Taking Healthcare by Storm: Industry Insights with Dr. Laura Makaroff

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Laura Makaroff, DO, a family physician and Senior Vice President of Prevention and Early Detection at the American Cancer Society.

Dr. Makaroff discusses her journey to the American Cancer Society and the organization's launch of CancerRisk360™, a personalized cancer risk assessment tool. She emphasizes the critical importance of early cancer detection, addressing disparities, and the role of modifiable risk factors in reducing cancer incidence and mortality.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-102425-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

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 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today we are joined by Dr. Laura Makaroff. Dr. Makaroff is a primary care physician. And senior Vice President of Cancer Prevention at the American Cancer Society, where she leads a team of public health experts and clinicians in building on the organization's rich history to improve cancer prevention, early detection, and survivorship to end cancer as we know it for everyone.

Prior to joining  the American Cancer Society, Dr. Makaroff served as a senior clinical advisor for the Bureau of Primary Care at the Health Resources Services Administration or hrsa. Dr. Makaroff completed a fellowship in health policy at Georgetown University and the Robert Graham Center in Washington, DC and completed her residency In family medicine at the University of Colorado, her professional and personal lives collided in an unexpected way when her husband, Jason, was diagnosed with stage four pancreatic cancer in 2021, she credits his diagnosis and their cancer journey with adding to her life in ways she never wanted, but always needed.

And she carries on Jason's legacy. She's raising two young boys and is more committed than ever to helping reduce the burden of cancer for patients and families around the world. At the American Cancer Society, Dr. Laura Makaroff oversees a broad portfolio of cancer prevention and early detection initiatives including health equity.

Cancer screening, HPV vaccination, tobacco Control, comprehensive Cancer Control, and other national partnerships. We are going to be talking about something very new and exciting today. She and her team are behind the 2025 launch of the American Cancer Society's Cancer Risk 360. A free online cancer risk assessment tool.

That provides personalized recommendations for how a person can improve their health and lower their risk for cancer. Dr. Laura  Makaroff, thank you so much for joining us today. Thanks so much Dr. Storm. It's really great to be with you all. We really appreciate the opportunity and I'm looking forward to talking about reducing the risk of cancer.

Very important. Can you start by sharing your personal and professional journey? What led you to your current role as director of early detection at the American Cancer Society? Oh sure. Happy to share. It's definitely been  a fun journey  and maybe not totally a straight road. So I think a lot of people will relate.

Sometimes our  lives, you know, have lots of twists and turns, but I've had a lot of great twists and turns in my career for sure.  So you know, I started out my clinical practice and solo practice, so I finished my residency and hung up a shingle. And opened up a solo practice in Colorado where I finished my training and where I grew up.

 And that was really fun.  that was, you know, in the early two thousands and we got to do a lot of great things. I was a very early adopter of the patient-centered medical home model, which now feels like obviously very old news, thank goodness, and so many good things we've been able to do in healthcare over the years.

Did that   live in the community, took care of my community  had lots of intergenerational families that I took care of there.  And it was great. And then I guess at some point I just felt like,  this can't be it.  we have to build a better healthcare system for everybody.

 I was working very hard. My patients were doing everything they could do, and yet  not very many people had everything they needed to really get well or be healthy throughout their lifespan just because of so many  system barriers. So I    made a decision that I wanted to learn more about working on the system of healthcare and making the system better for everybody.

And Emma had the good fortune of moving to Washington DC and doing a fellowship in health policy at the Robert Graham Center  in Georgetown  as you mentioned, and learned a lot more about health policy, health services, research, public health, and how to you know, take care of the, whole like population level health versus individual level health, which was  such a great experience.

And then I  long story short, of course, I worked at HRSA for a little while. Early 2010s. And then  we moved to Atlanta for personal reasons, just to be close to friends and family. And the American Cancer Society was looking for a physician who had a lot of experience with community health centers, which I did.

 And I love community health centers and could help build what we've been doing here at ACS to help advance and improve cancer screening and cancer prevention.  And early detection through primary care.  And so I had the opportunity to join the American Cancer Society.  Now  more than eight years ago.

 And my role here has  evolved and changed over the years. But I've gotten to be a part of a lot of really important work um, to work on a really big public health problem called cancer, which  impacts so many. And then certainly, as you mentioned, my   personal life collided unexpectedly as I, say in my bio, which is really true.

