburg have the approximate lowest cancer incidence rate overall among men.
• Women living in PUMA “Neighborhoods” Tottenville, Great Kills and Annadale, New Springville and South Beach, and Bay Ridge and Dyker Heights, have the approximate highest cancer incidence rate overall among women.
• Women living in PUMA “Neighborhoods” Greenpoint and Williamsburg, Jackson Heights and North Corona and Washington Heights, Inwood and Marble Hill have the approximate lowest cancer incidence rate overall among women.
• Non-Hispanic Whites have the highest rate, 510 cancer cases per 100,000 males and females, of all cancers on average annually between 2011-2015.
• Non-Hispanic Blacks have the highest cancer death rate, 167 cancer deaths per 100,000 males and females, of all cancers on average annually between 2011-2015.
• About 30 percent of all cancer deaths are caused by cigarette smoking. 
• The combined effects of excess body weight, poor diet, alcohol consumption, and physical inactivity are associated with 18 percent of all cancer cases.
• Certain cancers caused by infectious agents, such as the human papillomavirus (HPV), could be prevented through vaccination.

Those last three points will shape the remainder of my testimony today.

For nearly two decades, leadership from the Mayor’s office, the City Council and the Department of Health and Mental Hygiene has led to declining cancer rates and other positive health outcomes. While the progress is to be celebrated, the findings in our report show that more work must be done.  

In the 2019-2020 Budget ACS CAN recommends that New York City use its substantial financial resources to:

• Increase Cancer Screening
• Reduce Human Papillomavirus Related Cancers
• Help New Yorkers Live at Healthy Weights
• Reduce Sun Related Skin Cancers

Increase Cancer Screening—Cancer screening increases the chances of detecting certain cancers early, when treatment is more likely to be effective. The American Cancer Society recommends screening for cancers of the breast, cervix, colon and rectum, and lung. For most cancers, five-year survival is generally higher when detected at an early stage.  Unfortunately, disparities in cancer screening rates and stage of diagnosis exist by race/ethnicity, cancer type, gender, borough, and neighborhood. Citywide:

• 63.4 percent of women were diagnosed with breast cancer at an early stage,
• 40.9 percent of men and 40.8 percent of women were diagnosed with colorectal cancer at an early stage
• 21.6 percent of men and 28.3 percent of women were diagnosed with lung and bronchus cancer at an early stage
• 44 percent of women were diagnosed with cervical cancer at an early stage

Over the past fifteen years, the New York City DOHMH has coordinated a citywide effort to increase cancer screening for uninsured and underinsured New Yorkers. This effort has seen historic increases in colorectal cancer screening rates and declines in racial disparities among other positive health outcomes. Yet many New Yorkers are still lacking access to potentially lifesaving cancer screening. Barriers to screening include lack of transportation to and from appointments, time off for screening, cost, and insurance coverage. Many of these barriers could be addressed with public and private support.

• ACS CAN recommends $2.7 million to expand cancer screening programs--The DOHMH currently receives $1.35 million annually to run a cancer screening programs that focuses on increasing colonoscopy rates in underserved communities. New York City should increase the amount to $2.7 million annually to allow for the program to help more people in medically underserved areas of New York City access screening for colorectal cancer and breast cancer, regardless of their income or insurance status.

Reduce Human Papillomavirus Related Cancers—Every year, approximately 976 New York City residents are diagnosed with a cancer related to human papillomavirus (HPV) according to the New York State Department of Health. Two thirds of those cases are in women.  Virtually all cervical cancers are caused by HPV, 95 percent of anal cancers and 70 percent of Oropharyngeal cancers are caused by HPV among others. What almost all these cancers have in common is that they are all preventable with a vaccine. The HPV vaccine can prevent infection by certain types of HPV, and some of the cancers linked to those types.

Despite the widespread availability of the vaccine, a substantial number of youth ages 13-17 have not completed the HPV vaccine series, with 67.5 percent of girls and 62.6 percent of boys in New York City having done so. Meanwhile there are significant gaps exist in vaccination rates from borough to borough and neighborhood to neighborhood. For example, the highest overall vaccination rates are in Jackson Height Queens (87.6 percent) and Mott Haven in the Bronx (87.5 percent). The lowest overall vaccination rates are in Williamsburg Brooklyn (22.7 percent) and Tottenville Staten Island (19.4 percent).

