American Cancer Society Cancer Action Network Testimony Regarding the Fiscal Year 2021-2022 Budget

American Cancer Society Cancer Action Network Testimony Regarding the Fiscal Year 2021-2022 Budget

 

Chair Pintor Marin, Vice Chair Burzichelli and the distinguished members of the Assembly Budget Committee, I appreciate the opportunity to testify today. My name is Michael Davoli and I am the New Jersey and New York City Government Relations Director for the American Cancer Society Cancer Action Network (ACS CAN).The American Cancer Society Cancer Action Network (ACS CAN) is the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society. Our mission is to support evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. With that objective in mind, we appreciate the opportunity to comment on the Fiscal Year 2021-2022 budget as viewed “through the cancer lens”

 

To summarize our budget priorities, ACS CAN calls upon the legislature to:

  • Maintain at least $7.8 million in funding from tobacco sales revenue for tobacco control and prevention initiatives in 2021-2022, increase the state’s cigarette tax by $1.65 per pack and increase the tax on all other tobacco products at an equivalent rate, and end the sale of menthol cigarettes and all other flavored tobacco products;
  • Maintain the current level of funding for the New Jersey Commission on Cancer Research at $2 million in 2021-2022 and establish a new non-lapsing fund for the Commission; and
  • Restore funding for the New Jersey Cancer Education and Early Detection Screening Program to $3.5 million in 2021-2022 and immediately reduce the age in New Jersey at which health benefit plans cover colorectal cancer screenings from 50 to 45.

 

As we all know, the Covid-19 pandemic has upended lives and the economy. But as this virus grips the nation, cancer is ever-present; 1 in 2 men and 1 in 3 women in the United States will be diagnosed with cancer in their lifetime. Cancer patients have long faced significant barriers to accessing care. Covid-19 has magnified these barriers, with 46% of cancer patients and survivors reporting a change in their ability to pay for care due to the pandemic, and 79% experiencing delays in active treatment. The pandemic has also shone a spotlight on health disparities across populations. Individuals from racial and ethnic minority groups are more likely to be uninsured, increasing the likelihood they will be diagnosed with advanced cancer. The 5-year relative survival rate is lower in Blacks than in Whites for every stage of diagnosis in the four most common cancer sites.

 

 

 

The American Cancer Society estimates that 56,360 new cases of cancer will be diagnosed in New Jersey and 15,710 cancer deaths will occur in the state in 2021, making it the second leading cause of death in the state. Below is a listing of the most prevalent cancers and their impact.

 

Cancer Burden in New Jersey[1]

Type of Cancer New Cases Deaths
Total, all sites 56,360 15,870
Lung and Bronchus 5,900 3,050
Colon and Rectum 4,250 1,410
Female Breast 8,330 1,250
Prostate 8,120 760
Non-Hodgkin Lymphoma 2,460 570

 

While policymakers are addressing acute needs related to COVID-19, cancer patients need changes that promote innovation, expand access, and drive towards health equity to relieve suffering during the pandemic and beyond. Eliminating cancer relies as much on public policy as it does on scientific discovery and innovation. To reinforce New Jersey’s commitment to the fight against cancer ACS CAN recommends the following be included in the FY 2021-2022 state budget.

 

  • Budget Recommendation #1: Protecting all New Jerseyans from the predatory tactics of Big Tobacco and a lifetime of addiction by maintaining at least $7.8 million in funding from tobacco sales revenue for tobacco control and prevention initiatives in 2021-2022, increase the state’s cigarette tax by $1.65 per pack and increase the tax on all other tobacco products at an equivalent rate, and end the sale of menthol cigarettes and all other flavored tobacco products;

The number one cancer killer is lung cancer. Smoking is responsible for 24.6% of cancer deaths in New Jersey,[2] while almost 12,000 people die each year from smoking- related diseases of all types, and 143,000 kids under 18 who are alive today will ultimately die from smoking if we do not act more urgently to intervene.[3] The 2014 U.S. Surgeon General report, The Health Consequences of Smoking – 50 Years of Progress, identified twelve cancers for which the “evidence was sufficient to infer a causal relationship” between smoking and the incidence of the disease.[4] The Surgeon General found that smoking caused a significant percent of cancers occurring in the lung, larynx, oral cavity and pharynx, esophagus, pancreas, bladder, kidney, uterine cervix, stomach, and acute myeloid leukemia. To reduce the overall number of cancer deaths and deaths from lung cancer in particular, New Jersey must act now to adopt stronger policies to reduce tobacco use.