 With my husband's diagnosis. And so  clearly this has been like a really a meaningful part of my career and something that I  wake up every day and I'm so honored to get to be a part of our team and help end cancer as we know it for everyone. Yeah. It sounds like you are exactly where you need to be.

E why is early detection such a critical focus area in the fight against cancer? Yeah. Such a, great question. So important. And maybe I'll just start by just  offering just the level set on like where are we with cancer today? And I think as we think about cancer overall  cancer  is becoming more common  excluding non-melanoma skin cancers.

We are expecting a little more than 2 million new cancer cases to be diagnosed  this year in the US and more than 618,000 people will die from the disease. And that  that comes out to the equivalent of about 1700 deaths per day. So certainly it's you know, maybe more common  than we maybe might think and more common than it used to be.

 Also, we know as we think about what's changing in cancer you know, we like to look at cancer mortality rates as the best measure of progress against cancer and less affected by changes in detection than incidents, of course.  So as we think about cancer mortality rates, we know that the death rate rose during most of the 20th century  largely driven by the smoking epidemic.

 But that's really dropped from its peak in 1991 by 34% as of 2022. So over the past  several decades  the cancer death rate has dropped by 34%, which is really good news.  And that reduction you know, of course is connected to reductions in smoking.  And also some advances in treatment We've had, especially you know, in sort of more, more modern day  some really significant advances in treatments.

 But certainly the early detection for some cancers where we have. The possibility and ability to do early detection through cancer screening has made a huge difference in that decline in mortality. So, you know, what does that mean? That sounds like a lot of numbers, but that translates to nearly 4.5 million fewer cancer deaths during this time than what would've been predicted or occurred if the death rate had remained at its peak and continued along that trajectory.

 So it's really good news and the progress really mostly reflects declines in our foremost common cancers. Of which we happen to have average risk available screening in lung, colorectal, breast, and prostate. So  that really speaks to this, the importance  and the significant part that early detection has in our  work to end cancer.

Yeah. Very impactful. 4.5 million people.  that's a lot. That's a huge number. I. so you, you mentioned I think the four most common types of cancer, and so you said  I believe you said colorectal, prostate, breast, and I think I'm missing one. Yeah. Lung. Yep. Yep, you got it. So are there particular populations more affected by certain types?

Yeah, that super definitely. So I'll say yes to that question and   cancer disparities occur across all cancer types and just like healthcare disparities and health disparities, so, so we know that cancer disparities happen when there are differences in access to healthcare and access to high quality healthcare.

That includes access to cancer prevention, screening, and treatment that may differ based on kind of non-medical factors. So obviously there's so much to all this um, in cancer disparities, but there's a few things that I think are important to point out here.  One, we know race and ethnicity are social constructs that really aggregate, like heterogeneous population groups.

So I, I don't mean to make these too big of assumptions or associations here, but it's very useful for using race ethnicity to examine the influence of injustice and discrimination. On  health disparities and cancer disparities. So there's a few things I think are important here to highlight that, that I, that may might not be known to everybody or maybe overlooked sometimes, but they're really significant disparities that happen in cancer.

So I'll give you a few facts on this, and this is all you can, I'll read more about all of these, statistics in our  ACS Annual Cancer Facts and Figures report that comes out each January. It's available on cancer.org. You'd like to, anyone would like to read more there, but a few highlights I think are really significant and important.

So black men, along with American Indian, Alaska native men have the highest overall cancer mortality rate, which is 16% higher than white men. So that's important within that.  We know that prostate cancer mortality in black men. Is two to three times higher than men of other racial ethnic groups. So prostate cancer is really significant when we think about population groups that are more impacted and black men  are one of those more impacted populations.

 then if we, um, look at breast cancer and other common cancer. Breast cancer mortality in black women is about 40% higher than white women despite a lower incidence. So that means while black women may be diagnosed at a less frequent rate than white women, the mortality for black women who gets breast cancer is maybe 40% more than a white woman.

This is a disparity that's been really difficult to uncover and understand the root cause in students remain pretty consistent. Since the mid, um, two thousands. So it's really an important area of research focus  for both the American Cancer Society as well as  researchers around the nation.

 Our current ACS Voices study  we're recruiting black women to participate in the longitudinal  cohort study to learn more about those underlying factors that are contributing to this.  Really dis discourage, well discouraging, but also disconcerting  difference in black breast cancer mortality.

