Colorado Colorectal Screening Program Holly Wolf University of Colorado School of Medicine

Colorful Colorado

Map of Colorado

Colorectal Cancer in Colorado Second leading cause of cancer death - Each year, 1690 diagnosed and 620 die Screening can reduce incidence (polyp removal) Screening can also reduce mortality »FOBT by 30% »Sigmoidoscopy by up to 50% »Colonoscopy by up to 80% Only 55% Coloradans ages 50+ are screened –66% ages 65 + (Medicare) –52% ages with health insurance –26% ages without health insurance

Colorectal cancer mortality, US and Colorado United States Cancer Statistics: 1999–2002

5-Year CRC survival CRC in Colorado 5-year colorectal cancer survival in Colorado by proportion of neighborhood in poverty

CRC screening trends, US and Colorado % Non-Hispanic Whites Hispanics

Colorado Colorectal Screening Program Funded by revenues from a tobacco tax Began in January 2006, expanded statewide in November 2006 Partnership with community clinics

Approach Provide endoscopic colorectal screening to Coloradans without health insurance who are under 250% Federal Poverty Level and who need screening Encourage all Coloradans ages 50 and older to get screened.

Program Components Endoscopic screening in clinics or by referral Follow-up and Rx Patient navigation support Capacity development Public outreach & marketing Evaluation

Program Eligibility Coloradan ages 50 and older Under 50 if family or personal history Patient of a participating clinic Income below 250% of Federal Poverty No health insurance Need colorectal screening Lawfully present

Need for screening Assessed by primary care provider using consensus screening/surveillance guidelines Average risk – 50 years and older Increased risk - under 50 –Family history of colorectal cancer or adenomatous polyps –Personal history of adenomas or colorectal cancer High risk – Under 50 –Family history of FAP or HNPCC –Personal history of IBD for 8 years or longer Symptomatic - 45 years or older

Findings from the first 925 CCSP colonoscopies 65% female 47% Hispanic 8% African American 99% had an adequate exam 21% had adenomas 1% had cancer

Goals Implement statewide screening asap –Seamless program management –Patient navigation and support –Flexibility for new screening methods Screen approx 3000 per year –Year 2010 objectives of 75% screening compliance among uninsured

Program information – –CCSP coordinating center: –ACS help line:

Tim Byers, MD, MPH Angela Sauaia, MD Susan Rein, RN Andrea Dwyer BS Jan Lowery, PhD Holly Wolf, PhD The Colorado Colorectal Screening Program