 

Increasing the Cigarette Tax

It has been over 11 years since New Jersey has increased its cigarette tax. If passed, this cigarette tax increase will put us on par with states like New York and Connecticut. We estimate the proposed tax increase will reduce youth smoking by 17.2% and help 46,300 people who currently smoke to

 

 

 

quit. Adults with lower incomes, youth, and pregnant persons are especially likely to quit or reduce their smoking with such a tax increase.

 

It’s estimated that if New Jersey raises its cigarette tax to $4.35 per pack that 23,700 youth under 18 will be kept from becoming adults who smoke, 18,700 premature smoking-related deaths will be prevented and over $103 million in new annual revenue will be generated while saving the state $1.44 billion in long-term health care costs from the declines in adult and youth smoking rates. Increasing the tax on all other tobacco products, including e-cigarettes, to 90% of their wholesale price to parallel the new cigarette tax would provide additional health and economic benefits for New Jersey.

 

Tax Parity

Increasing tobacco taxes is one of the best ways to reduce tobacco use. It is important that tax increases apply to all tobacco products at an equivalent rate to encourage people to quit rather than switch to a cheaper product as well as to prevent youth from starting to use any tobacco product.

 

As we increase the tax on cigarettes and smoking rates decline, increasing taxes on all other tobacco products to achieve tax parity takes on greater importance. All other tobacco products (OTP), including, but not limited to, moist snuff, nasal snuff, loose-leaf and plug chewing tobacco, snus, dissolvable tobacco products, cigars, pipe tobacco, roll-your-own tobacco, hookah, and electronic cigarettes should be taxed at the same rate as cigarettes to encourage smokers to quit rather than switching to lower-priced alternatives.

 

We ask the legislature to protect all New Jerseyans from the predatory tactics of Big Tobacco and a lifetime of addiction by supporting this proposed increase, ending the sales of all flavored tobacco products and dedicating additional funding to New Jersey’s tobacco control program. Dedicating additional funds of the cigarette tax revenue to tobacco prevention and cessation programs will help amplify the benefits of the tax increase and further reduce suffering and death from tobacco-related disease.

 

Closing Tobacco Related Health Disparity Loopholes

The legislature has the opportunity to make clear their commitment to protecting New Jerseyans from falling prey to Big Tobacco by addressing flavored tobacco products left on the market. Nearly 6,000 New Jerseyans will be diagnosed with lung cancer in 2021.  Over 900,000 adults in New Jersey smoke and 2,200 kids become new daily smokers each year. By ending the sale of all flavored tobacco products, including menthol cigarettes, flavored cigars, hookah and smokeless tobacco. New Jersey will become a leader that other states look to when addressing tobacco issues.

 

In 2019 Massachusetts passed legislation that restricts the sale of all flavors of all tobacco products, including menthol cigarettes, e-cigarettes, flavored cigars, hookah, and smokeless tobacco. Last year California passed legislation that banned the sale of menthol cigarettes statewide. New Jerseyans deserve the same protection from an industry that shamelessly preys on high-risk groups including communities of color; those who identify as LGBTQ; people with lower income and education levels; and those in the disability community.

 

To be effective, comprehensive legislation that restricts the sale of all flavored tobacco products, including menthol cigarettes and flavored cigars must be enacted in New Jersey.

