Cancer Plan

While cancer impacts people of all ages and backgrounds, outcomes related to cancer across populations are not the same. Health equity acknowledges that all New Yorkers have a right to live in social and physical environments that promote good health and have access to quality cancer care. It means that everyone has a fair and just opportunity to achieve their full health potential, no matter how old they are, who they are, where they live or work, what school they go to, what they believe in, or how much money they make.

Many New Yorkers face either individual or community-level social conditions that can negatively affect their health. Such conditions include unequal access to affordable health care, healthy foods, quality housing, economic opportunity, social relationships, transportation, and education. Health differences, also known as disparities, that are linked to these factors can cause or lead to differences in the chances of getting or preventing cancer, receiving timely and appropriate cancer diagnosis and treatment, and surviving after a cancer diagnosis.

Some disparities include the following:

• Lung Cancer - New Yorkers living in small towns and rural areas are diagnosed with regional or distant stage lung cancer more often than those living in metropolitan or micropolitan areas.
  
• Breast Cancer - Black, non-Hispanic female New Yorkers die 33% more often from breast cancer compared to White, non-Hispanic female New Yorkers.
  
• Prostate Cancer - Black, non-Hispanic male New Yorkers die 111% more often from prostate cancer compared to White, non-Hispanic male New Yorkers.
  
• Colorectal Cancer - Black, non-Hispanic New Yorkers die from colorectal cancer 25% more often than White, non-Hispanic New Yorkers.
  
• Melanoma - White, non-Hispanic New Yorkers are diagnosed with and die from melanoma more often than individuals of other races or ethnicities. 

Partners have also emphasized that current hospital staffing and support systems may lack the resources needed to address the comprehensive impact of a cancer diagnosis, in particular pediatric cancers, creating additional barriers for affected families and caregivers.

Burden

Screening tests can find cancer in people who have no signs or symptoms of cancer. They can detect cancer at an early stage or, in some cases, find pre-cancerous cells which can be removed before cancer starts. Clinical guidelines recommend adults be screened for breast, cervical, colorectal, prostate, and lung cancer based on age and risk factors for those cancers. Adults should talk with their health care provider about their risk of cancer, screening guidelines, and screening options. 

Health Equity Focus

Health care can be difficult to access, navigate, and pay for. Cancer screening rates are lowest among individuals without health insurance, without a regular health care provider, living with mental illness, living in lower-income communities, identifying as LGBTQIA+, and of certain racial and ethnic groups.

The United States Preventive Services Task Force (USPSTF) recommends getting screened for different cancers at different times depending on a person’s age, sex and risk factors. Some organizations’ recommendations differ from USPSTF recommendations.

Get involved with the NYS Cancer Consortium. Become an active member of the Colorectal Cancer Screening Action Team or Lung Cancer Screening Action Team.

Use New York State Cancer Registry surveillance data and other reputable sources to identify communities across New York State where incidence and/or mortality rates of screenable cancers are high. 

Make cancer screening accessible and affordable for all New Yorkers: 

• Advocate for health insurance coverage of cancer screening and diagnostic tests without cost-sharing.
  
• Raise awareness about existing New York State laws (breast, colorectal, lung) that prohibit cost-sharing for cancer screening and associated diagnostic tests.
  
• Promote health plans available through the New York State of Health: The Official Health Plan Marketplace.
  
• Promote and advocate statewide programs that serve vulnerable populations, such as the New York State Cancer Services Program.
  
• Encourage employers to adopt policies that provide all employees with paid time off for cancer screening or the option to use flex time to attend screening appointments. 

Build community demand for cancer screening using evidence-based, accessible, and culturally tailored messaging:

• Partner with community members to tailor messaging for underserved communities facing disparities.
  
• Develop and use educational materials that align with evidence-based, tested messaging.
  
• Disseminate messaging through social media (videos, letters, brochures, and newsletters) and earned media (letters to the editor, appearances on local news programs, and on-air or print interviews).
  
• Provide information on risk factors and potential symptoms to help individuals make informed decisions about screening. 

Implement evidence-based strategies and best practice workflows, including:

• Tools to support patient education and informed decision making.
  
• Patient reminders (e.g., letters, postcards, emails, text, phone, and electronic health record (EHR) alerts).
  
• Electronic health record and population health management systems that assess patient panels to identify who needs screening or follow-up tests.
  
• Building daily clinic team huddles into practice to review patient panel reports and plan out appropriate screening recommendations.
  
