Overcoming Barriers to Cancer Screening. Durado Brooks, MD, MPH Director, Prostate and Colorectal Cancer American Cancer Society
|
|
- Charla Small
- 5 years ago
- Views:
Transcription
1 Overcoming Barriers to Cancer Screening Durado Brooks, MD, MPH Director, Prostate and Colorectal Cancer American Cancer Society
2 Cancer Disparities
3 Cancer Disparities: A Definition Cancer health disparities are differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions, beyond what would be expected under equitable circumstances, that exist among specific population groups in the United States. These population groups may be characterized by gender, age, race/ethnicity, education, income, social class, disability, geographic location, or sexual orientation. 1 Adapted from the National Cancer Institute, Division of Cancer Control and Population Sciences
4 Disparities in Health Health Status Disparities - unequal health status and/or outcomes between different groups -higher rates of disease -higher rates of side effects, complications, deaths Health Care Disparities - unequal consumption of health care services, or unequal quality of provided services -Some consume too little (Necessary care not given) -Some consume too much (Unnecessary care given)
5 Contributors to Health Disparities Patient variables Attitudes, expectations, preferences, biases, biology Clinician variables Biases, uncertainty System variables Administrative, financing, accessibility
6 Cancer Death Rates* by Race and Ethnicity, US,
7 Colorectal cancer death rates by educational attainment and race/ethnicity, ages years, 2008
8 Poverty and Cancer Survival 100 Cancer Survival Among Men Non-Hispanic White African American American Asian/Pacific Indian/Alaska Islander Native Hispanic- Latino Census tract poverty rate <10% % 20% or higher
9 Cancer Survival by Insurance Status* Covariate Adjusted Survival Private Insurance Medicaid Uninsured Survival Time in Months *Patients aged years diagnosed from Covariates included in the model are age, race, sex, and zip-code based income. Data Source: National Cancer Data Base. Ward, E. et al. CA Cancer J Clin 2008;58:9-31
10 Total number of premature (ages 25 to 64) cancer deaths that could have been avoided in 2007 by eliminating economic and racial disparities
11 Cervical Cancer
12 Cervical Cancer Incidence and mortality rates decreased 67% over the past three decades, mainly due to the Pap test 2012 estimates in US o o 12,170 cases of invasive cervical cancer 4220 deaths Highest incidence and death rates in: o African American o American Indian/Alaska Native o Hispanic/Latina 60% - 80% of women with advanced cervical cancer have not had a Pap test in the past five years.
13 Pap Smear w/in Past 3 Years (18 and older)
14 Pap Smear by State, Age, Insurance Status
15 2012 Cervical Screening Recommendations Women <21 No screening Women ages Women ages Women ages >65 After Hysterectomy Screening after HPV vaccination Pap test every 3 years Recommend AGAINST annual Paps HPV + Pap cotesting every 5 years (preferred) or Every 3 years with Pap alone (acceptable) Recommend AGAINST more frequent screening Discontinue after age 65 if 3 negative Pap tests or 2 negative HPV tests in last 10 years with most recent test in last 5 years Discontinue if for benign reason Follow age-appropriate recommendations (same as unvaccinated women)
16 2012 Cervical Screening Recommendations Women at any age should NOT be screened annually by any screening method HPV testing should NOT be used for screening women <30 years of age Screening by HPV testing alone is not recommended for most clinical settings. These guidelines do NOT address women 1) with a history of cervical cancer, 2) who were exposed in utero to DES, or 3) who are immune-compromised, e.g. HIV+
17 Comparison of Guidelines ACS-ASCCP-ASCP (2012) USPSTF (2012) Age to start Age 21 Age 21 Pap test every 3 years (liquid or conventional) Women ages Recommend AGAINST annual Pap Pap test every 3 years (liquid or conventional) Women ages Women ages >65 Cotesting every 5 years (preferred) or Every 3 years with Pap alone (acceptable) Recommend AGAINST more frequent screening Discontinue after age 65 if 3 negative Pap tests or 2 negative HPV tests in last 10 years with most recent test in last 5 years Cotesting every 5 years or Every 3 years with Pap alone Discontinue after age 65 if adequate prior screening (3 negative Pap tests or 2 negative HPV tests in last 10 years with most recent test in last 5 years) Post-Hysterectomy Discontinue if for benign reason Discontinue if for benign reason Screening after HPV vaccination Same as for unvaccinated Same as for unvaccinated
18 What Changed from the Previous Guideline? Age to start Women ages Women ages Women ages > years after initiating sexual activity or age 21 Age 21 Cytology every year (conventional Cytology every 3 years (liquid or Pap) or conventional) Every 2 years (liquid Pap) Recommend AGAINST annual Pap Pap plus HPV test ( Cotesting ) every 3 years or Every 2-3 years with Pap (liquid or conventional) May discontinue after age 70 if 3 negative Pap tests in last 10 years Cotesting every 5 years (preferred) or Every 3 years with Pap alone (acceptable) Recommend AGAINST more frequent screening Discontinue after age 65 if 3 negative Pap tests or 2 negative HPV tests in last 10 years with most recent test in last 5 years Post- Hysterectomy Discontinue if for benign reason Discontinue if for benign reason Screening after HPV vaccination 2007 guideline: Same as for unvaccinated Same as for unvaccinated
19 Human Papilloma Virus (HPV) and Cervical Cancer HPV is the most common sexually transmitted infection in the US, with approximately 6.2 million people becoming newly infected annually. There are more than 100 types of HPV, more than 40 of which can infect the genitals. Although most HPV infections are benign and transient, virtually all cervical cancers are causally related to infections by HPV. Approximately 70% of cervical cancers are caused by HPV types 16 or 18. HPV vaccines prevent persistent new infections and reduce precursor lesions (adenoma in situ or intraepithelial neoplasia) in the cervix.
