1. HOW STANDING ORDERS HELPED US IMPROVE CANCER SCREENING: REPORT FROM A NEW PPRNet MEMBER JULIO A SAVINON, MD RIO GRANDE MEDICINE INC. HARLINGEN, TX

2. IN CASE SOMEBODY ASKS WHERE HARLINGEN IS

3. ABOUT HARLINGEN Population: 65,679; increases by 14% annually. Most over 18 years old (near 70%) Winter Texans 2 major hospitals All specialties available. Need for improvement: poverty, uninsured, lifestyle…

4. ABOUT RGM More than 2,500 patients and growing 2 providers (1 IM, 1 FP) 4 MAs,2 Secretaries, 2 billers, one office manager, and others. EMR PPRnet. Managed care and ACO participation Level 3 PCMH Bariatric medicine and referrals.

5. USING PPRNet REPORTS

6. CANCER FACTS ESTIMATES FROM ACS FOR 2014 96,830, 40,000 new cases of COLON CA AND RECTAL CANCER, respectively. 50,310 expected to DIE. 232,670, 62,570 new cases of invasive and in situ BREAST CANCER, respectively. 40,000 expected to DIE. 12,360 new cases of invasive CERVICAL CANCER. 4,020 expected to DIE.

7. MORE CANCER FACTS Estimated cost for 2009 was US $216.6 billion, 86 billion for direct medical cost, 130 billion for indirect (lost productivity). Early detection usually results in less extensive treatments and better outcomes; to less suffering. The USPSTF recommends screening mammography for women 50-74 years, biennial. For cervical cancer: initiate at age 21; every 3 years, or every 5 years with HPV co-testing for women ages 30-65, then stop if not any abnormality. For colon cancer: colonoscopy age 50, every 10 years, until age 75, or until life expectancy is less than 10 years. FOBT yearly; sigmoidoscopy with FOB every 3 years. BE is not recommended by USPSTF.

8. CANCER SCREENING FACTS SOURCE: MKSAP 16 and NCI Breast cancer mortality reduction with mammography: 10-20%. Cervical cancer reduction with PAP: 95% (at least 80% including mortality reduction) Colon cancer reduction with colonoscopy: 53- 72% (similar for sigmoidoscopy, left colon), mortality reduction: 31%; with FOBT 17-20% cancer reduction; mortality reduction: 15-33%

9. RISK OF CANCER SCREENING source: NCI Overdiagnosis and unnecessary treatments. False positive with additional testing and anxiety False negative with false sense of security and potential for delay in diagnosis Radiation, bleeding, perforation, death. Cost

10. BREAST CANCER SCREENING SOURCE: CDC, US, 2010, MAMMOGRAPHY

11. COLON CANCER SCREENING SOURCE: CDC, BRFSS, US, 2010

12. CERVICAL CANCER SCREENING SOURCE: NATIONAL CENTER FOR HEALTH STATISTICS.

13. PAP TEST AFTER IMPLEMENTATION OF STANDING ORDERS AT RGM

14. MAMMOGRAM AT RGM AFTER IMPLEMENTATION OF STANDING ORDERS

15. COLON CANCER SCREENING AT RGM AFTER STANDING ORDER IMPLEMENTATION

16. CONCLUSION. STANDING ORDERS ARE HELPING US IMPROVE CANCER SCREENING

17. THE END