Five Questions With: Robert Dulski

Robert Dulski is the government relations director for the American Cancer Society Cancer Action Network in Rhode Island. ACS CAN is the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society. ACS CAN offices are located in Warwick. 

In July, Dulski and his wife, Annie, moved from Chicago to Providence, as she began her residency in emergency medicine at Kent Hospital. Dulski has held several positions on local and state campaigns and did logistical support on the most recent presidential cycle. He has worked for the federal government on Capitol Hill and has also served in two administrations at the Illinois comptroller’s office. Before joining ACS CAN in Rhode Island, Dulski worked for the largest health system in Illinois, Advocate Health Care, where he served on their government relations team.

PBN: According to cancerstatisticscenter.cancer.org, Rhode Island is slightly above the national cancer death rate at 167.1 versus the national 163.5 rate. What may account for that difference?

DULSKI: Cancer death rates have continued to fall at a rate of about 1 percent per year since the early 1990s. Over the past decade of available data, the cancer death rate declined by about 1.5 percent annually in both men and women. Although it is difficult to pinpoint exactly why Rhode Island’s cancer death rate is slightly higher than the national average, we know what we can do to help continually decrease this number, including both medical and public-policy improvements.

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In the early 1990s, cancer mortality rates began to turn downward after steady increases over many decades. These downturns were the direct result of improvements in cancer prevention, early detection and treatment, including declines in smoking prevalence. Without those improvements, cancer mortality rates would most likely have continued to rise – and by committing to continued research and public-policy improvements, we can help bring about continued decreases in cancer death and suffering, both here in Rhode Island and nationally.

PBN: There’s also a higher rate of lung-cancer deaths in the state, 48.3 versus 43.4 [nationally]. Can you explain that difference and how the state may work to improve it?

DULSKI: Lung cancer is the most common cause of cancer death in both men and women and even one person suffering or dying from this disease is one too many. We know that over 14 percent of Rhode Island adults smoke, and 28.3 percent of all cancer deaths in Rhode Island are attributable to smoking.

While data does not explain precisely why the rate of lung-cancer deaths in Rhode Island is higher, we know that smoking is the leading cause of lung cancer, and that Rhode Island’s tobacco prevention and cessation program is woefully underfunded.

Despite collecting $195.5 million in revenue this year from tobacco taxes and the 1998 state tobacco settlement, Rhode Island will spend only $375,622 of the money on tobacco prevention and cessation efforts. This program is critical to help Rhode Islanders quit smoking and prevent our youth from ever picking up this deadly addiction, and funding levels must be increased in order to help decrease smoking – and smoking-related disease and death, including cancer.

PBN: Your release notes much of the progress nationally is attributable to decreasing death rates for lungbreastprostate and colorectal cancers. Rhode Island doesn’t appear to be enjoying the same success with lung cancer – how much is that contributing to the higher death rate?

DULSKI: While we do not have the statistics to answer this question specifically, we must look again to tobacco use as a leading cause of lung cancer and lung-cancer deaths.

While adults struggle to quit smoking and youth are tempted to pick up tobacco for the first time, the state of Rhode Island spends less than 3 percent of the Centers for Disease Control and Prevention’s recommended amount on proven tobacco control and prevention strategies.

This is despite the fact that the tobacco industry spends an estimated $26 million marketing their products in Rhode Island each year. Any association between the overall cancer death rate in Rhode Island and the lung-cancer death rate would see a downturn with strong tobacco-control policies, including comprehensive smoke-free laws, regular and significant tobacco-tax increases and well-funded tobacco prevention and cessation programs.

PBN: Please share your own takeaway from the state and national data.

DULSKI: We’ve made tremendous progress in the way we diagnose and treat cancer across the country, and we have seen advances in research each and every day that help reduce the burden of cancer. But to leverage this progress, state and federal lawmakers must take advantage of the opportunities to pass evidence-based laws and policies that are proven to save lives and money.

In Rhode Island alone in 2018, nearly 6,000 people will be diagnosed with cancer and approximately 2,180 will die from the disease. We can’t wait to take action when the stakes are that high. It is critical that Congress commit to federal priorities such as increased federally funded cancer research and increased access to affordable, adequate health insurance.

Locally, ACS CAN is working closely with the Rhode Island General Assembly to promote increased tobacco-control program funding and legislation that would prohibit minors under 18 from using cancer-causing indoor-tanning devices.

This report is also an important reminder that there remains work to be done; but the good news is that everyone can play a role in the fight against cancer. The American Cancer Society and ACS CAN are always looking for new volunteers and advocates – ordinary Americans who are ready to dedicate a little bit of their time to the fight against cancer. I encourage interested Rhode Islanders to visit ACSCAN.org/RI today to get involved.

PBN: Colorectal-cancer death rates declined 52 percent from 1970 to 2015 among men and women because of increased screening and improvements in treatment. However, between 2006 and 2015, the death rate among adults younger than 55 increased by 1 percent per year, according to the site. Is more screening required to make up the lost ground, and is Rhode Island well-prepared to start that work?

DULSKI: Colorectal cancer is the third-leading cause of cancer death in men and women in the U.S., and a cause of considerable suffering among the estimated 460 adults who will be diagnosed with colorectal cancer in Rhode Island in 2018, but screening can help bring down this number.

When adults get screened for colorectal cancer, it can be detected early at a stage when treatment is most likely to be successful, and in some cases, it can be prevented through the detection and removal of precancerous polyps. Because we know that screening saves lives, the American Cancer Society has joined with National Colorectal Cancer Roundtable to commit to eliminating colorectal cancer as a major public-health problem and are working toward the shared goal of reaching 80 percent of adults aged 50 and older screened for colorectal cancer.

The society works closely with local communities to empower patients, providers, community health centers and health systems to embrace these models and develop the partnerships needed to deliver coordinated, quality colorectal-cancer screening and follow-up care that engages the patient and empowers them to complete needed care from screening through treatment and long-term follow-up.

ACS CAN is also advocating lawmakers in Congress to support the Removing Barriers to Colorectal Cancer Screening Act, which would remove a loophole that allows Medicare patients to face cost-sharing requirements for a colonoscopy with polyp removal.

All of these efforts can help bring about decreases in colon-cancer rates in Rhode Island and nationally. House [Majority] Leader [K. Joseph] Shekarchi aims to extend coverage for mastectomies to all treatments.

Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.