• Employing and training community health workers, patient navigators, and peer educators from the community to deliver group education, one-one-one education, and barrier reduction support services.
  
• Identifying clinical champions to focus on implementing and monitoring activities to improve cancer screening and timely follow-up on abnormal results.
  
• Adjusting clinic working hours to offer evening or weekend appointments.
  
• Joining with community organizations to address structural barriers to getting screened and going to follow up appointments such as those that offer free transportation, assistance with child or adult care, and access to other supportive services.

Burden

High risk for cancer means having a greater chance of developing cancer compared to the general population, due to factors like family history or genetic mutations. Children, adolescents, adults, and their families can benefit from knowing their family history of cancer and discussing their risk with a health care professional to decide if screening at an earlier age, genetic counseling, and/or genetic testing is needed. 

Health Equity Focus

Individuals from underserved communities and those living in rural parts of the state can face barriers such as limited access to genetic counseling and testing. These barriers can lead to missed opportunities for early detection and personalized cancer prevention strategies. In addition, existing genetic research and testing panels often underrepresent diverse populations, reducing the accuracy and relevance of results for these groups. 

Increase public and provider knowledge about family health history, cancer risk assessment, and cancer genetics.

• Promote the use of family history questionnaires such as My Family Portrait as a method of collecting a complete family history of cancer.
  
• Encourage cancer survivors of all ages to talk about their diagnosis with their family members to inform collection of family health history.
  
• Distribute information about the availability of genetic counselors in the state, including those that provide services at low or no cost.

Implement programs that increase access for children, adolescent, and adult patients to genetic counseling, genetic testing, risk reduction and early detection interventions:

• Identify and promote electronic health records that collect family history information and which link to evidence-based screening and surveillance recommendations. 
  
• Offer genetic counseling in pediatric and adult cancer treatment facilities.
  
• Assess females with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool. 
  
• Increase organizational readiness for implementation of universal Lynch Syndrome screening.

Promote access to genetic testing and protection of genetic health information:

• Identify and measure inequities in use of genetic services and health outcomes for people with genetic disorders.
  
• Disseminate information about existing coverage for genetic counseling and testing.
  
• Advocate for enhanced coverage of family health history collection and genetic testing through efforts such as value-based payment and coverage for universal genetic cascade testing.
• Support efforts to adhere to the confidentiality and privacy of genetic test results to prohibit genetic discrimination, including health information gathered from commercially available gene testing kits used for genealogical and not health related reasons. 

Burden

Palliative and hospice care is of benefit to patients, caregivers, and families to help control symptoms, improve quality of life, and support end-of-life care. Palliative care focuses on easing pain and symptom management associated with serious illnesses, helping with emotional and spiritual needs, supporting families and caregivers, and improving quality of life. Palliative care can be provided throughout the continuum of care, alongside other treatments, from diagnosis to death. Hospice care is offered to people at the end of their life. 

Health Equity Focus

 Access to and utilization of palliative care and hospice services can be limited by lack of health insurance coverage and availability of services. Achieving health equity means raising awareness and increasing access to high quality palliative care and hospice services, including transitions between the two, for individuals of all ages regardless of geography or insurance status. 

Increase community and health care system awareness:

• Engage with public health, community- and faith-based organizations, and health care systems to raise awareness about the benefits of palliative and hospice care among patients diagnosed with cancer, caregivers and health care providers.

Increase palliative care workforce:

• Promote palliative care certification among physicians, nurses and other disciplines. 
• Promote training in pediatric palliative care.
• Support increased reimbursement for palliative care and hospice services.
• Promote efforts such as the Palliative Care Education and Training Act that supports workforce training, increased education and awareness, and palliative care research.

Improve quality of palliative care services:

• Promote registration and participation in the National Palliative Care Registry, a free service to measure program progress and track operational capacity and reach. 
• Promote accreditation standards and quality measures for high-quality palliative care.

This section highlights issues and challenges faced by New Yorkers which impact multiple parts of the cancer continuum. There is a need to draw attention to the impact these topics have on the cancer burden and work together to address them.

Inadequate numbers of health care professionals at all levels of care, and limited investment in supportive roles such as patient navigators, community health workers and peer educators, threaten progress and ongoing efforts to address the State’s cancer burden. The Association of American Medical Colleges projects shortages in the supply of both primary care and medical specialty physicians compared to demand by 2036. The University at Albany’s Center for Health Workforce Studies reports a continued shortage of registered nurses, personal care aides, and medical assistants. The Office of the New York State Comptroller describes how rural counties in New York face specific shortfalls of health care professionals. The COVID-19 pandemic increased concerns about health care workforce burnout, and health care workforce shortages are compounded by the aging population. 