20 Human Papilloma Virus (HPV) and Cervical Cancer Two vaccines: Cervarix Protects against HPV-16 and HPV-18 Approved for use in females 9 to 25 years of age Gardasil Protects against four HPV types (16 and 18, as well as HPV-6 and HPV-11) Approved for use in females 9 to 26 years of age Also approved for use in males 9 to 26 years of age to prevent genital warts, anal cancer and associated precancerous lesions (about 90% of anal cancers have been linked to HPV infection)
21 Recommendations for HPV Vaccine Use to Prevent Cervical Cancer and Its Precursors Routine HPV vaccination is recommended for females 11 to 12 years of age. Females as young as 9 years of age may receive HPV vaccination. The HPV vaccination is also recommended for females 13 to 18 year of age to catch up on missed vaccine or to complete the vaccination series. There are currently insufficient data* to recommend for or against universal vaccination of females 19 to 26 years of age in the general population. The HPV vaccination is not recommended for women over 26 years of age. * Decision should be based on risk of previous HPV exposure and potential benefit from vaccination
22 HPV Vaccine Trends Among US girls 13 to 17 years of age, HPV vaccine initiation (at least one of the three-dose HPV vaccination series) increased from 25.1% in 2007 to 48.7% in % of girls had the complete three-shot vaccine series by Lower initiation and completion rates among poor and minority girls. Increase in catch-up vaccine among previously unvaccinated women between the ages of 13 and 26 o 17.1% had received at least one dose of HPV vaccination in 2009 compared to 10.5% in Non-Hispanic white women had higher catch-up HPV vaccine uptake (19.8%), than African American women (13.3%) or Hispanic women (12.6%).
23 Colorectal Cancer
24 Colorectal Cancer Third most common cancer, 2 nd deadliest o o 141,000 new cases 49,000 deaths Highest incidence and death rates in: o African American o American Indian/Alaska Native 1.1 million individuals living with current or past CRC
25 Colorectal Cancer Risk Factors Age 90% of cases occur in people 50 and older Gender slight male predominance, but common in both men and women Race/Ethnicity Increased rates documented in African Americans, Alaska Natives, some American Indian tribes, Ashkenazi Jews
26 Colorectal Cancer Risk Factors Modifiable Risk Factors Diet Obesity Physical Activity Tobacco Alcohol
27 Non-Modifiable Risk Factors Increased risk with: Personal history of inflammatory bowel disease, adenomatous polyps or colon cancer Family history of adenomatous polyps, colon cancer, other conditions Individuals with these risk factors may require earlier and more intensive screening The remainder of this presentation will focus on the average risk population.
28 Colorectal Cancer Sporadic (average risk) (65% 85%) Rare syndromes (<0.1%) Family history (10% 30%) Hereditary nonpolyposis colorectal cancer (HNPCC) (5%) Familial adenomatous polyposis (FAP) (1%) CENTERS FOR DISEASE CONTROL AND PREVENTION
29 Risk Factor - Polyps Types of polyps: Hyperplastic minimal cancer potential Adenomatous approximately 90% of colon and rectal cancers arise from adenomas
30 Normal to Adenoma to Carcinoma Human colon carcinogenesis progresses by the dysplasia/adenoma to carcinoma pathway
31 Benefits of Colorectal Screening Survival Rates by Disease Stage* 5-yr Survival * % 67.7% 10.3% Lo cal Reg io n al Distan t Stage of Detection
32 Trends in Recent* CRC Screening Prevalence (%), by Educational Attainment and Health Insurance S Adults Years, US, Source: Klabunde et al, Cancer Epidemiol Biomarkers Prev 2011;20: National Health Interview Survey Public Use Data File 2010, National Center for Health Statistics, Centers for Disease Control and Prevention, American Cancer Society, Surveillance Research, 2011.
