Many cancers are preventable by reducing risk factors or getting appropriate vaccinations. Screening is effective in identifying some types of cancers in early, often highly treatable stages.¹  Although the number of cancer deaths has experienced a significant decline over the years, cancer remains the second leading cause of death in New Jersey and the United States. Among some subpopulations, it is the leading cause of death.

2018-2023

Four cancers - lung, breast, prostate, and colorectal - represent almost half of all new cancer diagnoses and about 40% of all cancer deaths in the state. Lung cancer is the leading cause of death due to cancer in New Jersey and in the nation as a whole. This is true for both males and females and for each racial/ethnic group. In the United States, 80%-90% of lung cancer deaths are due to smoking.²  Breast cancer is the second leading cause of deaths due to cancer among women in New Jersey. Prostate cancer is the most common cancer among men and, in New Jersey, is the third leading cause of death due to cancer among men, following colorectal cancer.

Projects and Outreach

• The New Jersey Comprehensive Cancer Control Plan, 2021-2025 was developed collaboratively with the New Jersey Department of Health; the Governor’s Task Force on Cancer Prevention, Early Detection and Treatment in New Jersey; statewide cancer coalitions; community partners; and cancer researchers. The Plan is a five-year roadmap to reduce the burden of cancer and improve the quality of life for cancer survivors by outlining objectives and strategic actions across the cancer continuum -- primary prevention, early detection and treatment, and survivorship -- with cross-cutting priorities of health equity, policy systems and environmental change, and surveillance and evaluation.
• The New Jersey Cancer Education and Early Detection (NJCEED) Program provides funding to 19 Lead Agencies for statewide comprehensive breast, cervical, colorectal, and prostate cancer education, outreach, screening, and patient navigation for low-income, uninsured, and underinsured NJ residents at or below 250% of the Federal Poverty Level (FPL). The program’s goal is to engage communities to increase the awareness of each person’s risk for these cancers, decrease the morbidity and mortality due to cancer by encouraging the use of screening services for early detection and diagnosis, and bring awareness to cancer screening services, linkage to primary care services, and community resources. The NJCEED Program received Gold Standard recognition by the CDC National Breast and Cervical Cancer Early Detection Program (NBCCEDP) for increasing breast and cervical cancer screenings. The program increased the total number of breast, cervical, colorectal, and prostate cancer screening by 15% from July 1, 2022 to June 30, 2023.
• ScreenNJ is a statewide partnership between the Rutgers Cancer Institute of New Jersey, New Jersey Department of Health, and health care and community organizations. It was established in 2021 to implement and expand the reach of evidence-based cancer prevention and screening services, directly address barriers that prevent people from receiving timely cancer screenings, and reduce the cancer burden experienced by New Jerseyans. ScreenNJ focuses on colorectal, lung, breast, skin, and prostate cancer; cancers related to family and genetic risk factors; and HPV (human papillomavirus)-related cancers.  Services include free access to lung and skin cancer screenings; free cancer genetic counseling; breast, cervical, and colorectal screenings for insured individuals; and patient navigation to help individuals gain access to vital screenings. The program aims to reduce cancer mortality rates, reduce disparities, and educate New Jersey residents about the importance of cancer screening, early detection, and prevention.
• The Regional Chronic Disease Coalitions (RCDCs) conduct focus groups throughout the state to discuss barriers to care related to cancer screening. The RCDCs have also facilitated Cancer Thriving and Surviving (CTS) workshops targeted towards cancer survivors and their caregivers. The objective of the CTS workshops is to promote an active and healthy lifestyle and provide support for cancer survivors.
• In March 2023, NJCEED collaborated with ScreenNJ and Regional Chronic Disease Coalitions in the launch of the YouPlusTwo Campaign to promote breast, cervical, colorectal, lung, and prostate cancer screening. 

Legislation

• P.L. 2023, c.008 expands access to colorectal cancer screening in New Jersey by requiring that health insurers cover the cost of screening procedures as recommended by the United States Preventive Services Task Force (USPSTF). This law removes financial barriers such as copayments, deductibles, coinsurance, or other cost-sharing requirements for colonoscopies and other colorectal cancer screening services.

