1. Kentucky Colon Cancer Screening Program (KRS 215.540-215.544) PHN ITV April 18, 2013 Connie Gayle White, MD, MS, FACOG Deputy Commissioner, KDPH Division Director, DPQI

2. Why have a screening program? *Colon Cancer is the third most common cancer diagnosed in both men and women in the US *Colon Cancer is the second leading cause of cancer death in men in Kentucky *Colon Cancer is the third leading cause of cancer death in women in Kentucky *Colon Cancer is >90% preventable if precancerous polyps are removed

4. US Rate: 46.30

6. US Rate: 16.70

7. AgencyRepresentativeAgencyRepresentative American Cancer SocietyEllen SchroederVA Medical Center J. Mel Bennett, MD Chair Colon Cancer Prevention ProjectWilliam Beam Kentucky Department for Public HealthConnie Gayle White, MD, MS Colon Cancer Prevention ProjectWhitney Jones, MDKentucky Hospital AssociationKim Dees Colon Cancer Prevention ProjectAndrea Shepherd Kentucky House of RepresentativesRep. Rocky Adkins Kentucky African Americans Against CancerVirginia Bradford, RN Kentucky House of RepresentativesRep. Tom Burch Kentucky Cancer ConsortiumJennifer Redmond, DrPHKentucky SenateSen. Alice Forgy Kerr Kentucky Cancer ProgramDebra Armstrong, MSW, MPAKinkead & Stilz, PLLCBenjamin Kessinger, III Kentucky Cancer ProgramConnie SorrelPike County Health DepartmentPaul Hopkins Kentucky Cancer RegistryTom Tucker, PhD, MPHUK Markey Cancer CenterMark Evers, MD Kentucky Department for Medicaid ServicesMary Coleman, RNUL Brown Cancer CenterDonald Miller, MD, PhD Colon Cancer Screening Advisory Committee (KRS 214.544)

8. Colorectal Cancer Screening in Kentucky 70% 60% 50% 40% 30% 200220042006 58.6% 47.2% 43.9% 34.7% 200819992010 63.7% 49 th in the U.S.20 th in the U.S.

9. Funding: *KRS 215.540-215.544 *Legislature assigned $1 million this biennium (FY 13 – FY 14) *This money will be matched (another $1 million) by the Kentucky Cancer Foundation, a private organization *10 sites received funding for this project

10.  Target Population: Low income uninsured adults aged 50 to 64  Increase colon cancer screening  Reduce morbidity and mortality from colon cancer  Reduce the cost of treating colon cancer through screening and early detection  Screening Services (annual)  1,500 FIT Screenings  150 Colonoscopies following a positive FIT  500 Colonoscopies for those at increased risk for CRC Program Objectives

11.  Target Population: Low income uninsured adults aged 50 to 64  Increase colon cancer screening  Reduce morbidity and mortality from colon cancer  Reduce the cost of treating colon cancer through screening and early detection  Screening Services (annual)  1,500 FIT Screenings + 1,500 FIT screens donated by Metro LOU  150 Colonoscopies following a positive FIT  500 Colonoscopies for those at increased risk for CRC  Plus 150 Colonoscopies donated by Metro LOU Program Objectives

12.  Development and Release of RFP Review and Scoring of proposals  Development of program policies, manual, and forms  Contracted for lease of FIT analyzer  Programming of state lab data system for data collection  Provided 6 face to face trainings for patient navigators  10 initial site visits conducted – visits continue throughout the grant period Tasks Accomplished to Launch the Program

13. 10 Funded CRC Screening Sites * Note – Counties of the same color are funded as one site ** Counties with a starburst are the fiscal agent for multiple counties not part of a health department district

14. 10 Funded CRC Screening Sites Plus Counties with Coal Severance Funds

15. Positive FIT screening or High risk by history

16. Positive FIT screening would lead to colonoscopy or High risk by history

17. Outcome and Quality Control Reports  # and % Positive FIT  # and % Defined as Increased or High Risk  # and % Positive Scope  Complications on Scope  Cecum Reached and Entered – Target 95%  Quality of Prep – Target 90% Good or Excellent  # and % with Polyps  # and % with 1cm or larger polyps  # and % needing surgical resection  # and % lost to follow-up  Documentation of connection to cancer treatment  % with Positive FIT where colonoscopy occurs within 90 days – Target 95%

18. Data of colonoscopy results: first 2 months ● 25 colonoscopies ages 30 to 64 ● 7 with family history of colon cancer ● 3 with personal history of colon polyp removal ● 14 negative colonoscopies ● 9 polyps – 5 adenomatous polyps ● 1 cancer April 9, 2013

19. Kentucky General Assembly Kentucky Colon Cancer Screening Program Advisory Committee Kentucky Cancer Program Community Health Care Providers Local Health Departments Kentucky Department for Public Health Kentucky Cancer Foundation Kentucky Cancer Registry Thank you to all the partners who have made this program possible!

20. Colon cancer awareness IT’S NOT JUST FOR MARCH ANYMORE

21.  Stephanie Mayfield Gibson, MD – Commissioner  Director, Division of Kentucky State Laboratory  Connie Gayle White, MD, MS – Deputy Commissioner  Director, Division of Prevention and Quality Improvement  Gary L. Kupchinsky, MA - Assistant Director  Sue Thomas-Cox, RN, BA, MAC – Branch Manager Chronic Disease Prevention *Janet Luttrell – Colon Cancer Program Coordinator  Becki Thompson, RN, BSN, CDE - Nurse Consultant  Teri Wood, PhD - Epidemiologist, Data Management and Outcome Reporting Kentucky Department for Public Health Staff