33 Lower use of colorectal screening examinations in minority populations
34 ACS Screening Guidelines Options for Average risk adults age 50 and older Tests That Detect Adenomatous Polyps and Cancer Colonoscopy every 10 years, or Flexible sigmoidoscopy (FSIG) every 5 years, or Double contrast barium enema (DCBE) every 5 years, or CT colonography (CTC) every 5 years Tests That Primarily Detect Cancer Guaiac-based fecal occult blood test (gfobt) with high test sensitivity for cancer, or Fecal immunochemical test (FIT) with high test sensitivity for cancer, or Stool DNA test (sdna), with high sensitivity for cancer
35 Comparison of Guidelines ACS-USMSTF (2008) USPSTF (2010) Age to start Age 50 Age 50 Stool Occult Blood: Guaiac FOBT Fecal Immuno Flexible sigmoidoscopy Annual screening with high sensitivity gfobt or FIT Low sensitivity guaiac tests not recommended Screening every 5 years Addition of annual FOBT/FIT is an option Annual screening with high sensitivity gfobt or FIT Screening every 5 years, with FOBT/FIT every 3 years Colonoscopy Screening every 10 years Screening every 10 years CRC screening between ages Adults in good health who would be candidates for treatment should continue screening Recommend against routine screening in adults There may be considerations that support screening in an individual patient. CRC screening >85 Adults in good health who would be candidates for treatment should continue screening Screening not recommended in adults > 85 years
36 Colonoscopy
37 Why Not Colonoscopy for All? Evidence does not support best test or gold standard Colonoscopy misses ~ 10% of significant lesions in expert settings Higher potential for patient injury than other tests Test performance is highly operator dependent Greater patient requirements for successful completion Requires a bowel prep and facility visit, and often a preprocedure specialty office visit (all with associated costs) Patient factors Some may not have access to the invasive tests due to lack of coverage or local resources Many individuals don t want an invasive test or a test that requires a bowel prep
38 Patient Preferences Inadomi, Arch Intern Med 2012
39 Stool Guaiac Tests Most common type in U.S. Best evidence (3 RCT s) Need specimens from 3 bowel movements Non-specific Results influenced by foods and medications Older forms (Hemoccult II) have unacceptably low sensitivity Better sensitivity with newer versions (Hemoccult Sensa)
40 Fecal Immunochemical Tests (FIT) Specific for human blood and for lower GI bleeding Results not influenced by foods or medications Some types require only 1 or 2 stool specimens Higher sensitivity than older forms of guaiac-based FOBT Slightly more costly than guaiac tests FIT use in the US will likely increase due to recent elimination of guiaic- based testing by LabCorp and Quest Labs
41 Stool Test Quality Issues CRC screening by FOBT should be performed with high-sensitivity FOBT - either FIT or a highly sensitive gfobt (such as Hemoccult SENSA). Older, less sensitive guiaic tests (such as Hemoccult II) should not be used for CRC screening. Annual testing In-office FOBT is essentially worthless as a screening tool for CRC and must be strongly discouraged. All positive screening tests should be evaluated by colonoscopy
42 Stool Test Quality Issues Clinicians Reference: FOBT One page document designed to educate clinicians about important elements of colorectal cancer screening using fecal occult blood tests (FOBT). Provides state-of-the-science information about guaiac and immunochemical FOBT, test performance and characteristics of high quality screening programs. Available at
43 Improving Screening Rates
44 Opportunistic vs. Organized Preventive Care Most preventive care for adults in the U.S. is opportunistic, i.e. occurs incidentally during encounters with healthcare professionals Opportunistic care depends on a coincidence of encounters, circumstances, and interests between patient and provider This means some adults get some preventive care on some occasions and at some interval Few adults receive the full package, or even the majority of recommended preventive services
45 Clinician s Toolbox Inadomi, Arch Intern Med 2012