 

 

Investing in Tobacco Prevention and Cessation Programs

According to established standards and best practices for state tobacco control efforts,[5] New Jersey has never adequately financed its tobacco prevention and cessation program. In past years, state support for the program had been cut entirely. While the program was funded with approximately $7.8 million appropriation of revenue from the state’s tobacco tax revenue in fiscal year 2020, there is still work to be done. The approximately $7.8 million appropriation was a major step in the right direction, however the program will continue to operate at a greatly reduced impact until it is fully funded. As a direct result, New Jersey ranks near the bottom of the nation in funding tobacco control programs.[6]

 

Budget cuts in the last decade to New Jersey’s tobacco program have been amongst the deepest in the nation. The program’s state funding was completely eliminated in 2012, and the fiscal year 2018 budget saw a $500,000 restoration. In 2018, legislation was signed into law to dedicate one percent of the state’s cigarette and tobacco tax revenues to the implementation of a comprehensive tobacco control program. The amount initially appropriated from that law was approximately $7 million.

 

New Jersey’s inadequate funding of tobacco prevention and prevention and cessation programs is of particular concern because it pales in comparison to the huge amount tobacco companies spend each year to market their deadly and addictive products, and the num bers are alarming. Tobacco companies spend an estimated $175.5 million a year advertising their deadly products in New Jersey.[7] New Jersey is no different than other states in the sense that ample revenue streams are already in place to provide life-saving tobacco control funding. In fact, New Jersey received over $700 million last year in tobacco tax revenue alone, but only a small fraction of that amount was specifically dedicated to comprehensive statewide programs that prevent and reduce future tobacco usage. This failure by the state to adequately fund tobacco prevention and cessation programs contributes to preventable chronic disease, suffering and death in New Jersey, and furthermore undermines the nation’s efforts to reduce tobacco use – still the leading cause of preventable death in the nation. Tobacco use furthermore takes a terrible toll on New Jersey’s finances, costing the state an estimated $4.06 billion in health care bills annually, including $1.17 billion in Medicaid payments alone.[8]

 

ACS CAN calls on the legislature to maintain at least $7.8 million in funding from tobacco sales revenue for tobacco control and prevention initiatives in 2021-2022 as a first step towards fully funding the program at CDC’s recommended $103.3 million annually

 

The decline of smoking has not occurred among people with lower incomes

A lack of funding prevents the Tobacco Use Prevention and Cessation Program from reaching the people most disproportionately impacted by tobacco use. Educational attainment and income are factors associated with disparities in smoking prevalence. Those with less than a high school education now smoke at a rate more than five times that of an individual that has attained an undergraduate degree.

 

 

 

Nationwide Adult Prevalence of Smoking by Education, 2019[9]

Education Level Smoking Rate
GED Certificate 36.8%
High School Diploma 18.7%
Some College 17.4%
Associate Degree 15.5%
Undergraduate Degree 7.1%
Graduate Degree 4.1%

 

Nationwide Adult Prevalence of Smoking by Income, 2019[10]

Annual Household Income Smoking Rate
Less than $35,000 21.4%
$35,000 to $74,999 15.3%
$75,000 to $99,999 11.8%
Greater than $100,000 7.6%

 

According to the latest Census, nearly 10% of New Jersey households have incomes below $15,000. Individuals with lower incomes and lower educational attainment live throughout the state. In urban, rural and suburban areas of New Jersey, individuals with lower incomes struggle not only with extremely tight finances, but with the financial and health consequences of this powerful addiction as well. Yet they receive little help from the state when they want to quit smoking.

 

Ranges Exist Between Counties

The northern New Jersey region has significantly lower rates of overall cancer incidence and mortality, a difference that is partially due to lower rater of lung cancer incidence and mortality. Men living in the counties of Atlantic, Camden, Cape May, Cumberland, Gloucester and Ocean have lung cancer incidence and mortality rates that exceed the state average. By contrast, men living in the counties of Bergen, Hunterdon, Middlesex, Morris, Somerset and Union have rates of lung cancer incidence and mortality that are lower than the state average.[11] Women residing in Atlantic, Camden, Cape May, Gloucester, Monmouth and Ocean had lung cancer incidence and mortality rates that exceed the state average. Women living in the countries of Bergen, Essex, Hudson, Hunterdon, Mercer, Middlesex, Morris, Passaic, Somerset and Union had lung cancer incidence and mortality rates that are below the state average.[12]

