Cancer is the leading cause of death in San Francisco and costs patients, families and taxpayers hundreds of millions of dollars each year. Seeing an opportunity to change this, a group that includes UC San Francisco (UCSF), the City and County of San Francisco, the San Francisco Department of Public Health (DPH), and health care and community organizations has launched the San Francisco Cancer Initiative (SF CAN), a major public health effort to reduce cancer in San Francisco.
SF CAN, conceived and supported by UCSF, aims to reduce the incidence and mortality from the most common cancers in San Francisco that are likely to be affected by known interventions or better screening. Those are prostate, breast, liver, colorectal and tobacco-related cancers. Since the majority of those cancers disproportionately affect racial and ethnic minorities, as well as the socio-economically disadvantaged, a primary focus of SF CAN will be reducing inequities in prevention, screening rates, access to quality health care and overall outcomes. The initiative will address other cancers in the future.
"Someone's ability to survive cancer should not be dependent on their socio-economic status," said San Francisco Mayor Ed Lee. "We know that prevention and access to quality health care can make all the difference, so I'm proud to stand with UCSF, DPH, and our community health organizations as we take this important and exciting step forward in the fight against cancer."
Collaborative Effort with Collective Impact
The initiative builds on a 2016 report by UCSF researchers that catalogued the state of cancer in San Francisco in 2013/2014, identifying the most prevalent types, the burden within different populations, risk, and disparities among diverse communities.
"A public-private partnership like this, aimed at reducing deaths, as well as cancer's other debilitating effects on health and quality of life, is a unique and innovative plan for a major city," said Alan Ashworth, PhD, FRS, president of the UCSF Helen Diller Family Comprehensive Cancer Center and an internationally recognized cancer scientist who will spearhead the new initiative. "The task before us is enormous, but if we implement what we know about cancer's causes and preventing them, we could eliminate more than half of all cancers.
"The city's size, population, and history of social justice around all kinds of inequity make San Francisco an ideal place for an effort like SF CAN," Ashworth said. "We are fortunate to be in a city with forward-thinking leadership and community groups that will work on a common cause with UCSF."
The project is launching with a $3 million investment from a donor to the UCSF Helen Diller Family Comprehensive Cancer Center. This funding will support task forces for each of the five cancer types, creating what amounts to a cancer plan for the city.
The task forces already have begun evaluating existing resources for screening, access, prevention and education, and will develop strategies for unmet needs. Efforts underway include improving access to liver cancer clinical trials; partnerships with African-American churches to raise awareness about prostate cancer screening and follow up; a translation of the SF Hep B Free website into Chinese; establishing a phone line for people with Hepatitis B, a risk factor for liver cancer; and social media and radio campaigns to reduce smoking by young people.
SF CAN's success will rely on the power of collective impact - tackling an intractable problem like cancer through collaboration by public and private partners. SF CAN's partners include the City and County of San Francisco and its Department of Public Health, American Cancer Society, Hospital Council of Northern & Central California, Kaiser Permanente, San Francisco Chinese Hospital, San Francisco Community Clinic Consortium, San Francisco Medical Society, SF Hep B Free, and Project Inform. These organizations, and ones that join in the future, will leverage their existing programs' knowledge to reduce cancer and create a new model for public health in the city.
Cancer's Cost in San Francisco
One of the most common diseases nationwide, cancer strikes more than 3,800 San Francisco residents and kills nearly 1,400 each year, according to the UCSF report. Hospital and other health care costs for prostate, breast, liver colorectal, lung and other common cancers cost San Franciscans about $213 million annually. This does not include time lost from work and other activities or diminished quality of life, the report found.
Overall, the top 15 cancers account for 81 percent of deaths, but some cancers are more aggressive and lethal than others. For example, breast cancer is the most common cancer diagnosis, but lung cancer - often diagnosed at a late stage - is more difficult to treat and deadly. Consequently, it is the top cancer killer in San Francisco.
"Advancements in science give us new opportunities to cure cancer," said Barbara A. Garcia, MPA, director of health at the San Francisco Department of Public Health. "We have to make sure that our most vulnerable communities get our full attention to access these new medical opportunities. SF CAN is committed to this."
Dramatic Disparities in Cancer Risk
Cancer in San Francisco predominately affects white and Asian-American populations, due to their large numbers in the city. Forty-seven percent of the city's new cancers occur in whites, and 34 percent in Asian-Americans. However, there are dramatic disparities in prevalence and death from certain cancers in African-Americans.
African-American men, for example, had almost twice the risk of developing prostate cancer compared to the general male population, according to the report, and they were more than three times as likely to die from it. Colorectal cancer death rates for African-Americans were approximately 60 percent higher than for the general population in the same time period.
Likewise, the rate of liver cancer - which causes an average of 81 deaths a year in San Francisco - is disproportionately higher for Asian-Americans or African-Americans. Asian-Americans comprised about 35 percent of the population during the timeframe of the report, but represented nearly 45 percent of all liver cancer deaths. It's worse for African-Americans, who comprised only six percent of the population, but represented about 13 percent of liver cancer deaths.
The report also found:
•For three of the most common cancers - lung, colorectal and prostate - incidence and mortality are decreasing for all ethnic groups, but African-Americans consistently have the highest rates for all three cancers;
•Liver cancer, historically high among Asian-Americans, is now increasing among African-American and Latino men in the Bay area. The shift is likely due to Hepatitis B and C infections, as well as escalating rates of obesity, diabetes and non-alcoholic fatty liver disease;
•Melanoma rates are soaring among white men over 65 across the Bay Area.
"The novelty of SF CAN is its focus on making a collective impact on the main causes of cancer deaths in a major American city," said the cancer report's author, Robert Hiatt, MD, PhD, chair of the Department of Epidemiology and Biostatistics at UCSF. "Individual cancer prevention programs by single institutions are common, but applying scientific approaches to multiple common cancers with collective efforts of diverse communities, major health systems, government, public health, and academia is pretty unique and very exciting."
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