Members of the NYS Cancer Consortium may be in a unique position to lend their support to national and statewide efforts that aim to incentivize the development and maintenance of a diverse health care workforce in all regions of the state. Examples might include supporting policies that seek to increase the number of funded residency positions eligible for graduate medical education payments, educating decision makers about the need to train, fund, and reimburse patient navigation and other supportive services, and advocating for efforts that increase participation in clinical training programs among underrepresented populations. Support can also focus on expansion and maintenance of access to telehealth and telemedicine services, as well as promotion and use of tele-education programs such as Project ECHO (Extension for Community Healthcare Outcomes) where primary care teams in more remote locations learn from specialists to address issues of access to care.

According to the National Cancer Institute and other experts, financial toxicity describes the problems faced by patients and their families related to the cost of care. Financial toxicity can occur because of co-payments and high deductibles as well as the high cost of prescription drugs and recommended treatment regimens not covered by insurance. This can be compounded by patients unable to work resulting in the loss of health insurance, less income and assets, increased debt, trouble paying for housing and food, and, in extreme circumstances, bankruptcy. 

Members of the NYS Cancer Consortium may be in a unique position to raise awareness about the reality and impact of financial toxicity, advocate for efforts to provide value-based pricing, promote the use of financial navigators, and advertise existing financial support resources offered by statewide partners to the public. Member organizations of the Consortium include accredited cancer centers, community-based organizations, governmental entities, and patient advocacy organizations. Such organizations can assist with building awareness about and increasing access to financial support services, providing direct financial support to survivors, and making system-wide changes to address financial toxicity among their patient population.

The COVID-19 pandemic highlighted the need for multidisciplinary approaches to address health inequities as it pertains to access to and delivery of patient care. It also challenged cancer care programs and hospital networks to deliver timely evaluation and management, including surgical interventions and treatments. A well-documented decrease in the rates of cancer screenings occurred, which are slowly beginning to return to pre-pandemic levels. Disruptions in care also impacted cancer research participation and compounded already existing health inequities across underserved and historically marginalized populations.   

For members of the NYS Cancer Consortium, the pandemic heightened the use of virtual meetings, telehealth consultations, remote screenings, and telephone follow-up appointments. It also sparked creative approaches to continued outreach to communities and provision of support services. The Consortium can continue to advocate for policies and emergency plans that support preparedness that allows continued access to services during any future pandemics or other major health care disruptions.

Burden

Clinical trials are much broader than cancer treatment trials and include work related to biobanking, registries, health services research, and genetic studies, among others. Individuals who participate in clinical trials may gain access to cutting-edge approaches and evaluations (yet unavailable to the public) but also contribute to the progress of medical research. This includes precision oncology trials, including molecular profiling and targeted therapy studies.

Health Equity Focus

Cancer clinical trials face population-level challenges that limit their effectiveness, generalizability, and accessibility. These include low participation rates, lack of population diversity, limited trial sites, participant concerns over cost or uncovered services, and long-standing mistrust among some communities. Increasing the effectiveness, inclusiveness, and generalizability of cancer clinical trials means ensuring studies have diverse patient cohorts and improving enrollment, access, and participation across all populations. 

Increase opportunities for diverse populations to participate in clinical trials through education:

• Provide education to physicians, other health care providers, patients, and caregivers on the availability, purpose, and benefits of clinical research studies as well as tools to support informed decision making. 
• Expand education on precision medicine trials and targeted therapy approaches to providers and patients, explaining the role of genomic profiling in trial eligibility and expected outcomes.

Increase opportunities for diverse populations to participate in clinical trials through improving access:

• Promote clinical trial recruitment and retention strategies that engage and increase awareness among diverse patients.
• Reduce the economic burden of participation in clinical trials by advocating for insurance and/or third-party payer coverage for participation and associated of costs such as transportation. 
• Promote patient navigation or case management programs that facilitate access to care and clinical trials across rural areas of the state and among population groups often underrepresented (e.g., children, adolescents and young adults (AYA), individuals from the LGBTQIA+ community, and racial/ethnic minority groups).
• Build trust through community engagement and culturally competent care, including expanding access to enrollment to community settings and rural areas.