 

Because we know that 80% or more of lung cancer deaths are caused by smoking, it is not surprising to find that the smoking rate in the northern New Jersey region has been lower than in the southern region of the state for some time.[13] Given the overwhelming scientific connection between lung cancer and smoking rates, we examined smoking rates by county. As you can see below, the counties’ smoking rates tend to reflect the differences in both lung cancer incidence and mortality rates. Clearly, tobacco control measures must focus on these counties with the above average smoking rates. As seen below, those counties are more likely to be found in the southern half of the state.

 

Percentage of Adults Who Reported Current Cigarette Smoking by County of Residence, Adults Aged 18 and Older, 2018[14]

County Percentage of Adults
Gloucester 24.1%
Cape May 22.2%
Monmouth 19.6%
Salem 18.5%
Atlantic 18.0%
Camden 16.2%
Hudson 16.2%
Passaic 14.9%
Warren 14.6%
Essex 14.5%
Cumberland 13.9%
Hunterdon 13.6%
Ocean 13.1%
Union 13.0%
Middlesex 12.5%
Burlington 11.9%
Sussex 11..9%
Bergen 10.8%
Mercer 10.8%
Morris 9.4%
Somerset 8.5%

 

Smoking and COVID-19

According to the CDC, being a current or former smoker increases the risk of severe illness from COVID-19. Smoking impairs the immune system and lung function, making it harder for the body to fight off coronaviruses and other respiratory diseases.

 

Investing in Tobacco Prevention and Cessation Programs Saves Money and Lives

A well-funded tobacco control program will not only produce long-term savings but can have an immediate benefit. While we appreciate the FY 2020-2021 allocation of approximately $7.8 million in funding for comprehensive state tobacco control, ACS CAN believes that if we do not take steps to provide additional state funds for tobacco prevention and control in the future, there will continue to be a detrimental impact on the prevention of cancer and will ultimately result in more people dying prematurely from tobacco-related illnesses including cancer.

 

For every dollar spent on tobacco prevention, states can reduce tobacco-related health care expenditures and hospitalizations. California saw a $55 to $1 return on investment between 1989 and 2008.[15] Tobacco control programs in Massachusetts and elsewhere have been proven to reduce youth smoking and help people who currently use tobacco to quit.

 

Florida has provided robust and sustained funding for its program for over a decade. In 2007, Florida launched the Tobacco-Free Florida program, which was based on CDC best practices. The program uses community-based efforts, hard-hitting media campaigns and help for people who use tobacco who are trying to quit. Florida voters approved a constitutional amendment in 2006 requiring the state to spend 15% of its tobacco settlement funds on tobacco prevention. In 2017, Florida spent $67.8 million on tobacco prevention and cessation programs. In 2015, Florida reported that its high school smoking rate fell to 6.9%, a 75% decline since 1998.[16] In 2019, Florida reported that its high school smoking rate fell even further to 2.1%.

 

A study in the American Journal of Public Health found that for every dollar spent by Washington State’s tobacco prevention and control program between 2000 and 2009, more than five dollars were saved by reducing hospitalizations for heart disease, stroke, respiratory disease and cancer caused by tobacco use.[17] Over the 10-year period, the program prevented nearly 36,000 hospitalizations, saving $1.5 billion compared to $260 million spent on the program. The 5-to-1 return on investment is conservative because the cost savings only reflect the savings from prevented hospitalizations. The researchers indicate that the total savings could be more than double if factors like physician visits, pharmaceutical costs and rehabilitation costs were included.

 

  • Tobacco Control Recommendation #1: Increase the state’s cigarette tax by $1.65 per pack to raise the rate to $4.35 per pack, matching the rates in New York and Connecticut, as well as increase the tax on all other tobacco products at an equivalent rate, including e-cigarettes. Evidence shows that increases in cigarette taxes must be significant to have a public health impact, creating a deterrent to using the products, and the generation of additional revenue from these products should be used to bring the state funding for the tobacco control program into closer alignment with the CDC recommended amount, beyond the 1% dedication.