Grants and funding given by NJDOH

• NJDOH provides grant funding to ten Regional Chronic Disease Coalitions (RCDCs) and the NJCEED 19 lead agencies.
• The New Jersey Cancer Education and Early Detection (NJCEED) Program, with funding from the Centers for Disease Control and Prevention (CDC) and the State of New Jersey, provides funding to all 21 counties in the State for comprehensive breast, cervical, colorectal, and prostate cancer education and outreach, screening, and diagnostic services. NJCEED provides statewide coverage through screening providers known as Lead Agencies. Screening services for women include screening mammograms, clinical breast examinations, instruction on breast self-examinations, Pap tests, pelvic examinations, and colorectal cancer screenings. Men receive Prostate-Specific Antigen (PSA) tests for prostate cancer and colorectal cancer screenings. If symptomatic, men can also receive breast cancer diagnostic tests. Diagnostic testing is performed if needed, and case management, tracking, and follow-up services are provided. 
• In collaboration with the Office of Primary Care and Rural Health (OPCRH), the NJCEED program funds all cancer screenings at Federally Qualified Health Centers (FQHC). This collaboration also ensures that FQHC patients diagnosed with breast or cervical cancer will receive coverage in accordance with the Medicaid Breast and Cervical Cancer Treatment Waiver Program. 
• The New Jersey Cancer Education and Early Detection (NJCEED) program and New Jersey Office of Cancer Control and Prevention - Regional Chronic Disease Coalitions (NJOCCP RCDCs) implemented a transportation program in January 2022 after health disparities among certain racial and ethnic groups were highlighted by the onset of the Coronavirus (COVID-19) pandemic. NJCEED Lead Agencies were tasked to provide NJCEED patients with no-cost transportation services to breast and cervical cancer screening and diagnostic follow-up appointments. NJCEED and RCDCs collaborated with UberHealth, Lyft, and New Jersey Access Link to offer no-cost transportation services for patients to attend cancer screening appointments. NJCEED's 19 lead agencies and NJOCCP Regional Chronic Disease Coalitions combined provided 3,830 rides for program recipients during the first year of implementation. With this success rate, a higher reach is anticipated for upcoming years.

Grants received by NJDOH

• New Jersey was awarded a CDC Cancer Prevention and Control grant for 2022-2025 that funds the New Jersey State Cancer Registry, New Jersey Comprehensive Cancer Control Program, and New Jersey Cancer Education and Early Detection Program working synergically to reduce cancer incidence and mortality. 

Assets/resources

• The NJ State Cancer Registry (NJSCR) is a high-quality cancer registry funded by both the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI) and the National Program of Cancer Registries. NJSCR’s high quality rating by the North American Association of Central Cancer Registries (NAACCR) and large case counts make New Jersey a prime location for cancer research and surveillance.
• NJDOH helps to promote and facilitate important research in New Jersey through its partnership with the Rutgers Cancer Institute and Rutgers School of Public Health.
• The NJDOH Office of Cancer Control and Prevention coordinates 10 Regional Chronic Disease Coalitions (RCDCs), which are volunteer groups of over 2,000 individuals and organizations including regional health providers and hospitals, non-profit organizations, faith-based organizations, local health departments, and corporate partners.
• The Choose Your Cover initiative is a free, state-wide skin cancer screening and education program coordinated by RCDCs and the Melanoma Workgroup of the Task Force on Cancer Prevention, Early Detection, and Treatment in New Jersey.

Challenges

• Undocumented individuals screened and diagnosed with breast cancer enrolled in the NJCEED program are unable to receive cancer treatment funded through the Medicaid 1115 Waiver due to citizenship. NJDOH leadership and program staff have met with the Office of Legislative Services and NJ Medicaid to explore pathways for undocumented patients diagnosed with cancer to receive treatment through NJ Family Care.  
• According to the Center for Disease Control and Prevention (CDC), as of June 2020, 4 in 10 adults surveyed reported delaying or avoiding routine or emergent medical care because of the pandemic. This phenomenon exacerbated existing health disparities disproportionately affecting priority populations. 
• NJCEED cannot provide lung cancer screening because of the high cost, but they partner with ScreenNJ to coordinate lung cancer screening services.

Disparities/inequities

• In the total New Jersey population and among each racial/ethnic group, males have higher cancer incidence and death rates than females, with the exception of Asian and Pacific Islander (API) persons. API females have slightly higher cancer incidence rates than males but have lower cancer mortality rates.
• The age-adjusted incidence rate due to invasive cancer, which had been highest among Black males in New Jersey for many years, has recently been surpassed by White males.
• The age-adjusted death rate due to cancer is highest among Black persons in New Jersey, but the gap is narrowing.
• Lung cancer death rates among White and Black persons are more than double those of Hispanic and Asian persons.
• While breast cancer incidence rates are highest among White women in New Jersey, breast cancer mortality rates are highest among Black women.
• Black men have the highest prostate cancer incidence and mortality rates in New Jersey, with 48% higher incidence rates than White men (221.4 vs. 135.6 in 2017-2021) and 77% higher mortality rates (35.7 vs. 15.8 in 2017-2021).
• NJCEED places a special focus on racially and ethnically diverse populations who are disproportionately impacted by a late-stage cancer diagnosis, low cancer screening rates, cancer incidence and mortality, and unmet health-related social needs. These populations consist of non-Hispanic Black, Hispanic, seasonal migrant workers, foreign-born populations, undocumented populations, recognized urban residents, Tribal, and Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) populations.

Final Assessment

• Twelve of the seventeen Cancer targets were achieved by 2020.
  • Targets were met for all cancer incidence and mortality objectives, as well as colorectal cancer screening.
• The five-year cancer survival rate improved but the target was not achieved.
• The other three cancer screening objective rates and the sunburn rate worsened.

For more information, please refer to these resources:

• NJDOH Cancer Initiatives
• Rutgers Cancer Institute of New Jersey
• National Cancer Institute
• CDC Division of Cancer Prevention and Control
• Healthy People 2030

References: 

1. Cancer. Healthy People 2020. 10/08/20.
2. Lung Cancer Risk Factors  CDC. 9/22/20.

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