Advance research:

• Promote and support pediatric, young adult and adult biorepositories and data sharing for research. This includes clear communication with families, consent, coordination across institutions, and efforts to respectfully facilitate tissue donations that advance scientific understanding.

Burden

Cancer treatment guidelines, quality standards, and accreditation standards for cancer centers exist to inform care and improve patient outcomes. When cancer is detected, the patient’s quality of life and survival are dependent on timely diagnosis and access to timely, age-appropriate, precision-guided, quality, and affordable treatment. Advances in molecular diagnostics and targeted therapies have expanded the therapeutic landscape.

Health Equity Focus

Barriers to timely diagnosis and quality cancer treatment include a lack of, or inadequate, health insurance coverage, transportation to treatment facilities, and paid time off from work. Children 14 years old and younger (pediatric cancer survivors) and those between age 15 and 39 years old (adolescents and young adult, or AYA cancer survivors) facing a cancer diagnosis may lack access to care that meets their unique needs. Limited access to precision medicine technologies (e.g., genomic sequencing, molecular profiling) and targeted therapies further exacerbate disparities. Some populations can face barriers such as language and cultural differences, stigma due to lack of knowledge about patient needs (e.g., LGBTQIA+ health care needs) and underrepresentation in clinical trials. 

Support facilities in their efforts to achieve and maintain cancer care accreditation through reputable national organizations. 

Address unique needs of pediatric, adolescent, and young adult cancers:

• Expand access to programming for developmental assessments and neuropsychological evaluations by those with expertise in pediatric cancer.
• Provide school re-entry assistance within hospital programs.
• Raise awareness of and access to fertility preservation or family planning programming.
• Support evidence-based approaches around precision diagnostics and targeted treatment decision-making.

Support patients of all ages, their caregivers and families to improve quality of life.

• Increase the hiring of and reimbursement for patient navigation services.  
• Increase the availability and utilization of culturally affirming, linguistically diverse, and low-literacy cancer care and management information materials.
• Educate about employee rights and resources available, including the Family and Medical Leave Act and Paid Family Leave. 
• Reimburse for telehealth technology and services to increase access to care.
• Promote informed decision-making about cancer care and treatment options, such as those recommended by the American Board of Internal Medicine’s Choose Wisely campaign.
• Promote use of patient satisfaction survey tools that help providers improve patient experiences, such as tools created by the Agency for Healthcare Research and Quality. 

Decrease the time between cancer diagnosis and cancer treatment.

• Minimize delays in prior authorization.
• Recruit and train patient navigators and community health workers.
• Promote available cancer information resources within the community.
• Provide transportation support. 

Assist patients of all ages and their families to navigate available support services. 

• Employ full-time patient advocates in cancer centers, including for pediatric cancers.
• Promote availability of New York’s Medicaid Cancer Treatment Program and ensure treatment facilities have access to trained individuals responsible for enrollment. 

Implement high-quality treatment standards and recommendations for pediatric, adolescent, young adult and adult patients including:

• American College of Surgeons Commission on Cancer (CoC) accreditation standards, Optimal Resources for Cancer Care, and CoC Operative Standards for Cancer Surgery.
• National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology.
• Children’s Oncology Group.
• Standards for Psychosocial Care for Children with Cancer and Their Families.

Burden

A cancer survivor is a person of any age who has cancer or who has had it in the past. Cancer survivors are at greater risk of developing other cancers than people who have never had cancer and are at increased risk for health problems after treatment including emotional issues (anxiety, depression, fear of cancer recurrence). They may also face financial stress. Survivors that are 14 years old and younger (pediatric cancer survivors) and between 15 and 39 years old (adolescents and young adult, or AYA cancer survivors) face unique challenges including limited resources for education, employment, and reproductive health. 

Health Equity Focus

Cancer survivors of all ages living in low-income areas or rural parts of the state, as well as those representing LGBTQIA+ populations, may face challenges related to limited access to specialized and culturally competent care. The financial problems cancer survivors and their families may face, including loss of income due to missed work and high costs of treatment, can lead to skipping or not filling prescriptions or not seeking follow up or preventive care. Survivors who experience financial problems are also less likely to enroll in clinical trials, further impacting their treatment. These factors can lead to unmanaged late- and long-term side effects of cancer treatment, poorer quality of life, higher rates of cancer recurrence, and unmet physical and emotional needs. Pediatric and young adult survivors and their caregivers may face additional inequities related to access to mental health supports, long-term follow-up care, and survivorship programs tailored to the developmental needs of children and adolescents.

