Turning Data into Action for Colorectal Cancer November 17, 2014 Jessica Shaffer, Director, Maine CDC Colorectal Cancer Control Program Tim Cowan, Director, Health Index Initiative

 Five-year funding through US CDC ( ).  One-year extension funding ( ).  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

Colorectal Cancer Incidence and Mortality Decreasing Over Time

CRC Incidence & Mortality among CRCCP States, 2010 a a Incidence rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P ). (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.) a Mortality rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P ). (Source: U.S. Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention, 2014.)

BRFSS Methodology Changes 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, 2012 a a Percentages reported for adults aged years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.)

CRC Screening Prevalence by CRCCP States, 2012 a a Combined. Percentages reported for adults aged years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.)

CRC Screening by Gender, 2012 a a Percentages reported for adults aged years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.)

CRC Screening by Age, 2012 a a Combined. Percentages reported for adults aged 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, 2012 a a Combined. Percentages reported for adults aged 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, 2012 a a Combined. Percentages reported for adults aged 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

Five-year Relative Survival Rates Top Five Cancers All Stages LocalRegionalDistant Lung/Bronchus* Colon/Rectum Breast-Female Uterine Cervix Prostate * screening test available only for those with high-risk

Stage of Cancers Diagnosed Cancer/SEER Stats vs MaineU.S. Whites Early-stage (in-situ or localized) 47%45%40%43% Late-stage (regional or distant cancers) 47%49%55%52% Unknown Stage 6% 5% Total 100%

Evidence-Based Interventions: FIT Testing Randomized Control Trial in 16 Rural Family Medicine Offices in Iowa Intervention Number of Patients (743 total) % screened for colorectal cancer (any type) Usual Care % Physician chart reminder % Physician reminder + mailed educational materials & FIT % Physician reminder + mailed educational materials & FIT + Telephone call % JABFM, September-October 2013, Vol. 26 No. 5; p doi: /jabfm

Randomized Control Trial- 16 Rural FM Offices in Iowa JABFM, September-October 2013, Vol. 26 No. 5; p doi: /jabfm Percent Screened with fecal immunochemical test (FIT) or colonoscopy (CS)

U.S. CDC: Screen for Life: The Community Guide: Maine CDC Cancer Screening: Additional Resources

Jessica Shaffer Thank You! Tim Cowan