46 Community Health Center Version Customized to meet unique needs of patients and providers in these settings Step-by-step guidance on how to implement systems change in CHCs Developed by UNC researcher Dr. Catherine Rowheder ) Available at: Funding for this project was provided by the University Cancer Research Fund of The UNC Lineberger Comprehensive Cancer Center
47 4 Essentials to Improve Screening
48 Clinician Recommendation
49 Office Screening Policy
50 Reminders
51 Measure and Track Progress
52 Flu/FIT
53 CRC Screening Outreach During Annual Flu Shot Activities Potential Benefits of Flu-FOBT or Flu-FIT Programs: Reaches patients at a time each year when they are already thinking about prevention Creates a seasonal focus on cancer screening that may add to other screening efforts Time-efficient way to involve non-physician staff in screening activities Educates patients that just like a flu shot, you need FOBT/FIT every year Slide courtesy of M. Potter, MD
54 Results SFGH Randomized Trial (Flu shot clinic attendees randomized to Flu Only vs. Flu + FOBT on different dates included telephone follow-up for FOBT recipients) FLU Only days FLU+FOBT days (246 patients) (268 patients) Up-to-Date Before Flu Season 52.9% 54.5% (Oct 16, 2006) Up-to-Date After Flu Season 57.3% 84.3% (Mar 31, 2007) Change: (p<0.001) +4.4 points points Ann Fam Med, 2009
55 FLU-FOBT/FIT FLU-FOBT/FIT Interventions Has been tailored and results replicated in: (1) primary care underserved settings, (2) high volume managed care flu shot clinics (3) commercial pharmacies where flu shots are increasingly provided Can be done with limited resources Leads to higher screening rates
56 Flu/FIT Implementation Guide and Materials
57 ACS Resources
58 ACS Guidelines Facts for Professionals Cancer Presentations COLONMD PROSTATEMD Asian Pacific Education Materials Easy Reading Materials Other ACS Resources Global Health
59 Patient Education Get Tested For Colon Cancer: Here's How." An 7-minute video reviewing options for colorectal cancer screening tests, including test preparation. English and Spanish versions. Available in DVD and VHS format, or you can refer patients to the URL to view from their personal computer.
60 Office Wall Chart Screening guidelines for Breast, Cervical, Colon, Prostate and other cancers General lifestyle/prevention Tobacco cessation Healthy diet Weight, etc English and Spanish
61 Keys to Quality Stool Testing Clinicians Reference: FOBT One page document designed to educate clinicians about important elements of colorectal cancer screening using fecal occult blood tests (FOBT). Provides state-of-the-science information about guaiac and immunochemical FOBT, test performance and characteristics of high quality screening programs. Available at
Improving Outcomes in Colorectal Cancer: The Science of Screening. Colorectal Cancer (CRC)
Improving Outcomes in Colorectal Cancer: The Science of Screening Tennessee Primary Care Association October 23, 2014 Durado Brooks, MD, MPH Director, Prostate and Colorectal Cancers Colorectal Cancer
More informationColorectal Cancer Screening in Ohio CHCs. Ohio Association of Community Health Centers
Colorectal Cancer Screening in Ohio CHCs Ohio Association of Community Health Centers 2 1/29/2015 Your Speakers Dr. Ted Wymyslo Ashley Ballard Randy Runyon 3 1/29/2015 Facts 3 rd most common cancer in
More informationGrand Rounds. Des Moines University. May 5, Durado Brooks, MD, MPH Director, Cancer Control Intervention American Cancer Society
Grand Rounds Des Moines University May 5, 2016 Durado Brooks, MD, MPH Director, Cancer Control Intervention American Cancer Society Case Summary Mrs. J is a 56 y o w female complaining of always tired;
More informationColorectal Cancer Disparities: Addressing the Challenge
Colorectal Cancer Disparities: Addressing the Challenge Inaugural Cancer Disparities Conference The Ohio State University Wexner Medical Center March 28, 2015 Durado Brooks, MD, MPH Cancer Disparities:
More informationColorectal Cancer Screening: State of the Science
Colorectal Cancer Screening: State of the Science LA Academy of Family Practice Convention July 9, 2016 Sandestin, FL Durado Brooks, MD, MPH Director, Prostate and Colorectal Cancers Colorectal Cancer
More informationThe New Grade A: USPSTF Updated Colorectal Cancer Screening Guidelines, What does it all mean?