Get involved with the NYS Cancer Consortium. Become an active member of the Survivorship or Healthy Eating and Active Living Action Teams.

Enhance survivorship care and support for cancer survivors of all ages:

• Increase oncology and primary care use of nationally recognized cancer survivorship care guidelines, including those from the National Comprehensive Cancer Network,  American Society of Clinical Oncology, and the Children’s Oncology Group.
• Implement and establish reimbursement mechanisms for cancer survivor patient navigation programs, including within rural communities of New York State.
• Train and offer continuing education to clinicians including primary care providers, nurse practitioners, nurses, and physician assistants to meet the post-treatment and continuity of care needs of pediatric, young adult, and adult cancer survivors.
• Build support for policies that expand survivor resources, including the Comprehensive Cancer Survivorship Act, the Childhood Cancer STAR Act and the Give Kids a Chance Act.
• Promote informed decision-making about surveillance for cancer recurrence and second caners, such as those recommended by the American Board of Internal Medicine’s Choose Wisely campaign.

Support health care systems in meeting National Standards for Cancer Survivorship Care standards, including:

• Written treatment summaries and/or survivorship care plans for survivors of all ages.
• Clear communication and coordinated care between providers.
• Access to physical, emotional, and practical supports. 
• Promotion of healthy behaviors.
• Culturally competent, inclusive care.
• Use of data to track survivor outcomes and improve services.

Cancer centers serving pediatric and young adult patients can:

• Establish a survivorship program or a clear referral pathway to age-appropriate local survivorship services.
• Educate patients, families, caregivers, teachers, and clinicians about the unique challenges of pediatric and young adult cancer and provide tools and supports to address these needs.
• Assess mental health needs of their patients and caregivers early after diagnosis and throughout treatment and survivorship, provide appropriate counseling and therapy, and connect families to specialized mental health services when needed.

Inadequate numbers of health care professionals at all levels of care, and limited investment in supportive roles such as patient navigators, community health workers and peer educators, threaten progress and ongoing efforts to address the State’s cancer burden. The Association of American Medical Colleges projects shortages in the supply of both primary care and medical specialty physicians compared to demand by 2036. The University at Albany’s Center for Health Workforce Studies reports a continued shortage of registered nurses, personal care aides, and medical assistants. The Office of the New York State Comptroller describes how rural counties in New York face specific shortfalls of health care professionals. The COVID-19 pandemic increased concerns about health care workforce burnout, and health care workforce shortages are compounded by the aging population. 

Members of the NYS Cancer Consortium may be in a unique position to lend their support to national and statewide efforts that aim to incentivize the development and maintenance of a diverse health care workforce in all regions of the state. Examples might include supporting policies that seek to increase the number of funded residency positions eligible for graduate medical education payments, educating decision makers about the need to train, fund, and reimburse patient navigation and other supportive services, and advocating for efforts that increase participation in clinical training programs among underrepresented populations. Support can also focus on expansion and maintenance of access to telehealth and telemedicine services, as well as promotion and use of tele-education programs such as Project ECHO (Extension for Community Healthcare Outcomes) where primary care teams in more remote locations learn from specialists to address issues of access to care.

Burden

Annually in NYS, 28,000 adults die from smoking commercial tobacco, and another 3,000 nonsmoking adults die from diseases caused by secondhand smoke. Cigarette use among high schoolers in NYS is low, though e-cigarette use is more common. Commercial tobacco use and exposure to secondhand smoke increases the risk of cancers of the lung, larynx (voice box), mouth, esophagus, bladder, pancreas, kidney, cervix, stomach, colon and rectum, and liver, as well as acute myeloid leukemia.

Health Equity Focus

The tobacco industry targets advertising and marketing to people from racial and ethnic minority groups, as well as the lesbian, gay, bissexual, transgender, queer or questioning, intersex, and asexual community, people living with mental illness and substance use disorders, and those living in lower-income communities. These practices contribute to inequities in tobacco-related health outcomes.

Promote changes that counteract commercial tobacco marketing and use among disproportionately affected populations, such as:

• Maintain the high cost of commercial tobacco by 1) setting a hard price floor below which no cigarettes may be sold; and 2) requiring that inexpensive cigars be sold in multi-unit packs with a hard price floor.
• Prohibit the sale of flavored commercial tobacco products including menthol in cigarettes and all flavored electronic cigarette products. 
• Limit the impact of commercial tobacco marketing on youth smoking by 1) restricting sales; and 2) reducing the total number of retail tobacco licenses.
• Adopt commercial tobacco-free policies in multi-unit housing units in NYS.
• Establish commercial tobacco-free outdoor areas including parks, playgrounds and beaches.

