One in every four deaths in the United States is from cancer. As with other diseases, advocates, researchers, practitioners, and survivors are promoting preventions and appealing for cures. But there are many different cancers. As a result, many cancer prevention and control initiatives originate around specific sites for the disease or particular risk factors. For example, the Centers for Disease Control and Prevention (CDC) has developed programs to address breast and cervical cancers, skin cancer, colorectal cancer, cancer genetics, environmental carcinogens, cancer registries, and others. As a result of the categorical federal support, most state cancer-related programs are also built around the same specifics, and this translates into the same categories at the local level.

Concerned about duplication and missed opportunities for cancer prevention and control due to segmentation, CDC is encouraging states to take a coordinated approach toward addressing cancer. To this end, CDC is conducting a pilot effort - - the National Comprehensive Cancer Control Program - - in selected states, tribal organizations, and territories.

CDC's purpose for comprehensive cancer control "is to work toward an integrated and coordinated approach to reduce the incidence, morbidity and mortality [of cancer] through prevention, early detection, treatment, rehabilitation, and palliation." Accordingly, CDC is providing funds and technical assistance to selected jurisdictions for development and implementation of four-year pilot comprehensive cancer control plans.

Five states and one tribal organization are in the implementation phase of the pilot: Colorado, Massachusetts, Michigan, North Carolina, Texas, and the Northwest Portland Area Indian Health Board. States still in the process of developing their comprehensive cancer control plans are: Arkansas, Illinois, Kansas, Kentucky, Maine, and Utah.

CDC's goal is for all states to take a comprehensive approach toward cancer control, and that approach will eventually be seen at the community level. Based on reports from members of The Mayors' Campaign Against Breast Cancer, a more integrated approach is beginning to occur in that some mayors are currently addressing other cancers through their local initiatives. The Mayors' Campaign Against Breast Cancer, launched in November 1997 and now 285 members strong, is supported through a five-year cooperative agreement between CDC and the Conference of Mayors. Now entering the third year of a very successful initiative, the question now is whether the Campaign should reflect CDC's pilot initiative with selected states and be expanded to include other cancers or remain focused on breast cancer.

If you would like to share your perspective on the comprehensive cancer control approach, particularly vis-a-vis expansion of The Mayors' Campaign Against Breast Cancer to include other cancers, please contact Richard C. Johnson, Director of Health Programs for the Conference of Mayors at 202-861-6753.