The New Grade A: USPSTF Updated Colorectal Cancer Screening Guidelines, What does it all mean? Robert A. Smith, PhD Cancer Control, Department of Prevention and Early Detection American Cancer Society
More informationWellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer
Wellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer Healthy Habits and Cancer Screening Rev 10.20.15 Page
More informationACS FluFOBT Program A Proven Approach to Increase Colorectal Cancer Screening
ACS FluFOBT Program A Proven Approach to Increase Colorectal Cancer Screening Massachusetts Annual Adult Immunization Conference April 27,2016 Terry E Shlimbaum, MD New York State Chief Medical Officer
More informationColorectal Cancer Screening: The Science Behind the Guidelines. CRC Incidence North Dakota. Colorectal Cancer (CRC) CRC Incidence North Dakota
Reaching 80% Screened For Colorectal Cancer by 2018: Using Systems Change to Increase Cancer Screening Colorectal Cancer Screening: The Science Behind the Guidelines September 2017 Jeff Hostetter, MD Based
More informationCOLORECTAL CANCER. Colorectal Cancer (CRC) 3 rd most common cancer in U.S. 3 rd deadliest cancer in U.S. 12/4/2014
The heart and science of medicine. UVMHealth.org/CancerCenter COLORECTAL CANCER Claire Verschraegen, MD Co-Director University of Vermont Cancer Center 1 Colorectal Cancer (CRC) 3 rd most common cancer
More informationIncreasing Colorectal Cancer Screening in Wyoming. Allie Bain, MPH Outreach & Education Supervisor Wyoming Integrated Cancer Services Program
Increasing Colorectal Cancer Screening in Wyoming Allie Bain, MPH Outreach & Education Supervisor Wyoming Integrated Cancer Services Program Overview What is colorectal cancer? What are risk factors for
More informationColorectal Cancer Screening
Tool 2.1 Cancer Screening Basic Fact Sheet Are You at High Risk? Your risk for colorectal cancer may be higher than average if: stomach You or a close relative have had colorectal polyps or colorectal
More informationColon Screening in 2014 Offering Patients a Choice. Clark A Harrison MD The Nevada Colon Cancer Partnership
Colon Screening in 2014 Offering Patients a Choice Clark A Harrison MD The Nevada Colon Cancer Partnership Objectives 1. Understand the incidence and mortality rates for CRC in the US. 2. Understand risk
More informationCancer Screening & Prevention. Dr. Jamey Burton, MD, FAAFP
Cancer Screening & Prevention Dr. Jamey Burton, MD, FAAFP Cervical Cancer Breast Cancer Colon Cancer Prostate Cancer Lung Cancer How common is cervical cancer? What causes it? What screening is needed?
More informationScreening & Surveillance Guidelines
Chapter 2 Screening & Surveillance Guidelines I. Eligibility Coloradans ages 50 and older (average risk) or under 50 at elevated risk for colon cancer (personal or family history) that meet the following
More informationColorectal Cancer Screening
Colorectal Cancer Screening Colorectal cancer is preventable. Routine screening can reduce deaths through the early diagnosis and removal of pre-cancerous polyps. Screening saves lives, but only if people
More informationLearning and Earning with Gateway Professional Education CME/CEU Webinar Series
Learning and Earning with Gateway Professional Education CME/CEU Webinar Series Best Practices for Colorectal Cancer Screening March 14, 2018 12:00pm 1:00pm Robert A. Smith, PhD Vice President, Cancer
More informationColorectal Cancer Screening. Dr Kishor Muniyappa 2626 Care Drive, Suite 101 Tallahassee, FL Ph:
Colorectal Cancer Screening Dr Kishor Muniyappa 2626 Care Drive, Suite 101 Tallahassee, FL 32308 Ph: 850-297-0351 What we ll be talking about How common is colorectal cancer? What is colorectal cancer?
More informationCLINICAL PRACTICE GUIDELINE FOR COLORECTAL CANCER SCREENING
CLINICAL PRACTICE GUIDELINE FOR COLORECTAL CANCER SCREENING This guideline is designed to assist practitioners by providing the framework for colorectal cancer (CRC) screening, and is not intended to replace
More informationHOW TO EVALUATE ACTIVITIES INTENDED TO INCREASE AWARENESS AND USE OF COLORECTAL CANCER SCREENING. Using your toolkit to conduct an evaluation
EVALUATION TOOLKIT HOW TO EVALUATE ACTIVITIES INTENDED TO INCREASE AWARENESS AND USE OF COLORECTAL CANCER SCREENING Using your toolkit to conduct an evaluation Welcome Mary Doroshenk, MA Director National
More informationHow to Increase Preventive Screening Rates in Practice: An Action Plan for Implementing A Primary Care Clinician s Evidence-Based Toolbox and Guide
How to Increase Preventive Screening Rates in Practice: An Action Plan for Implementing A Primary Care Clinician s Evidence-Based Toolbox and Guide CRC Toolkit and Guide Available at http://www.cancer.org/aspx/pcmanual/pcm.swf
More informationColorectal Cancer Screening Guideline Issue Brief Updated May 30 th, 2018
Colorectal Cancer Screening Guideline Issue Brief Updated May 30 th, 2018 Issue Summary The American Cancer Society has updated its colorectal screening guideline, which have been published in CA: A Journal
More informationFinancial Disclosers
Slide 1 Colorectal Cancer Screening Jason Hemming, MD NESGNA November 15, 2014 Slide 2 Bio Slide 3 Financial Disclosers I have no actual or potential conflict of interest relation to this presentation
More informationCANCER SCREENING. Er Chaozer Department of General Medicine, Tan Tock Seng Hospital
CANCER SCREENING Er Chaozer Department of General Medicine, Tan Tock Seng Hospital Introduction Screening average risk patients Benefits and harms from screening Early cancer detection early treatment
More informationUpdates In Cancer Screening: Navigating a Changing Landscape
Updates In Cancer Screening: Navigating a Changing Landscape Niharika Dixit, MD I have no conflict of interest. 1 Why Should You Care Trends in Cancer Incidence by Site United States. Siegal Et al: CA
More informationGuidelines for the Early Detection of Cancer
Guidelines for the Early Detection of Cancer The American Cancer Society recommends these cancer screening guidelines for most adults. Screening tests are used to find cancer before a person has any symptoms.