Build awareness and support for evidenced-based tobacco cessation programs:

• Educate primary care providers to deliver evidenced-based tobacco cessation treatment to commercial tobacco users.
• Increase awareness and use of the expanded Medicaid benefit that includes coverage for all seven FDA-approved medications and counseling for smoking cessation.
• Increase health system adoption of the U.S. Public Health Service system strategies for tobacco treatment.
• Offer tobacco cessation opportunities in comprehensive low-dose CT lung cancer screening programs. See the ‘Early Detection’ Priority Area for more information.
• Work with health care and other partners to increase referrals to the New York State Smoker’s Quitline www.nysmokefree.com.

According to the National Cancer Institute and other experts, financial toxicity describes the problems faced by patients and their families related to the cost of care. Financial toxicity can occur because of co-payments and high deductibles as well as the high cost of prescription drugs and recommended treatment regimens not covered by insurance. This can be compounded by patients unable to work resulting in the loss of health insurance, less income and assets, increased debt, trouble paying for housing and food, and, in extreme circumstances, bankruptcy. 

Members of the NYS Cancer Consortium may be in a unique position to raise awareness about the reality and impact of financial toxicity, advocate for efforts to provide value-based pricing, promote the use of financial navigators, and advertise existing financial support resources offered by statewide partners to the public. Member organizations of the Consortium include accredited cancer centers, community-based organizations, governmental entities, and patient advocacy organizations. Such organizations can assist with building awareness about and increasing access to financial support services, providing direct financial support to survivors, and making system-wide changes to address financial toxicity among their patient population. 

Burden

Scientific literature provides evidence of environmental and occupational causes of cancer. People can be exposed to environmental carcinogens (substances known to cause cancer) through physical factors such as sunlight, ionizing radiation and radon, and chemicals in air, water, soil, dust, and consumer products. Exposures in the ambient environment are generally lower than exposures in the workplace and may influence individuals during stages of life including gestation, infancy, childhood, and adolescence. Workplace exposures may include certain chemicals, dust, metals, combustion products, radiation (e.g., ionizing radiation), patterns of behavior (shift work), and profession (e.g., firefighters). An estimated 2-8% of cancers in the U.S. are attributed to carcinogens in the workplace.

Health Equity Focus

The cancer risks of environmental and occupational exposures can differ based on how exposure happens (breathing, drinking, eating, skin contact) and how much, how long and how often exposures occur. Factors such as geography, occupation, housing, and social norms can impact the exposure to carcinogens that some New Yorkers receive compared to others. According to the National Cancer Institute, socio-economic status predicts the likelihood of an individual's occupation and living conditions in which exposure to carcinogens is common and can be associated with the risk of developing cancer. Communities identified as environmental justice areas may have a higher risk of environmental exposures.

Get involved with the NYS Cancer Consortium. Become an active member of the NYS Cancer Consortium Environmental Carcinogens Action Team. 

Educate about ways to reduce cancer risk on topics including: 

• The relationship between indoor radon exposure and lung cancer. 
• Resources to increase radon testing and remediation. 
• Potential risks from household products (including pesticides, solvents and other chemicals), in drinking water supplies, and from indoor and outdoor air pollution and particulates.
• Potential risks for known or possible occupational/agricultural carcinogens to be brought into the home (“take-home exposure”) and actions to reduce exposures.

Equip New Yorkers with resources and opportunities to address environmental justice in their communities by working with occupational health partners to:  

• Educate employers on their responsibilities related to employee exposures.
• Educate employees about their rights under the federal Occupational Safety and Health Administration and New York State public employee hazard communication regulations and potential exposure to carcinogens in the workplace.
• Communicate with NYS chemical manufacturers, importers, and distributors to reinforce their responsibilities for identification and communication of carcinogen status of their chemicals.

Increase awareness and education through the health care sector:

• Support health care providers to educate patients about environmental exposures, especially individuals who are pregnant or trying to be, parents whose children may encounter childhood exposures, and those in communities identified as environmental justice areas. 
• Increase awareness of such programs as New York’s “Image Gently” and the national “Image Wisely” campaigns that educate physicians and the public about potential radiation exposure from computed tomography (CT) scans and X-rays. 

