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In recent years, the state health department and other health organizations have significantly enhanced the number and quality of cancer-related programs conducted in Colorado. Most of these, however, came about through issue-specific grants that impose restrictions and limitations on program activities, cross–program collaboration, and planning across cancer sites and risk factors. Although Colorado has an existing infrastructure for public-private collaboration in which public health functions are integrated into the larger health system, a formal structure is needed to ensure that comprehensive cancer prevention, control, and care happens in a systematic and synchronized manner. The following are objectives and strategies for implementing this plan.
The following logic model is used to guide the efforts of the Colorado Cancer Coalition (CCC) to implement this plan:
The CCC Executive Committee interfaces with health and disease-specific task forces. These task forces are eztablished as volunteers and interested parties convene to address certain issues.
Each member organization is represented on the CCC and may bring issues for discussion and action for consideration of the CCC as a whole. Participation of individual member organizations in various projects such as this one can be queried via email listserv.
Governance and Membership
According to the CCC rules of operation, membership is open to any organization whose mission is not in conflict with coalition priorities and who meets all membership requirements. Each member organization is expected to do the following:
Endorse and support the implementation of CCC priorities.
Assist with recommending and recruitment of new members.
Coordinate and collaborate within its own organization to implement strategies that address one or more CCC priorities.
Coordinate and collaborate with one or more other organizations to implement strategies that address on or more CCC priorities.
Provide information at least annually about organization progress and accomplishments.
Attend regularly scheduled meetings (attendance can be in person or via teleconference). If unable to attend, all effort will be made to appoint someone to attend in place.
Share ideas, recommendations, and agree to disagree.
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Colorado's Comprehensive Cancer Program invests a portion of its Center's for Disease Control and Prevention (CDC) funding dollars in the cancer initiative. The first state appropriation t for the CCC was made in the2009. These funds are used for basic infrastructure and communication needs.
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While state appropriations represent the bedrock of the coalition's funding in its formative years, the initiative is dedicated to developing a balanced portfolio of financial support. The CCC has also receives private donations and in-kind gifts. As programs continue to develop, individual contributions, proceeds from events, corporate gifts, and foundation and government grants will be emphasized as essential to the CCC's ability to leverage its state appropriation.
More detailed information about the Colorado Cancer Coalition and its activities can be accessed at
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Introduction
Health Equity
Prevention
Selected Cancers
Pediatric (Children)
Quality of Life
Evaluation & Research
Coordination & Evaluation
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"It's hard to deal with them, because we are so overwhelmed by these advertisements," he said. "But I don't think we should reject them out of hand. We should think of what they say about illness and health."
When administered in vitro, PDE5 inhibition induces apoptosis in colon carcinoma (15) and chronic lymphocytic leukemia cells (16). To determine whether similar effects could be observed in vivo, we used various transplantable mouse tumors, including CT26WT (a colon carcinoma; Fig. 1 A), the more aggressive variant C26GM (Fig. 1 B), TS/A (a mammary adenocarcinoma; Fig. 1 C), and the MCA203 fibrosarcoma (Fig. 1 D). PDE5 inhibitors were administered starting on the day of tumor challenge. Sildenafil and tadalafil significantly delayed tumor outgrowth by 50 to 70% in immune-competent mice, although all mice ultimately died (Fig. S1, available at http://www.jem.org/cgi/content/full/jem.20061104/DC1). Similar results were obtained even if sildenafil treatment was started on day 7 after tumor challenge in the CT26WT model (Fig. S2). The fact that no difference in tumor outgrowth was seen between early versus late administration of sildenafil suggests that PDE5 inhibition does not appreciably affect the early phases of tumor uptake but rather influences the later stages of tumor outgrowth. Because the addition of sildenafil to cultured CT26WT cells did not increase their apoptosis or affect their doubling time (unpublished data), we conclude that sildenafil does not have a direct antitumor effect but rather interferes in host–tumor interactions.
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Studies published in the British Medical Journal indicate that some birth control pills have a higher risk of blood clot than others. Combined pills that contain both estrogen and progesterone have been associated with developing blood clots in the vein (deep vein thrombosis).
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As of May 1999, postmarketing reports of sildenafil have not resulted in a change by the FDA concerning the safety of the drug. Although several patients have died after receiving prescriptions for sildenafil, it is unclear how many of these deaths resulted from appropriate use of the medication. Between late March and July 1998, 3.6 million outpatient prescriptions for sildenafil were dispensed. During the same period, 69 patients in the United States died after the confirmed use of sildenafil. No cause of death could be found in 21 of these cases. Of the remaining 48 deaths, 46 were attributed to cardiovascular events. Twelve of the men who died had taken nitroglycerin, either prescribed or self-administered. Postmarketing studies are continuing.18 A patient who has been advised not to have sex for medical reasons clearly should not be given a prescription for sildenafil.
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Surgery for erectile dysfunction may have as its goal:
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Vasoactive injection–When injected into the penis, certain solutions cause erection by dilating blood vessels in erectile tissue. Normally, these injections produce an erection lasting about 20 minutes. During this procedure, penile pressure is measured and x-rays may be taken of the penile blood vessels using a special dye (contrast agent).
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A small percentage of men undergo vascular reconstructive surgery to improve blood flow to the penis. Revascularization involves bypassing blocked veins or arteries by transferring a vein from the leg and attaching it so that it creates a path to the penis that bypasses the area of blockage. Young men with only local arterial blockage are the best candidates for this procedure. It may restore function in 50% to 75% of men.
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Dr. Andrew McCullough, director of male sexual health, fertility and microsurgery at NYU Langone Medical Center, said the results are promising.
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Alprostadil, PGE1, has been formulated into a small suppository that can be inserted into the urethra. In a selected group of men, the agent was effective in 65%. This agent may be effective in men with vascular disease, diabetes, and status post prostate surgery. This is a useful agent for men who do not want to use self-injections or for men in whom oral medications have failed. It has been successfully used together with sildenafil in cases in which each agent alone failed. Few adverse effects occur, and the most common is a painful erection and urethral burning, which occurs in less than 10% of the patients.
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