More informationColon Cancer Screening and Surveillance. Louis V. Antignano, M.D. Wilson Gastroenterology October 11, 2011
Colon Cancer Screening and Surveillance Louis V. Antignano, M.D. Wilson Gastroenterology October 11, 2011 Colorectal Cancer Preventable cancer Number 2 cancer killer in the USA Often curable if detected
More informationEvidence-based Cancer Screening & Surveillance
Oncology for Scientists Spring 2014 Evidence-based Cancer Screening & Surveillance Martin C. Mahoney, MD, PhD, FAAFP Departments of Medicine & Health Behavior /Oncology_Feb 2014.ppt 1 Objectives: Principles
More informationCANCER SCREENING IN MINORITY AND UNDERSERVED POPULATIONS
CANCER SCREENING IN MINORITY AND UNDERSERVED POPULATIONS Gina Villani, MD, MPH CEO and Medical Director Healthfirst 2016 Fall Symposium Prevention as a Priority in Value-Based Healthcare Part II Disparities
More informationColorectal Cancer Screening and Risk Assessment Workflow. Documentation Guide for Health Center NextGen Users
Colorectal Cancer Screening and Risk Assessment Workflow Documentation Guide for Health Center NextGen Users Colorectal Cancer Screening and Risk Assessment Workflow and Documentation Guide for Health
More informationColorectal Cancer Screening. Paul Berg MD
Colorectal Cancer Screening Paul Berg MD What is clinical integration? AMA Definition The means to facilitate the coordination of patient care across conditions, providers, settings, and time in order
More informationColorectal Cancer Screening. Daniel C. Chung, MD GI Unit and GI Cancer Genetics Service Massachusetts General Hospital
Colorectal Cancer Screening Daniel C. Chung, MD GI Unit and GI Cancer Genetics Service Massachusetts General Hospital March, 2018 CRC Epidemiology 4th most common malignancy in US (136,000 cases/yr) 2nd
More informationGuidelines for Breast, Cervical and Colorectal Cancer Screening
Guidelines for Breast, Cervical and Colorectal Cancer Screening Your recommendation counts. Talk to your patients about screening for cancer. CancerCare Manitoba provides organized, population-based screening
More informationColorectal Cancer Screening in Later Life: Blum Center Rounds
Colorectal Cancer Screening in Later Life: Blum Center Rounds OCTOBER 10, 2018 Agenda CRC Screening and Surveillance Recommendation Screening for Colon Cancer later in life Discussion and listening Families
More informationCancer Screening 2009: New Tests, New Choices
Objectives Cancer Screening 2009: New Tests, New Choices UCSF Annual Review in Family Medicine April 21, 2009 Michael B. Potter, MD Professor, Clinical Family and Community Medicine UCSF School of Medicine
More informationCRC Risk Factors. U.S. Adherence Rates Cancer Screening. Genetic Model of Colorectal Cancer. Epidemiology and Clinical Consequences of CRC
10:45 11:45 am Guide to Colorectal Cancer Screening SPEAKER Howard Manten M.D. Presenter Disclosure Information The following relationships exist related to this presentation: Howard Manten MD: No financial
More informationCancer Facts for Women
Cancer Facts for Women Some of the cancers that most often affect women are breast, colorectal, endometrial, lung, cervical, skin, and ovarian cancers. Knowing about these cancers and what you can do to
More informationObjectives. Definitions. Colorectal Cancer Screening 5/8/2018. Payam Afshar, MS, MD Kaiser Permanente, San Diego. Colorectal cancer background
Colorectal Cancer Screening Payam Afshar, MS, MD Kaiser Permanente, San Diego Objectives Colorectal cancer background Colorectal cancer screening populations Colorectal cancer screening modalities Colonoscopy
More informationACS FluFIT Program A Proven Approach to Increase Colorectal Cancer Screening Assembling a FluFit Team
ACS FluFIT Program A Proven Approach to Increase Colorectal Cancer Screening Assembling a FluFit Team Terry E Shlimbaum, MD Medical Director NY State Senior Whole Health, Inc T OBJECTIVES Background Describe
More informationCENTERS FOR DISEASE CONTROL AND PREVENTION CENTERS FOR DISEASE CONTROL AND PREVENTION. Incidence Male. Incidence Female.
