1. Cigarette Restitution Fund Colorectal Cancer Program—Update November, 2003 Diane M. Dwyer Center for Cancer Surveillance and Control Maryland Dept. of Health and Mental Hygiene

2. THANKS: 25 Maryland Local PH Programs DHMH Staff Carmela Groves Alyse Weinstein Lorraine Underwood Eugene Small University of MD Team Eileen Steinberger Annette Hopkins Min Zhan Jane Uman Ebenezer Israel

3. Maryland Cigarette Restitution Fund Allocation—FY03 $ 202 Million

4. CRF Budget—Local PH $ in Millions

5. Create a Network through Partnerships and Contracts

6. State Health Dept. Program Minority Outreach, Technical Assistance 2 Statewide Academic Health Centers: Research, PH, Statewide Health Network Providers: Doctors Labs, Hospitals, Pharmacies 24 Community Health Coalitions Community based orgs. Faith based organizations Volunteers Maryland Citizens, esp. Minority & Underserved 25 Local PH Programs CRF Cancer Control “Network”

7. Local PH—Number of Contracts for Education/Outreach/Media Services* ~ 46 from 14 programs * Non fee-for-service to CBO, Minority, Faith-based, Education, Advertising ~ 68 from 17 programs ~ 75 from 17 programs

8. Local PH CRF Programs— Number of Contracts for Medical Services* 336 605 * Fee-for-Service for Providers, Hospitals, Labs, Pharmacies, Radiology

13. Colorectal Cancer CRF Programs 23 of 24 jurisdictions chose to focus on colorectal cancer (not Baltimore City) Screening began ~January, 2001 22 jurisdictions screening for colorectal cancer under CRF funding in FY04

15. CRC Medical Advisory Committee Medical experts Advise program on screening procedures, screening intervals Formulated Minimal Elements for CRC Screening

16. Colorectal Cancer Education and Outreach

17. Colorectal Cancer--Number Educated by Type of Audience Maryland, June 2000-November 4, 2003 N = 151,507 Source: Education Database, Form 1 as of November 4, 2003

18. General Public CRC Education (Brief, Individual, and Group) by Quarter and Minority Status Source: Education Database, Form 1 as of November 4, 2003

19. Media, Newspaper, Pamphlets, Billboards, etc. July 2000—November 4, 2003: >22 million Colorectal cancer messages targeted to reach >22 million people

20. Colorectal Cancer Screening and Treatment

22. Washington County Colonoscopies, 2001-2003 Washington Co. CRC program began 2001 20022003

24. Colorectal Cancer Screening >50 years old Maryland Cancer Survey--2002

25. Current CRC Screening Status of Marylander’s >50 years old—Maryland Cancer Survey, 2002 *UTD—Up to date per ACS options for screening

26. Colorectal Cancer CRF Public Health Program Screening Data

29. Summary of CRF CRC Screening As of October 30 2003: 6,523 FOBTs 129 sigmoidoscopies 129 sigmoidoscopies 3,976 colonoscopies 3,976 colonoscopies * Using “highest numbers” reported to DHMH

30. CRC Screening by Gender Maryland FY01-present

31. CRC Screening by Minority Maryland FY01-present

32. CRC Screening by Minority and Gender Maryland FY01-present

33. Persons Screened* for CRC by Minority Status, Maryland 7/1/00-6/30/03 * Screened with FOBT, Sig., or Colonoscopy—DHMH database 42% Minority

34. CRF CRC Screening Results * Using “Highest numbers” NumberResult FOBT 6523 * 10% positive Sigmoidoscopy 121 ** 41 (34%) had “findings” Colonoscopy 3,976 *782 (20%) adenomas 45 (1.1%) with cancer ** Using those in DHMH database As of October 30, 2003

35. CRF CRC Screening Results* * Using those in DHMH database; as of October 30, 2003 Number Adenomas Cancer Colonoscopy only 2,922594 (20.3%) 29 (1%) FOBT positive; then colonoscopy 22441 (18.3%) 9 (4%) FOBT negative; then colonoscopy 49790 (18.1%) 0 (0%) 72538

36. Other Findings on Colonoscopy 46% of colonoscopies without adenomatous polyps or cancer had other findings: Non-adenomatous polyps hemorrhoids diverticular disease inflammatory bowel disease other

37. CRF CRC Screening Complications of ~3,700 Colonoscopies (with and without biopsy) Perforation3 Bleeding requiring ER visit or hospitalization 3-ER 1-Hosp Dehydration requiring hospitalization 1 Drug reactions2

38. * Pay for service until funds are depleted *

39. Lessons 45 colorectal cancers detected; over 70 cancers possibly prevented through polyp removal An effective colorectal cancer screening program for the under-served (uninsured and low income) is possible Services well received by providers and the community Programs shifted from FOBT-sig to colonoscopy Complications happen (at expected frequency) More difficult to reach men

40. Challenges Budget cuts How to screen those not covered by a program or insurance How to pay for diagnosis and treatment Incorporating new CRC screening methods