Burden

In NYS an estimated 4.4% of cancer cases, and 3.2% of cancer deaths, in adults over 30 years, can be attributed to excessive alcohol use (binge or heavy drinking). Excessive alcohol use increases the risk for cancers of the oral cavity and pharynx, larynx, breast, esophagus, liver, colon, and rectum. The more alcohol a person drinks over time, the higher their risk of developing cancer. One in 6 New Yorkers (17%) are unaware that excessive alcohol use increases a person’s risk of cancer.

Health Equity Focus

Excessive alcohol use and its related harms do not impact all population groups equally. Among the cancer cases associated with alcohol, Black people experience higher rates of death than other racial/ethnic groups. Adults with lower socioeconomic status have disproportionately greater alcohol attributable risk even with lower levels of alcohol consumption.

Facilitate partnerships between community members, schools, law enforcement, health care, faith-based organizations, substance use disorder treatment partners and public health agencies to:

• Educate youth and adults about cancer risk related to excessive alcohol use.
• Adopt local policies such as those recommended by the Community Preventive Services Task Force.
• Eliminate alcohol advertisements near schools, playgrounds, and on public transportation.
• Conduct surveillance and act on lessons learned about how the number and concentration of places that sell alcohol contributes to excessive alcohol use and related harms among racial/ethnic and other demographic groups.
• Identify population-based policy and environmental changes that prevent excessive alcohol use and related harm across populations disproportionately impacted.
• Support policy-driven efforts including increasing alcohol taxes.
• Support the enforcement of laws that discourage underage drinking such as prohibiting alcohol sales to minors.

Facilitate partnerships between health care systems, substance use treatment facilities, institutes of higher education, and workplaces to implement systems and processes that:

• Standardize screening for excessive alcohol use in primary care settings to adults using face-to-face or virtual interactions.
• Provide those who screen positive for excessive alcohol use with brief behavioral counseling interventions using personalized feedback.
• Directly refer anyone who meets the diagnostic criteria for alcohol use disorder to specialized treatment.

Burden

Being physically active, keeping a healthy weight, eating a diet centered on plant-based foods, and limiting red meat and processed foods all contribute to a lower risk of cancer. The benefits of these healthful behaviors extend to cancer survivors. Being overweight or having obesity increases the risk for 13 types of cancer including cancers of the breast, colon, rectum, kidney, endometrium, thyroid, pancreas, liver, ovary, gallbladder, stomach, and esophagus as well as multiple myeloma and meningioma.

Health Equity Focus

Opportunities to be physically active, have a healthy weight and eat recommended foods are hindered by food insecurity, and lacking places for safe and accessible physical activity. Compared to White communities, Black and Hispanic communities generally have worse access to healthy foods, physical recreation, education, and economic opportunities. 

Get involved with the NYS Cancer Consortium. Become an active member of the NYS Cancer Consortium Healthy Eating and Active Living Action Team.

Reduce food insecurity and improve food access across New York State:

• Build partnerships with programs that work with food delivery companies, especially where transportation and access to full-service supermarkets are limited.
  
• Advocate for programs such as the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants and Children.
  
• Promote the NYS Hunger Prevention and Nutrition Assistance and Nourish New York programs for local emergency food relief organizations including food banks, food pantries, and soup kitchens.
  
• In New York City and Long Island, increase access to the Commodity Supplemental Foods Program.

Support health care systems, municipalities and employers to implement policies and systems changes:

• Promote food service and nutrition guidelines and healthy food procurement systems in facilities or organizations where food is sold, served, or distributed.
• Incorporate healthy food options at meetings/events. 
• Establish farmers markets or use incentives for local convenience stores to offer fresh fruits and vegetables
• Expand consumer use of fruit and vegetable coupons or cash incentives at the point of purchase. 
• Work with school districts to establish wellness policies and nutrition standards for school meals and snacks.
• Integrate Food as Medicine initiatives into health care systems such as medically tailored meals and grocery and produce prescription programs.

Increase access to weight management interventions:

• Promote insurance coverage of medical nutrition therapy and lifestyle change programs (e.g., diabetes prevention, weight management, nutritional and fitness services and programs).
• Encourage primary care practices to screen patients on their nutritional and physical activity needs and make appropriate referrals to community resources.
• Educate and engage health care and community partners to adopt, implement, and sustain Family Healthy Weight Programs.
• Promote the use of evidence-based technology-supported coaching or counseling to help clients lose or maintain a healthy weight.