 

  • Tobacco Control Recommendation #2: End the sale of menthol cigarettes and all other flavored tobacco products. Flavored tobacco products are used by the tobacco industry to lure kids into a lifetime of addiction. 143,000 kids who are alive now in New Jersey will die prematurely as a result of smoking. More than 80% of kids who use tobacco start with a flavored product. In this country, 54% of teens who smoke use menthol cigarettes. For African American teens who smoke, that figure rises to 70%.  Big Tobacco has shamelessly targeted communities of color, the LGBT community and low socioeconomic neighborhoods with predatory marketing of menthol products for decades. Now is the time to protect all kids from a lifetime of addiction by enacting comprehensive legislation to end the sale of all flavored tobacco products, including but not limited to menthol cigarettes, flavored cigars, hookah, and smokeless tobacco.

 

  • Tobacco Control Recommendation #3: At a minimum, maintain $7.8 million in funding from tobacco sales revenue for tobacco control and prevention initiatives, in accordance with the 2017 legislation that was passed that dedicates 1% of the revenue for this purpose. The recent Surgeon General’s report[18] found that while significant progress has been made in reducing smoking over the last several decades, there is still much more work to be done in reducing death and disease from tobacco use. New Jersey must continue to at the very least, fulfill its promise to use 1% of tobacco revenues for programs to help people who use quit and to keep children from starting. The Centers for Disease Control and Prevention’s (CDC) updated Best Practices document[19] provides a blueprint for state tobacco control programs based on the latest evidence. According to the CDC’s report, new research has identified strategies for states to have more impact with less cost – making it more important than ever to meet the recommended funding levels. We feel strongly that the state should, at a minimum, continue to dedicate at least 1% of its cigarette tax revenue to tobacco prevention and cessation programs for FY 2021.

 

 

Budget Recommendation #2: Find cures and new therapies by supporting and strengthening the NJ State Commission on Cancer Research (NJCCR).

 

Since 1983, NJCCR has funded promising cancer research in New Jersey. NJCCR promotes significant and original research in New Jersey into causes, prevention, treatment and palliation of cancer and serves as a resource to providers and consumers of cancer services. Throughout its 30-year history, the NJCCR has awarded over $40 million to over 800 peer reviewed cancer research grants and student fellowships. NJCCR is the only statewide institution that provides peer reviewed scientific cancer research grants to all eligible institutions in New Jersey, and this merit-based system has a strong track record of funding the best new scientists who engage in ground-breaking basic research. Last year’s final adopted budget included a $2 million appropriation for this program. The Governor’s proposed FY 2021-2022 budget maintains this appropriation at the same level.

 

The merits of cancer research are undeniable, and the benefits are vast. An independent study of NJCCR grant recipients show that these researchers leverage $10 in federal funding for each $1 of NJCCR funding. All eligible institutions in New Jersey can apply for cancer research funding grants. In the past, grants have been awarded to researchers at Rutgers Cancer Institute of NJ, Rutgers School of Biomedical and Health Sciences, Rutgers School of Dental Medicine, Princeton, Rider, and Rowan Universities.

 

With the $2 million in funding, the Commission will be able to fund 16 cancer research fellowships to scientists conducting basic cancer research in New Jersey this year. Additionally, the Commission will be able to award five bridge grants, providing funding to promising and productive New Jersey investigators who faced short term interruption in funding for research projects focused on cancer prevention, diagnosis, treatment and survivorship.

 

Researchers funded by an NJCCR grant have discovered life-saving scientific breakthroughs, including the recent discovery by Princeton and Cancer Institute of NJ researchers of the gene, Metadherin, a gene critical to breast cancer metastasis.

 

New Jersey’s cancer research enterprise extends beyond the laboratory and campus: NJCCR research and funding augments NJ’s reputation as the world’s medicine chest. The state has one of the highest concentrations of pharmaceutical and biotechnology firms in the nation: a $25 billion industry. The ability of the pharmaceutical industry to tap NJ’s cancer research talent and scientific breakthroughs bolsters their strength and in turn the NJ economy.