One more I'll mention, and we could do, this could be a whole podcast, but I'll just mention one more. I think that's really important that, um, again, I think it's gonna be overlooked, is that when we think about  and look at cancer rates in American Indian in Alaska, native men and women.  American Indian, Alaska native men and women combined have the highest cancer incidents and mortality of any population group.

 And importantly, this was driven by a lot by the extraordinary burden of colorectal cancer among Alaskan native people. Who have the highest rates in the world. So there's lots of multifactorial reasons for these disparities, but certainly an area that needs lots and lots more ongoing research.

And then more and more implementation support to help overcome  the known barriers and then find new solutions. Absolutely. So if we think about. Barriers to screening?  I guess two parts maybe to this question.  Do we have a sense, do we know how many people in the United States are actually up to date on recommended screenings, and what are the very biggest barriers?

What is preventing people from getting these recommended screenings? Yeah, I love that question. Um, It's really important.  Also and we do know, we actually do know how people are doing with cancer screening. When we think about the population overall. There's several really helpful and important data sets that look at cancer screening rates across the us.

  The ones that we use most commonly are  the public health data sets, like the B-R-F-S-S or the National Health Interview Survey. So those surveys tell us that breast cancer screening rates are 69%  for all females over age 45. So that means  two thirds ish, a little bit more  of women over age 45, which is the recommended starting point for breast cancer screening  are up to date.

 Alman, I'll go through the list here and I'll talk through some of the trends about all of these screening rates. So that 69% for breast cancer. Cerv cancer screening rates for females ages 25 to 65, again, which is aligned with the current recommendations is 76%. So 76% of females ages 25 to 65 are up to date with their cervical cancer screening.

Colorectal cancer screenings, 65% of adults over age 45.  However, the colorectal cancer screening starting age was lowered to age 45 back in 2018, and so the rates for.  Males and females who are 45 to 49 is only 37%. So we still have lots of room to get um, those younger people  up to date with screening.

Then lung cancer screening is, really lagging behind that.  Lung cancer screening is, perhaps a little bit newer recommendation, but really important and has made a big difference in finding lung cancer early. And there's been lots of advances in treatment in lung cancer. So important, important population to, to help. So for people who are higher risk and have a either current smoking history or past smoking history. The lung cancer screening rates are only 14% across the nation. So we have lots of room for improvement there. Wow. Now, yeah, so those are rates for like just the broad population, which can represent  a mix, but maybe more of a mix of insured people with health insurance.

So if we look at like in community health centers, do they also  measure breast, cervical and colorectal cancer screening rates in community health centers? All community health centers report out on their screening rates to HRSA every year through the uniform data system and screening rates there are, lower than this.

And that really speaks to barriers, other barriers to screening. Yeah, I, I didn't realize how low those numbers were.  We do have a long way to go. So shifting a little bit and  talking about ways and tools to get people to, to get those necessary screenings. Why did the American Cancer Society develop the Cancer Risk 360 assessment tool?

What gap or need was it designed to address? Yeah.  So a couple things. So you know, we've been working at the American Cancer Society really, you know, for, for quite some time. We're, We're a really old organization now, more than a hundred years old. But we've been you know, working on helping people know about cancer screening and have access to cancer screening for quite some time.

The Cancer Service 360 tool was really meant to address a couple of things.  One  cancer screening is just one piece of the puzzle of cancer risk reduction. And so Cancer Risk 360 is really designed to be a comprehensive risk assessment tool. So when you think about comprehensive cancer risk, wanna help people stay up to date with their recommended cancer screenings, of course.

 But also understanding and knowing about family history, where that's available  and knowing where it may be important to. Have access to genetic counseling and testing to identify genetic mutations that can put someone at higher risk or other family conditions that can put someone at higher risk.

 Is also important to the comprehensive picture of risk reduction. And then lastly  lifestyle  is another really important part of cancer risk reduction and  wanting to help people know  what parts of lifestyle and how to live a healthy lifestyle. And what does like healthy living mean? As it relates to cancer risk reduction.

So  what does it mean to stay physically active or  eat a healthy diet, follow a healthy, nutritious eating pattern?  What are those recommendations and how do we help people have personalized information about cancer risk, and that was a main driver of why we developed the Cancer Risk 360 tool.

And it's, wonderful. We're gonna link it on the podcast where people can find Cancer Risk 360. I love it. I've recommended it to many people and they feel the same, and it's eyeopening, but it provides. Really wonderful personalized information  which we all need in order to make decisions.

