Three years ago, Dr. Robert A. Hiatt and his partners in the San Francisco Cancer Initiative (SF CAN) posed the question, “What can a world-class university working with key collaborators do to impact cancer rates in its community?” Now they’re beginning to see some answers.

Launched in 2016 and sponsored by the Helen Diller Family Comprehensive Cancer Center and its Director, Dr. Alan Ashworth, SF CAN wants to make a measurable impact on five of the most common cancers in the city: breast, colorectal, liver, lung and other tobacco-related cancers, and prostate. Together, these five most common cancers account for 50% of cancer-related deaths in the city; in San Francisco, cancer is the number one cause of death. Heart disease is the second.

San Francisco is well-known for the richness of its diverse population. This diversity is important for the picture of cancer in San Francisco because both the numbers and the rates of new cases and mortality differ, sometimes markedly, by race and ethnicity. In general, and for many years, African American men have had the highest rate of new cancers followed by white men, and Asian American women have had the lowest rate. In terms of deaths from cancer, black men and also black women have the highest mortality rate, and Asian Americans the lowest.

Partnering with the City and County of San Francisco, its Department of Public Health, community groups, and cancer care institutions in the city, SFCAN’s goal is to reduce the cancer burden and particularly address inequities in the occurrence and outcome of cancer by harnessing innovative science, new technologies, and knowledge of the needs of San Francisco’s citizens.

“We knew we could extend our research and expertise into the community to make a real impact, not just within UCSF, but city-wide,” said Dr. Hiatt.

The first step was getting a group together to tackle these issues. To figure out where to start, scientists ran an analysis of cancer cases in San Francisco based on state registries and national data sources. They supplemented this data with surveys, census information, and geospatial mapping to identify specific areas in the city where people were sustaining the highest rates of cancer presenting at a late stage. The community groups provided critical support in connecting researchers with groups in these neighborhoods: their existing connections are a natural infrastructure.

Task forces formed around all five cancers, and each is now working on strategies to improve prevention, early detection and the health outcomes of those with their specific diseases. The lung cancer group, for example, found that menthol and other flavored cigarettes were popular among young people and the African American community, often serving as their introduction to smoking. In addition to helping build targeted campaigns to discourage smoking in these groups, they were also instrumental in providing research data that aided city supervisors in drafting the 2018 law banning the sale of menthol and flavored tobacco products in San Francisco.

In addition to the cancer-specific task forces, SF CAN is taking advantage of electronic health record (EHR)-empowered communication, coordination, and data sharing in the areas of cancer prevention and screening across San Francisco. UCSF and Department of Public Health are already partially linked through the Epic EHR (the “care everywhere” feature), and this feature could be enhanced to better enable these and the other major healthcare organizations to work together on a city-wide level.

What’s Next?

This effort is still young. SF CAN is tracking milestones, but Dr. Hiatt expects major impacts won’t be visible for another 10 years, given the scope of the challenges being tackled. The program promotes a long-term commitment to making a difference in the cancer burden in San Francisco. Some actions can have an effect within a few years, while other efforts must be sustained over a longer period to have a measurable impact. Cancer can take many years to develop and may even have its origins in early life development for some types, such as breast cancer. Thus, prevention strategies have to take into account this longer timeframe, while other measures that can detect cancers early, improve diagnosis and treatment, and the quality of life after cancer may have improvements in a shorter period of time.

Prevention and screening practices provide some low-hanging fruit for each of the task forces. Physical activity and diet, though not yet being addressed formally by SF CAN, are also essential factors in impacting cancer rates in the city. Working with community partners to encourage members of at-risk groups to be more mindful and proactive about their health continues to be a priority, as does lending expertise and resources to those partners.

“Helping high-risk patients, and those who have been diagnosed with cancer, to navigate complex healthcare systems is also an important function,” said Dr. Hiatt. “Marginally employed people, new immigrants, and the homeless are particularly at risk of falling through the cracks.”

The group hopes to expand the effort beyond the city at some point, but the project is also dependent on the generosity of donors, as it does not receive any government funding.