Burden

People of all ages can be exposed to viruses, bacteria and parasites that can cause cancer or increase the risk of cancer. For example, each year, nearly 2,900 adults across New York State are diagnosed with cervical, oropharyngeal, penile, vaginal, anal or vulvar cancer caused by a human papillomavirus (HPV) infection. The HPV vaccine can prevent more than 90 percent of cancers caused by HPV. Hepatitis C (HCV) is known to cause cancer later in life (most commonly liver cancer) and is curable. All people 18 and older should be screened for HCV and make an informed decision with a specialist about being treated. 

Health Equity Focus

All individuals, regardless of background, need equal access to HPV vaccination and HCV testing and treatment. Factors such as cost, limited health care access, language barriers, mistrust, and inconsistent provider recommendations contribute to higher rates of HPV-related cancers and unequal access to HCV detection and quality treatment. 

Get involved with the NYS Cancer Consortium. Become an active member of the NYS Cancer Consortium HPV Coalition.

Establish local coalitions with community members, community organizations, schools, health care, public health and dental professionals, and faith-based leaders to:

• Implement evidence-based strategies in support of starting the HPV vaccine at age 9.
• Educate youth and adults about the cancer risk related to HPV.
• Identify trusted sources of information to message the benefits of vaccination.
• Build relationships with parents to address vaccine misinformation.
• Encourage health care practices to institute reminder-recall systems and workflows that standardize on-time vaccination and series completion.
• Adopt local policies to increase vaccination recommended by the Community Preventive Services Task Force. 

Partner with health care systems to implement the NYS Viral Hepatitis Strategic Plan including to:

• Disseminate educational or media campaign materials about the New York State HCV Testing Law requiring that adults 18 years of age and older and those under the age of 18 with a risk, be offered a screening test for HCV.
• Promote HCV reflex testing, a follow-up diagnostic test for any individual who receives a positive HCV screening test, to ensure appropriate care and treatment.
• Co-locate HCV testing and treatment in high-risk settings such as harm reduction programs, substance use disorder treatment programs, shelters and jails/prisons.

Burden

Unprotected or extended exposure to UV radiation from the sun, indoor tanning or tanning lamps can lead to skin cancer. Ultraviolet radiation causes up to 90% of all melanomas, the deadliest form of skin cancer. Melanoma is the ninth most common type of cancer among New York State adults and ranks among the top four cancers for adults ages 20 to 34 years. Because melanoma tends to spread quickly, it causes most skin cancer deaths, even though it accounts for the least amount of cancer cases. 

Health Equity Focus

People with lighter skin tones are at higher biological risk for skin cancer, but efforts that overlook individuals with darker skin can lead to delayed diagnoses and worse outcomes. Outdoor workers face higher UV exposure yet may lack adequate sun protection or occupational safeguards. Additionally, access to dermatologic care and early detection can be limited within underserved communities and rural areas of the state. 

Get involved with the NYS Cancer Consortium. Become an active member of the NYS Cancer Consortium Skin Cancer Action Team.

Promote awareness among decision makers, health care providers, and the public:

• Implement educational programs that include sun safety messages to children, adolescents, young adults, parents, as well as lifeguards, summer camp and outdoor recreation instructors.
  
• Educate the public and decision makers about the importance of prohibiting access to indoor tanning for anyone under the age of 21, without exceptions.  
  
• Tailor interventions to address risk and clinical warning signs of skin cancer in all adults including individuals representing racial and ethnic minority groups.
  
• Increase training in skin cancer recognition among health care workers and other professionals such as hair stylists, barbers, tattoo artists, masseuses, estheticians, and nail technicians who are in a unique position to spot possible skin cancers early.
  

Use policy and environmental modifications to reduce access to UV radiation:

• Restrict use of indoor tanning booths, beds, and sunlamps at places of higher education, off-campus college housing, fitness centers, and spas.
  
• Enforce existing New York State tanning facility regulations to promote safe and appropriate use, including enforcement of New York State Law prohibiting those under eighteen (18) years from using indoor tanning beds, booths or sunlamps.
  
• Add sun protection structures and access to sunscreen in outdoor settings such as public pools, beaches, playgrounds, schools, summer camps, and other outdoor recreational settings, including low-income communities.
  
• Implement sun safety policies and requirements around use of sun-protective clothing across worksites with employees that spend time exposed to the sun.