So for someone using Cancer Risk 360 for the first time, what can they expect? What information do they need to provide, and how long does it take to do the assessment Typically? Yeah, so the assessment seems, takes most people about five to seven minutes.  Although you can spend as much time as you'd like, like reading more about your personalized recommendations through all of our information on cancer.org.

 But I think what you can expect is very like user-friendly, easy to use. Just, it's a web-based app, so there's, you don't have to log in, you just go to cancer.org to the cancer 360 landing page. And you'll start, you enter in information about yourself.  Everything that you know. If you don't know the answer to something, it's okay to leave it blank.

It doesn't, we'll still be able to help you with some personalized recommendations. And then  the tool is built on an automated decision making matrix. So there's   fairly complicated  decision trees that, that help. Provide the personalized recommendations based on the information you're putting into the tool.

So it'll ask, we'll ask things about your age. Your sex, your health history, your cancer screening history, your everyday life  just what's your daily habits look like?  What's your diet look like?  How physically active are you? Are you smoking cigarettes or using other forms of tobacco?  Your zip code and where you live just to be able to provide  the, as most personalized information as we can.

And so then at the end of the assessment asker, after you answer a bunch of questions just like tap, tap your screen, you can do on your mobile. Device or on your laptop. At the end you'll have an action plan that gives you personalized recommendations and tips about things you can do today to make a difference in reducing your risk of cancer.

And then really  we hope that action plan can be a conversation starter with your doctor  so that you can go into your, for your annual wellness visit or for any visit really, and say, Hey, I took this Cancer Risk 360 assessment and it says that I'm overdue on my.

Colorectal cancer screening, for example, and then you can have a conversation with your doctor.  And, but you've already had a chance to be informed as a patient and going into your visit  with some information that you can have a good discussion about. Yeah.  it's like, it's wonderful.  I spoke with one person who filled it out and they said, I didn't realize me sleeping five hours a night was, might increase my risk of cancer.

I said you know, among other things. Yeah, exactly. Exactly. But it brings attention to these things that  maybe we can all be    improving upon. So once someone completes the Cancer Risk 360 assessment. What do you recommend they do with the results? So you mentioned they, that they speak with their doctor  anything else that they should do with that information to take action?

Yeah. Um, Yeah, I would love for people to take action and that's, another important part of this tool is that we really wanna move from telling people like what to do  about cancer, to helping people  what, how to do it. And so the recommendations are really. Help with that.

I'm like, okay, so how can I sleep more? Like maybe someone's having difficulty sleeping or having a hard time staying asleep. Like those are important conversations to, to have with your doctor to learn more about you know, good sleep hygiene. Or maybe there's something about your diet where  you didn't realize that whole grains and fiber were important to a healthy diet.

And so you read more on cancer.org and learn about  higher fiber foods and then you can take that information with you to your. Go to the grocery store or incorporate that into your meal planning for the week.  And so you can start to eat different and incorporate more whole grains, for example.

So, you know, we'd really recommend that people at the end of the assessment, you can  download and save your own action plan. We don't save any of it.  So there's no, no information or data that is stored  by us.  But you can, as the user download your action plan. You can email it to yourself, text it to yourself, you can share it with your friends or family if you'd like.

 And then really use that and refer to it as really an action, like a personalized  cancer risk reduction action plan. And it doesn't mean you do everything today  but hopefully you can go back to that and check the boxes and just work on you know, maybe one new habit every so often and really make a difference in living a healthy life.

Which, which as you said, is matters to cancer prevention, but also matters to other chronic disease prevention. And so all of these tips about, especially on the lifestyle space are  matter to reducing the risk of diabetes, reducing the risk of heart disease, and reducing the risk of cancer.

These little steps make such a huge difference. So just getting that action plan and then doing small steps towards really working through those actions is, it's powerful. Very powerful. So, looking ahead, are there any upcoming enhancements or future directions planned for Cancer Risk 360 or for the American Cancer Society's approach to early detection more broadly?

Certainly we are enhancing the tool based on user feedback and based on any new science or new advancements in early detection that we learn about or that are published  all the time. We do enhancements you know, on a regular basis  and are planning for that to continue.

The user feedback I'll mention is really important to us. We definitely want to hear from users. There's a chance at the end of the tool. To, um, just tell us what you think through just a quick little survey and or share any written feedback you'd like, and that we look at all of those and take them seriously.