The biggest predictor of HPV vaccination uptake is an effective recommendation from a health care professional – specifically a family medicine or pediatric professional. A strong and clear recommendation from a provider is critical to ensuring that boys and girls get the vaccine. New York City should launch an aggressive campaign focused on educating and training providers on how to give accurate, consistent and strong HPV vaccination recommendations to their patients and increasing parents’ knowledge about the importance of protecting their children with the HPV vaccine and the appropriate time for a child to be vaccinated.

• ACS CAN recommends an initial investment of $500,000 for HPV Provider and Parent Education Campaign—With a dedicated allocation to the DOHMH, NYC could coordinate evidence-based targeted city level health care provider and parental education programming on the importance of the HPV vaccine.

Helping New Yorkers Live at a Healthy Weight—After more than a decade of decline, the percentage of obese adults rose to 25 percent.  That’s a 22 percent increase since 2002.  More than half of all adult New Yorkers are either overweight or have obesity.  Even more alarming is the sharp increase in obesity among youth in New York City. Nearly half of all elementary school and Head Start students are either overweight or obese. 

A significant portion of cancers in New York City could be prevented by helping New Yorkers live at a healthy weight.  Unfortunately, not everyone has the tools necessary to live at a healthy weight. Every family should have access to the foods that help support a balanced diet and a healthier life. Yet 1.2 million residents of New York City live in lower income communities with limited access to healthy food retail.

In the Fiscal Year 2019-2020 budget, the city should fund programs that will increase access to healthy food, especially for neighborhoods that need it most.

• ACS CAN recommends $3 Million For Healthy Corner Store Initiatives: Healthy corner store initiatives include mini-grants to provide financial support to owners for refrigeration, displays, or one-time capital expenditures that help store owners keep healthy food on their shelves at affordable prices and help stores educate their customers about the availability of healthy options.
• ACS CAN recommends $10 Million For a Healthy Food Financing Initiative (HFFI): An HFFI leverages both public and private funding to provide low-interest loans and grants specifically tailored for food establishments that may otherwise struggle to secure needed traditional capital. Given the success of HFFI at the state level and in markets across the country, New York City should invest $10 million to launch a local program to support healthy food access and strengthen local economies.
• ACS CAN recommends $15 Million Expand SNAP Incentives: 1 in 5 New Yorkers receive Supplemental Nutrition Assistance Program (SNAP) benefits, which reduce food insecurity and help households rise out of poverty. SNAP incentives such as Health Bucks can help people eat more fruits and vegetables and increase the quality of their diet. The City should increase funding for SNAP incentives and explore avenues for expanding access not only at farmer’s markets but also bodegas and supermarkets, online markets, or other retail venues that allow families to access these resources where they live and shop.

Reduce Sun Related Skin Cancers—Nearly 1,000 cases of melanoma of the skin are diagnosed in New York City annually, according to the New York State Cancer Registry and over 100 lives are lost to the disease each year. Ultraviolet (UV) radiation, from the sun and indoor tanning devices, can cause skin cancer as well as eye damage and premature aging of the skin. Severe sunburn during childhood significantly increases the risk of melanoma later in life. Safety in the sun at the beach and every time outdoors is important to prevent skin cancer, as is avoiding all indoor tanning.

The New York City Department of Parks & Recreation launched a two-year pilot project in 2017 that provided free sunscreen at all city beaches. By all measures the program was incredibly successful and widely popular. That program should be expanded and made permanent. New York City should leverage its purchasing power and private sector partnerships to ensure that a lack of sunscreen is never the reason for increasing skin cancer rates.

• ACS CAN recommends $250,000 to Provide Free Sunscreen at all New York City parks, pools and beaches. This allocation would allow for the New York City Department of Parks & Recreation to continue the program at all city beaches and pools for another two years.

In Conclusion

In 2015 Mayor de Blasio set a goal to cut premature mortality by 25 percent by 2040 as part of his OneNYC Plan. This is an ambitious goal and one that we must meet. But to do so, city officials need to use their budget authority to reduce the cancer burden in New York City. Nearly every New Yorker from every neighborhood has been touched by cancer in some way. Our recent report shows that we know how to reduce the cancer burden in New York City, if only we have the will to do so. We encourage the Administration and the City Council to include in the 2019-2020 budget investments in programs that will reduce cancer rates and improve health outcomes across our city.  ACS CAN recommends that New York City use its substantial financial resources to increase cancer screening, reduce Human Papillomavirus related cancers, help New Yorkers live at healthy weights and reduce sun related skin cancers.