A Call to Action: Prevention and Early Detection of Colorectal Cancer (CRC) 5 Key Messages Screening reduces mortality from CRC All persons aged 50 years and older should begin regular screening High-risk
More informationColon Cancer Screening & Surveillance. Amit Patel, MD PGY-4 GI Fellow
Colon Cancer Screening & Surveillance Amit Patel, MD PGY-4 GI Fellow Epidemiology CRC incidence and mortality rates vary markedly around the world. Globally, CRC is the third most commonly diagnosed cancer
More information10/25/2011 OBJECTIVES Cancer Screening in the United States, 2011 A Review of Current American Cancer Society Guidelines and Issues in Cancer Screenin
OBJECTIVES Cancer Screening in the United States, 2011 A Review of Current American Cancer Society Guidelines and Issues in Cancer Screening Kathy Gray, DNP, CRNP, FNP-BC Cancer Screenings and Guidelines
More informationGet tested for. Colorectal cancer. Doctors know how to prevent colon or rectal cancer- and you can, too. Take a look inside.
Get tested for Colorectal cancer Doctors know how to prevent colon or rectal cancer- and you can, too. Take a look inside. 1 If you re 50 or older, you need to get tested for colorectal cancer. It s one
More informationFREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS What is CRC? CRC (CRC) is cancer of the large intestine (colon), the lower part of the digestive system. Rectal cancer is cancer of the last several inches of the colon. Together,
More informationGuidance on Implementing FIT-based Screening Programs. June 29th, :00pm ET
Guidance on Implementing FIT-based Screening Programs June 29th, 2016 12:00pm ET Presenters: Emily Bell, MPH (Moderator) NCCRT Associate Director Durado Brooks, MD, MPH Managing Director, Cancer Control
More informationMISSING IN ACTION : Ethnic Groups in Cancer Screening
MISSING IN ACTION : Ethnic Groups in Cancer Screening Annette E. Maxwell, Dr.P.H. Division of Cancer Prevention and Control Research Jonsson Comprehensive Cancer Center University of California, Los Angeles
More informationEarly Detection: Screening Guidelines
Early Detection: Screening Guidelines National Cancer Statistics 2015 National Cancer Statistics 1. 6 Million Cases Expected 589,430 Cancer Deaths expected 2015 Virginia Cancer Statistics: Projected cases:
More information2019 Adult Preventive Health Guidelines
1 2019 Adult Preventive Health Guidelines Important Note Health Net s Preventive Health Guidelines provide Health Net members and practitioners with recommendations for preventive care services for the
More informationThe Guidelines Guide: Routine Adult Screening Created March 2009 by Alana Benjamin, MD Last updated: June 29 th, 2010
The Guidelines Guide: Routine Adult Screening Created March 2009 by Alana Benjamin, MD Last updated: June 29 th, 2010 Table of Contents Topic Page Introduction 2 Abbreviations 2 USPSTF Grades of Recommendations
More informationRazvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER
Razvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER Epidemiology of CRC Colorectal cancer (CRC) is a common and lethal disease Environmental
More informationUpdates in Colorectal Cancer Screening & Prevention
Updates in Colorectal Cancer Screening & Prevention Swati G. Patel, MD MS Assistant Professor of Medicine Division of Gastroenterology & Hepatology Gastrointestinal Cancer Risk and Prevention Clinic University
More informationEARLY DETECTION OF COLORECTAL CANCER. Epidemiology of CRC
Razvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER Epidemiology of CRC Colorectal cancer (CRC) is a common and lethal disease Environmental
More informationColorectal Cancer: Preventable, Beatable, Treatable. American Cancer Society
Colorectal Cancer: Preventable, Beatable, Treatable American Cancer Society Reviewed/Revised May 2018 What we ll be talking about How common is colorectal cancer? What is colorectal cancer? What causes
More informationCancer Screening I have no conflicts of interest. Principles of screening. Cancer in the World Page 1. Letting Evidence Be Our Guide
Cancer Screening 2012 Letting Evidence Be Our Guide Jeffrey A. Tice, MD Division of General Internal Medicine University of California, San Francisco I have no conflicts of interest Principles of screening
More informationONCOLOGY OUTCOMES REPORT
2017 EVANGELICAL COMMUNITY HOSPITAL ONCOLOGY OUTCOMES REPORT One Hospital Drive, Lewisburg, PA 17837 570-522-2000 evanhospital.com Cancer Screening The Commission on Cancer requires annual dissemination
More informationJoint Session with ACOFP and Cancer Treatment Centers of America (CTCA): Cancer Screening: Consensus & Controversies. Ashish Sangal, M.D.
