Efforts in advocacy and policy to lower cancer rates
Researchers at the Abramson Cancer Center are actively involved in various advocacy and policy initiatives aimed at reducing cancer incidence and mortality rates, both in the Abramson Cancer Center catchment area and across the nation. These efforts include advocating for tobacco-free spaces, restricting youth access to tobacco and vaping products, cancer screenings, biomarker testing and promoting equitable access to cancer clinical trials and lifesaving therapies. By collaborating with government and community partners, our researchers are leading impactful policy initiatives that address critical health challenges, such as asbestos exposure in schools, obesity, and environmental contamination—creating healthier communities for everyone.
Frank Leone, MD, MS (TEC) helped the University of Pennsylvania, the Commonwealth of Pennsylvania, and the City of Philadelphia establish tobacco-free workplace and public space laws, and led the Philadelphia Tobacco-Free Recovery Initiative, in partnership with the Philadelphia Department of Public Health. Brian P. Jenssen, MD, MSHP, an advocate of policies that restrict e-cigarette sales to youth (Jenssen, Children 2019, 6(2) 30) also successfully lobbied the City of Philadelphia to prohibit the sale of vaping products with flavorings and high nicotine content in youth-accessible retail establishments. Following his testimony to City Council, the city enacted a ban in all stores that permit sales to minors. Andrew A. Strasser, PhD published the positive impact of the tobacco retailer licensing regulations that were passed in Philadelphia in December 2016 by Board of Health vote and implemented beginning in January 2017. Prior to the adoption of these regulations, Philadelphia had up to double the number of retailers per 1000 people (2.21) compared with other major cities — including New York City (1.15); Chicago, Illinois (0.92); San Francisco, California (1.05) and Washington, DC (1.20) contributing to Philadelphia’s high adult smoking prevalence, which approaches 20 percent. (AJPH.2019.305512). This research was cited by the City of Philadelphia Board of Health, which passed legislation that limits the number of tobacco permits by planning district and prohibits new tobacco permits within 500 feet (approximately two blocks) of any K–12 school.
Trevor M. Penning, PhD expanded his community engagement work focused on asbestos from his Superfund Research Program to include the Philadelphia School District, which recently recognized widespread asbestos exposure. Penning serves as a partner in the Healthy Schools Initiative, a collective of experts and community stakeholders advising the City of Philadelphia on methods to reduce harmful exposure to unhealthy school building conditions.
Robert H. Vonderheide, MD, DPhil and Carmen E. Guerra, MD, MSCE lobbied the Pennsylvania legislature and governor to pass Senate Bill 576, Cancer Clinical Trial Access for Pennsylvania Patients, which made clear that financial support for incidental costs of participating in treatment clinical trials are not undue influence (passed unanimously in 2018). Holly Fernandez Lynch, JD, MBe has published several perspectives about the impact of Right to Try legislation (Lynch et al., JCO, 2019; JAMA. 2018;320(9):869-870; N Engl J Med. 2018 Feb 22;378(8):695-697.).
Justin E. Bekelman, MD (CCP) and David L. Porter, MD (Hematologic Malignancies) led policy efforts at the US Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS) to address the unaffordability of CAR-T cell therapies (Manz et al., JCO, 2019).
Samuel U. Takvorian, MD, MS, Ronac Mamtani, MD, MSCE, Lawrence Nathan Shulman, MD and Justin E. Bekelman, MD determined that Medicaid expansion was associated with a decreased rate of uninsured patients and increased rate of early-stage cancer diagnosis among patients with breast, colon, and lung cancer (JAMA, 2020). Takvorian and Guerra also advocated for the equitable access to clinical trials for patients with Medicaid after the enaction of a new policy in 2022 which would allow Medicaid to cover “routine” clinical trial costs. Takvorian and Guerra argued for addressing the social needs of patients which can prevent them from participating in a clinical trial, providing patient navigation and standardized reporting and data transparency about participation (“A Hidden Opportunity - Medicaid’s Role in Supporting Equitable Access to Clinical Trials” Takvorian, Guerra NEJM 2022).
Funded by the Bloomberg Foundation, the Philadelphia beverage tax was evaluated one year after its implementation and a decline in the sales volume of taxed beverages found (Christina Roberto et al., JAMA, 2019). Sweetened drink sales dropped by 38 percent, even when factoring in the rise in surrounding area purchasing, providing strong evidence to sustain support among city council members regarding the continued policy. Subsequent research on Philadelphia’s “soda tax” by Roberto found that the sweetened beverage tax was associated with a reduction in soda intake among adolescents (JAMA Pediatrics 2021).
As one of the world’s leading authorities on polycyclic aromatic hydrocarbon carcinogenesis, Trevor M. Penning, PhD is working with the Eastwick Lower Darby Creek Area Community Advisory Group to communicate the risk of polycyclic aromatic hydrocarbon contamination of residential yards and the resultant EPA response.
Precision medicine relies on biomarker testing and targeted treatments, which can lead to fewer side effects, improved survival, better quality of life, and potentially lower costs for patients facing cancer and other serious illnesses.
In collaboration with the American Cancer Society Cancer Action Network, Dr. Guerra met with legislators in Harrisburg to advocate for expanded biomarker testing. As a result, on July 1, 2024, Governor Josh Shapiro signed House Bill 1754 into law, requiring all state-regulated health plans, including Medicaid, to cover comprehensive biomarker testing.
For women with dense breasts, the sensitivity of mammography is as low as 30 percent, and results in missed opportunities to identify cancer early. Abramson Cancer Center researchers, including Susan Weinstein, MD, Emily Conant, MD, and Mitchel Schnall, MD, PhD, led a study demonstrating that abbreviated breast Magnetic Resonance Imaging (MRI) can be used for supplemental screening in women with dense breasts and average risk. They found that abbreviated MRI detected roughly 27 cancers per 1,000 women screened. By comparison, 3D mammography detects about four to five cancers in 1,000 women screened, on average.
The findings were published in the Journal of Clinical Oncology and contributed to a new Pennsylvania law enacted in July 2020, when Governor Tom Wolf signed Senate Bill 595, requiring insurers to cover supplemental screenings, including MRI, for women with dense breasts.
In May 2023, Pennsylvania Governor Josh Shapiro signed Act 1 of 2023, eliminating out-of-pocket costs for breast MRIs for high-risk Pennsylvanians. The law, which took effect on January 1, 2024, also covers breast ultrasounds, genetic testing, and counseling.
Abramson Cancer Center researcher Anne Marie McCarthy, PhD, is leveraging this policy change by conducting a behavioral economics-based study to examine whether “nudges” sent to patients, providers, or both can increase the ordering and completion of supplemental MRI screening for patients with dense breasts.
In collaboration with the Community Outreach and Engagement team, Pennsylvania Representative Tarik Khan developed communications to raise awareness about colorectal cancer screening and co-sponsored legislation to lower the minimum age for insurance coverage of colorectal cancer screening from 50 to 45.
Additionally, in partnership with Community Outreach and Engagement team member Eveline Phillips, the Philadelphia City Council declared March as Colorectal Cancer Awareness Month on February 29, 2024.