 

 

The NJCCR needs non-lapsing funding

While the NJCCR continues to do lifesaving work in New Jersey, its impact is limited by a lack of stable funding and an inability to plan for more than one year at a time. Cancer is the second leading cause of death in New Jersey, and yet more dollars are awarded for Brain and Spine research than for cancer.  This low funding stems from the omission of a dedicated non-lapsing fund for the NJCCR. Non-lapsing funds were legislatively established for the NJ Commission on Spinal Cord Research (NJCSCR) in 1999 and for the NJ Commission on Brain Injury Research (NJCBIR) in 2004. These funds are managed by the New Jersey Treasury Department and monies are allocated annually to fund the NJCSCR and the NJCBIR. The moneys from these funds provide each Commission between $4 to $6 million annually. Unlike the NJCSCR and NJCBIR, the NJCCR receives annually a legislative state appropriation in the amount of $1 million for cancer research.

 

The NJCCR was the first Commission to be established in 1982 and as a result no consideration was given to establish a dedicated non-lapsing fund. The absence of this fund has resulted in the NJCCR receiving far less research dollars compared to the other Commissions.

 

Overview of Non-lapsing Legislative Funds

In accordance with N.J.S.A. 39:5-41, the assessed fines and penalties stem from laws that govern motor vehicle and traffic violations in the state. Surcharges are added to the amount of each fine or penalty which help support other initiatives and funds including the: Body Armor Replacement Fund, Autism Medical Research and Treatment Fund, NJ Forensic DNA Laboratory Fund, NJ Spinal Cord Research Fund and the NJ Brain Injury Research Fund. Except for cancer research, the moneys raised from the $1 surcharge are added to the Brain, Spine and Autism Research Funds.

 

Comparison of Cancer, Brain and Spine Commissions (2019 & 2020)

The lack of a non-lapsing fund for cancer contributes to an unequal distribution and allocation of available research dollars. This results in the following: 1) Smaller awards for cancer research projects, 2) Large scale awards for NJCSCR & NJCBIR and 3) Less funds available for cancer research.

 

The New Jersey Cancer Research Act dictates that the NJCCR receive no less than a $1 million appropriation for research into the causes, prevention and treatment of cancer. Unlike Brain and Spine there is no enabling legislation that creates a non-lapsing fund for cancer research grants. Consequently, this limits the “pool” of available dollars for funding cancer research.  Thanks to the generosity of the legislature, the NJCCR received a total of $2 million in FY 2020-2021.

 

 

  • NJCCR Recommendation #1: In fiscal year 2021-22 we request the New Jersey maintain the NJCCR’s base appropriation of $2 million.

 

  • NJCCR Recommendation #2: Amend the Cancer Research “Act” to allow a fair and equitable distribution of revenue generated from motor vehicle and traffic violations. Amendments to the Act would establish a dedicated non-lapsing fund similar to Brain and Spine. This approach would provide a “pool” of available dollars ranging from $3 to $4 million to be allocated for deposit in the Cancer Research Act Fund. At the same time, the state should consider additional funding streams to ensure that the Brain, Spine and newly created Cancer funds all receive the resources they need to support their important work.

 

 

Budget Recommendation #3: Identifying cancers early, by restoring funding for the New Jersey Cancer Education and Early Detection Screening Program (NJCEED).

 

Support for NJCEED

NJ CEED offers a critically important service to men and women who lack health insurance – free cancer screening for breast, cervical, colorectal and prostate cancer. Detected early, these cancers are more easily treated. Failing to have these cancers detected early can lead to deadly consequences.

 

Program services are provided through 21 contracted lead agencies; each county in NJ has at least one lead agency[20]. Cancer screening saves lives. Detecting cancer early increases the chances of successful treatment, improves survival rates, and saves New Jersey overall on medical costs. For example, research shows that the earlier breast cancer is treated and detected, the better the survival rate. When breast cancer is diagnosed at an early stage while still confined to the breast, the 5-year survival rate is 99%.

