turning data into action for colorectal cancer november 17, 2014 jessica shaffer, director, maine...
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Turning Data into Action for Colorectal Cancer
November 17, 2014
Jessica Shaffer, Director, Maine CDC Colorectal Cancer Control Program
www.mainecancerconsortium.org
Tim Cowan, Director, Health Index Initiative
Five-year funding through US CDC (2009-2014). One-year extension funding (2014-2015). In collaboration with four largest health
systems in Maine.Program goals:
Direct provision of screening and diagnostic services to underserved populations.
Increase population screening rates through implementation of evidence-based policy & systems initiatives.
“Integrating Colorectal Cancer Screening in Chronic Disease”
*Year 06 screening goal = > 200 screenings
Year 01(July 2009 - June
2010)
Year 02(July 2010 - June
2011)
Year 03(July 2011 - June
2012)
Year 04(July 2012 - June
2013)
Year 05(July 2013 - June
2014)
0
50
100
150
200
250
300
350
400
64
350
314 322
226
Colorectal Cancer Screening Provision Through MCRCCP
Nu
mb
er
of
Scre
en
ing
s
Colorectal Cancer Incidence and MortalityDecreasing Over Time
CRC Incidence & Mortality among CRCCP States, 2010a
a Incidence rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25-1130). (Source: Combined data from the National Program of Cancer Registries as submitted to CDC by November 2012 and from the Surveillance, Epidemiology, and End Results program submitted to National Cancer Institute in November 2012.)
Incidence Mortality0.0
10.0
20.0
30.0
40.0
50.0
40.5
15.5
39.4
14.9
39.4
16.4
National CRCCP States Maine
Perc
en
t
Rank:13th
Rank:8th
a Mortality rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25-1130). (Source: U.S. Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention, 2014.)
BRFSS Methodology Changes- 2011
• Sampling method changes• Addition of cell phone users to increase coverage of
respondents with lower income, lower educational levels and of younger age groups
• Weighting method changes• Better adjustment for demographic differences between
respondents and the actual population by including additional demographic variables in the weighting method
• Due to these changes, BRFSS data from 2011 forward will not be directly comparable to data from previous years
Operational Definitions
• FOBT - Fecal Occult Blood Test within the past 1 year
• Colonoscopy - Colonoscopy within past 10 years
• FS + FOBT - Flexible sigmoidoscopy within the past 5 years with FOBT within the past 3 years
• Combined - FOBT within the past year; or flexible sigmoidoscopy within the past 5 years and FOBT within the past 3 years; or colonoscopy within the past 10 years
Colorectal Screening Prevalence, 2012a
FS+FOBT
FOBT
Colonoscopy
Combined
0% 10% 20% 30% 40% 50% 60% 70% 80%
NationalMaine
Adults 50-75 Receiving Screening (%)
a Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.)
0
10
20
30
40
50
60
70
80
Series1
CRCCP StatesNational
Percent
CRC Screening Prevalence by CRCCP States, 2012a
a Combined. Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.)
CRC Screening by Gender, 2012a
Male Female0
20
40
60
80
100
64.3 66.766.4 68.572.2 74.6
National CRCCP States Maine
Perc
en
t
a Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.)
CRC Screening by Age, 2012a
50-64 Years >=65 Years0
20
40
60
80
100
60.2
77.8
62.3
79.5
70.2
81.2
National CRCCP States Maine
Percent
a Combined. Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.) Data are suppressed if groups have fewer than 50 observations.
CRC Screening by Income, 2012a
<$15,000 $15,000-34,999
$35,000-49,999
$50,000-74,999
$75,000+0
20
40
60
80
100
47
5867 71 74
49
6068 72 76
6468
75 78 81
National CRCCP States Maine
Percent
a Combined. Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.) Data are suppressed if groups have fewer than 50 observations.
CRC Screening by Insurance Status, 2012a
Health Insurance No Health Insurance0
20
40
60
80
100
69
37
71
38
77
47
National CRCCP States Maine
Percent
a Combined. Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.) Data are suppressed if groups have fewer than 50 observations.
CRC Screening by Maine County, 2012
CRC Screening by Maine County, 2012
Five-year Relative Survival Rates 2001-07
Top Five CancersAll
StagesLocal Regional Distant
Lung/Bronchus*
16 52 24 4
Colon/Rectum
64 90 69 12
Breast-Female 89 99 84 23
Uterine Cervix 69 91 57 19
Prostate 99 100 100 29
* screening test available only for those with high-risk
Stage of Cancers DiagnosedCancer/SEER Stats- 2004-2005 vs.
2008-2010Maine U.S. Whites
2004-2005
2008-2010
2004-2005
2008-2010
Early-stage (in-situ or localized)
47% 45% 40% 43%
Late-stage (regional or distant cancers)
47% 49% 55% 52%
Unknown Stage 6% 6% 5% 5%
Total 100% 100% 100% 100%
Evidence-Based Interventions: FIT TestingRandomized Control Trial in 16 Rural Family Medicine Offices in Iowa
InterventionNumber of Patients
(743 total)
% screened for colorectal cancer
(any type)
Usual Care 185 17.8%
Physician chart reminder 185 20.5%
Physician reminder + mailed educational materials & FIT 186 56.5%
Physician reminder + mailed educational materials & FIT + Telephone call
187 57.2%
JABFM, September-October 2013, Vol. 26 No. 5; p 486-497doi: 10.3122/jabfm.2013.05.130041
Randomized Control Trial- 16 Rural FM Offices in Iowa
JABFM, September-October 2013, Vol. 26 No. 5; p 486-497doi: 10.3122/jabfm.2013.05.130041
Percent Screened with fecal immunochemical test (FIT) or colonoscopy (CS)
U.S. CDC: www.cdc.gov/cancer/colorectal/
Screen for Life: www.cdc.gov/cancer/colorectal/sfl/
The Community Guide: www.thecommunityguide.org
Maine CDC Cancer Screening: www.screenmaine.org
Additional Resources