And  I've been making enhancements really throughout this first year, and we'll continue to do that. I think we have a couple things on our, like maybe our dreaming list about future directions for cancer Risk 360.  Including  maybe first and foremost just continuing to get  the word out so that everybody who can use a little assistance with cancer prevention  has this kind of assistance.

 We've reached a lot of people so far.  We've seen more than 50,000 assessments completed since the launch, earlier this year. But the  the number of adults in the United States that could benefit from the information news is obviously much bigger than that. So we have lots of, work to do to just continue to get the word out and help people use the tool.

But we're also looking at things that we to enhance in the way that  for, there are some topics within the overall tool that could really be like, we could dive much deeper in for people who wanna go deeper or learn more about a certain part of topic. So  for example   for females there, there are specific  female specific  cancer risk things, you know. female cancers that are, that really matter. And there's some deeper questions we can ask that could be like a separate pathway. So not to overburden the tool is already fairly long, so we don't wanna make it much longer for everybody. But for some people you'll be interested in learning more or having something  even more specific to you, your individual circumstances.

So we're looking at  some like kind of add-on modules that may be related to. Cancer survivors. So you know, risk reduction um, and cancer prevention after cancer still matters. And there's some specific  things that matter for people with a history of cancer. So that may be a kind of a special pathway.

Like I said, maybe for women, a special pathway.  Maybe others  related to  family history where we or somebody that has a known  genetic mutation that can increase the risk of cancer. So, a few things to add more specificity. and then the other thing is, you know, I think we're always looking to just make it engaging and fun.

  Certainly   the topic is maybe dense and maybe feels a little  difficult to maybe grasp or. Take action, but we wanna  do what we can to help provide support for the behavior changes that, that may sound easy, but really need support.  And having  support along the way to make lifestyle changes can make a big difference.

Yeah. Exciting things coming. So I talk a lot to individuals who come on the podcast about health misinformation, health myths that are out there and  trying to really  get to the truth. So, last question. If you could change one common misconception about cancer risk or prevention, what would it be?

Oh yeah. I love this question and thank you for  addressing  misinformation or myths that can be out there.  I think there, there has been  a common,  misconception that about that  that cancer cannot be prevented. And so certainly there are lots of cancers and there's things that happen and cancers that happen that we don't know why.

Right? And that's, we are continuing to learn more about that. We need more and more research. There's so much to learn.  But importantly we do know that more than 40%, about 42% from our research of cancers overall are associated with modifiable risk factors. And so I think it's really important for people to know, I'd want people to know that cancer risk can indeed be modified.

  Risk is  relative for the individual and, has lots of pieces to it. But there are many things to do to, take the steps we know to take to reduce the risk of cancer, which also contributes to a healthy life overall.  And that includes what we talked about here when we think about  keeping up to date with recommended cancer screenings.

 Knowing if you may fit a high risk category and talking to your doctor about that. And then   taking steps to make healthy choices and live a healthy life and reducing  risky substances, eating a healthy diet, staying physically active, getting good sleep, managing stress, having social connection, all of that is so important just for healthy living overall, but can make a big difference in cancer.

Prevention too.  The other thing I, I always like to say when I have the chance about kind of cancer risk reduction and cancer prevention, is that all those things are really important and that equally important is that we want people to pay attention to any new symptoms that aren't going away. So if you have something new happening with your body that just isn't going away, that just doesn't seem right  I really would hope would want to encourage people  to go speak to your doctor about that and  make sure you get evaluated.

All of that together can make a big difference in reducing the risk of cancer or finding it early. I love those tips. They really empower people  to let them know that they can make a difference in prevention of disease. So they're still very important.

Yeah. Absolutely. If people want to learn more about the American Cancer Society or Cancer Risk 360, where can they do that? Yep. So cancer.org is the best place  to go to learn more.  So Cancer dot  has all of our information.  Cancer Risk 360 is available there at cancer.org/um, cancer Risk 360.

 Or if you'd like to call and speak to someone live, our National Cancer Information Center is always available.  And that number is 1 802 2 7 2 3 4 5. That's wonderful resources. Dr. Laura  Makaroff thank you so much for joining us and I look forward to more innovation from the American Cancer Society in the future.

Thanks so much for having us. We really appreciate it. Thanks for all your work.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.