 

Published research on the success of the National Breast and Cervical Cancer Early Detection Program, which partially funds and guides the state screening program, demonstrates a substantial impact on reducing mortality from breast cancer in medically uninsured, low income women. These evidence-based findings justify the state’s investment in NJCEED and the early detection of cancer.

 

NJCEED has never been more important to the health of New Jerseyans. Since the Covid-19 pandemic began, over 140,000 New Jerseyans have lost their employer-based health insurance. NJCEED is critical to ensuring that these New Jerseyans get the screening that they need.

 

Reduction in Funding for NJCEED

An initial read of the budget documents released on the eve of this hearing show a proposed reduction in state funds for NJCEED from $3.5 million in FY 2020-2021 to a proposed $3.1 million in FY 2021-2022. It is unclear what the justification is for the reduction at this time but after a year where many patients delayed care, including accessing their doctor recommended cancer screening, we need to maintain funding for critical programs like NJCEED.

 

Reduce the age in New Jersey at which health benefit plans cover colorectal cancer screenings from 50 to 45 and remove cost-sharing for a follow-up colonoscopy following a positive result of a non-colonoscopy screening test.

Research shows rates of colorectal cancer are increasing in young-and middle-aged populations, which spurred the American Cancer Society (ACS) to lower its recommended screening age to 45 in 2018. The new guideline for colorectal cancer screening recommends that average-risk adults aged 45 years and older undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) exam, based on personal preferences and test availability. As a part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy.

 

Following the ACS guidelines, the United States Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine, has released a draft recommendation statement on screening for colorectal cancer. The updated draft recommendations are in line with ACS’s recommendations regarding colorectal cancer screenings for average-risk populations. The new guidelines lowered the age to start screening from 50 to 45 and recommend continuing regular screening until age 75.

 

ACS CAN is pleased with the draft guidelines released by USPSTF and encourages the USPSTF to include removing cost-sharing for a follow-up colonoscopy following a non-colonoscopy screening test and expedite its review cycle to take into account new scientific evidence that supports starting routine screening at age 45. Knowing cost is a major barrier for patients getting screened, this change would help to end suffering and death from cancer.

 

Colorectal cancer is the third most common cancer in men and women and the second leading cause of cancer death in men and women combined in New Jersey. This year alone, ACS estimates nearly 4,350 individuals will be diagnosed with colorectal cancer and more than 1,410 will die from the disease in New Jersey. But colorectal cancer is preventable when polyps are found and removed through colonoscopy screenings. Beginning screening at a younger age will lead to earlier diagnoses, when treatment is less expensive and patients are more likely to survive, and in many cases, prevention of the disease altogether.

 

  • Cancer Screening Recommendation #1: Restore funding for the New Jersey Cancer Education and Early Detection Screening Program (NJCEED).  Total combined state and federal support for this important program is currently approximately $12 million with New Jersey contributing $3.5 million in FY 2020-2021. New Jersey should restore any cuts to the funding for the NJCEED program so the lead agencies can adequately serve their existing patients and outreach to the eligible population to the extent possible. We recommend that state funding for this program be restored to $3.5 million.

 

  • Cancer Screening Recommendation #2: In order to ensure that New Jerseyans benefit from the best available research when it comes to colorectal cancer screening, ACS CAN recommends that New Jersey immediately reduces the age in New Jersey at which health benefit plans cover colorectal cancer screenings from 50 to 45 and remove cost-sharing for a follow-up colonoscopy following a non-colonoscopy screening test.

 

Conclusion

ACS CAN’s mission is to support evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. With that objective in mind, we appreciate the Legislature’s commitment to the fight against cancer. With your support of the above-mentioned budget priorities in 2021-2022 you can reduce New Jersey’s cancer rate; help identify cancers at their earliest- and often most treatable- stage and ensure that cancer patients are adequately supported from the public policy standpoint as they battle this devastating disease.

 

While COVID-19 may have stopped many things in our lives, cancer hasn’t stopped. So, neither have we. We thank you again for the opportunity to testify today.

