In recent years, precision medicine has revolutionized cancer diagnosis and treatment. Now, precision public health is redefining what is possible in cancer prevention and epidemiology. Dr. Alan Ashworth and Dr. Robert A. Hiatt of the UCSF Helen Diller Family Comprehensive Cancer Center are at the forefront of this new approach to fighting cancer, spearheading the recently-launched San Francisco Cancer Initiative, SF CAN.
SF CAN is a broad new partnership among UCSF researchers, community organizations, and local government agencies with the goal of reducing the cancer burden in San Francisco. In addition to working toward a decrease in the absolute number of cancer cases in the city, SF CAN is paying particular attention to disparities in cancer occurrence and outcomes across racial, ethnic, and socioeconomic groups. With a focus on breast, colorectal, liver, prostate, and tobacco-caused cancers, which together make up nearly half of all new cancer cases and cancer deaths in San Francisco, the initiative is using a multi-level, data-driven approach to first describe and then attack the root causes of cancer. Motivating their work is the understanding that up to 50% of cancer cases could be prevented if what we currently know about addressing cancer’s causes were put into practice.
Initially, their approach centered on defining and identifying the current cancer burden in San Francisco in terms of incidence, mortality, trends, disparities, and cost. By gathering cancer surveillance data from the Cancer Prevention Institute of California’s Greater Bay Area Cancer Registry, SF CAN has been able to strategically target the populations most at risk of particular cancers and identify interventions that will have the greatest impact on reducing cancer morbidity, mortality, and disparities in access to care.
SF CAN has task forces focused on various interventions for each of the five types of cancer they are targeting whether in primary prevention or early detection. For example, one of the initiative’s most immediate goal is to reduce tobacco use. SF CAN and its extensive network of partners are working to promote smoking cessation particularly among young adults, low-income communities, the homeless, and people with mental illness. The initiative is also working towards enabling increased data sharing and electronic health record integration across UCSF, Kaiser Permanente, Sutter Health, Dignity Health and the San Francisco Department of Public Health to make more effective collaboration possible in the major settings serving the San Franciscans most at risk of cancer.
SF CAN is bringing together academic researchers, clinicians, city public health officials, and a broad network of community partners in a concerted effort to drive down the burden of cancer in San Francisco. By using innovative partnerships and “big data” to more precisely and effectively target the populations most at risk, SF CAN is building a model for what precision public health can look like in a large urban setting.