[1] Source: American Cancer Society. Cancer Facts & Figures 2021. Atlanta: American Cancer Society; 2021. Rounded to the nearest 10. Analysis does not include basal cell and squamous cell cancers and in situ carcinomas. Full list of cancer cases and deaths available upon request.

[2] Loret-Tieulent,J, et al., “State-Level Cancer Mortality Attributable to Cigarette Smoking in the United States,” JAMA Internal Medicine, October 24, 2016.

[3] Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004-2014external icon. Tob Control. 2016;25:ii14-ii20. Doi:10.1136/tobaccocontrol-2016-053329.

[4] U.S. Department of Health and Human Services, “The Health Consequences of Smoking – 50 years of Progress: A Report of the Surgeon General, 2014” Executive Summary, pages 2 and 3.

[5] CDC, Best Practices for Comprehensive Tobacco Control Programs – 2014, http://www.cdc.gov/tobacco/stateandcommunity/best_practices/.

[6] American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonmokers’ Rights, Campaign for Tobacco Free Kids, Robert Wood Johnson Foundation et al “Broken Promises to Our Children: The 1998 Tobacco Settlement 17 Years Later,” 2015.

[7] Campaign for Tobacco Free Kids, Broken Promises to Our Children: A State by State Look at the 1998 State Tobacco Settlement 18 Years Later, available at: http://www.tobaccofreekids.org/what-we-do/us/statereport/new-jersey

[8]   CDC, Best Practices for Comprehensive Tobacco Control Programs – 2014, http://www.cdc.gov/tobacco/stateandcommunity/best_practices/, Health costs do not include estimated annual costs from lost productivity due to premature death and exposure to second hand smoke.

[9] US Centers for Disease Control and Prevention, Behavioral Risks Factor Surveillance System, Prevalence and Trends Data, 2019

[10] US Centers for Disease Control and Prevention, Behavioral Risks Factor Surveillance System, Prevalence and Trends Data, 2019

[11] New Jersey Department of Health, State Cancer Registry

[12] New Jersey Department of Health, State Cancer Registry

[13] New Jersey Department of Health, State Cancer Registry

[14] Behavioral Risk Survey, Center for Health Statistics, New Jersey Department of Health

[15] Dilley, Julia A., et al, “Program Policy and Price Interventions for Tobacco Control: Quantifying the Return on Investment of a State Tobacco Control Program,” American Journal of Public Health, Published online ahead of print December 15, 2011. See also Washington State Department of Health, Tobacco Prevention and Control Program, News release, “Thousands of lives saved due to tobacco prevention and control program,” November 17,2010, http://www.doh.wa.gov/Publicat/2010_news/10-183.htm.

[15] Lightwood J, Glantz SA. The effect of the California tobacco control program on smoking prevalence, cigarette consumption, and healthcare costs: 1989–2008. PLoS One 2013;8(2):e47145

[16] Florida Department of Health. Bureau of Epidemiology, Division of Disease Control and Health Protection. Florida Youth Tobacco Survey, 2015.

[17] Dilley, Julia A., et al, “Program Policy and Price Interventions for Tobacco Control: Quantifying the Return on Investment of a State Tobacco Control Program,” American Journal of Public Health, Published online ahead of print December 15, 2011. See also Washington State Department of Health, Tobacco Prevention and Control Program, News release, “Thousands of lives saved due to tobacco prevention and control program,” November 17,2010, http://www.doh.wa.gov/Publicat/2010_news/10-183.htm.

http://www.floridahealth.gov/statistics-and-data/survey-data/florida-youth-survey/florida-youth-tobacco-survey/_documents/2019-fyts-tables.pdf

[18] The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General, 2014.

[19] CDC, Best Practices for Comprehensive Tobacco Control Programs – 2014, http://www.cdc.gov/tobacco/stateandcommunity/best_practices/,

[20] New Jersey Department of Health and Senior Services, see: http://web.doh.state.nj.us/apps2/cancerfacilities/njceed.aspx, See appendix B for the listing of agencies providing screening services through NJCEED.

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