Joint Session with ACOFP and Cancer Treatment Centers of America (CTCA): Cancer Screening: Consensus & Controversies Ashish Sangal, M.D. Cancer Screening: Consensus & Controversies Ashish Sangal, MD Director,
More informationFast Track to FluFIT: Develop a FluFIT Workflow Amber Rogers, RN, MSN Mountain-Pacific Quality Health
Fast Track to FluFIT: Develop a FluFIT Workflow Amber Rogers, RN, MSN Mountain-Pacific Quality Health Presenter: Amber Rogers, RN, MSN Mountain-Pacific Quality Health Developed by the American Cancer Society
More informationACG Clinical Guideline: Colorectal Cancer Screening
ACG Clinical Guideline: Colorectal Cancer Screening Douglas K. Rex, MD, FACG 1, David A. Johnson, MD, FACG 2, Joseph C. Anderson, MD 3, Phillip S. Schoenfeld, MD, MSEd, MSc (Epi), FACG 4, Carol A. Burke,
More informationColon Cancer Screening. A Provider Opinion Survey
Colon Cancer Screening A Provider Opinion Survey 1. Background Information What is colon cancer? Who needs to be screened? Colorectal Cancer» Presence of abnormal cells in the colon or rectum that divide
More informationSpecial Cancer Behavioral Risk Factor Survey, 2008
Special Cancer Behavioral Risk Factor Survey, 28 April 21 Table of Contents Introduction... 1 Methodology... 1 The Survey Instrument... 1 Interview Protocols... 2 Response Rates... 2 The Sample... 3 Analysis...
More informationBlue Star Sunday. Increasing Awareness About Colon Cancer. Dear Faith Community,
Blue Star Sunday Increasing Awareness About Colon Cancer Dear Faith Community, West Virginia s Cancer Coalition, Mountains of Hope, invites your faith community to participate in Colorectal Cancer Awareness
More informationCancer Prevention and Control, Client-Oriented Screening Interventions: Reducing Client Out-of-Pocket Costs Colorectal Cancer (2008 Archived Review)
Cancer Prevention and Control, Client-Oriented Screening Interventions: Reducing Client Out-of-Pocket Costs Colorectal Cancer (2008 Archived Review) Table of Contents Review Summary... 2 Intervention Definition...
More informationONLINE CONTINUING EDUCATION ACTIVITY
ONLINE CONTINUING EDUCATION ACTIVITY Take free quizzes online at acsjournals.com/ce ARTICLE TITLE: Cancer Screening in the United States, 2017: A Review of Current American Cancer Society Guidelines and
More informationObjectives. 80% by A Pledge is Just the First Step. Thank You, ND Pledge Signers! What will it really take?
Making a Difference: How Stakeholders are Working Together to Increase Colorectal Cancer Screening in North Dakota Joyce Sayler, Community Partnership Coordinator, NDDoH Tasha Peltier, Quality Improvement
More informationColorectal Cancer: Screening & Surveillance
Objectives Colorectal Cancer: Screening & Surveillance Chanda K. Ho, MD MPH Advances in Internal Medicine Brief overview epidemiology and pathogenesis of colorectal cancer (CRC) To review screening modalities
More informationColorectal cancer screening: Is total prevention possible?
Just the facts colorectal cancer Colorectal cancer screening: Is total prevention possible? Jeffrey Fox, MD, MPH Concepts and Controversies 2011 2010 NCI estimates for US: 142, 570 new CRC diagnoses 51,370
More informationSummary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky (includes kynect)
Summary of Cancer Prevention and Screening Benefits of the Talk with patients about ü Potential benefits, harms, and uncertainties of cancer screening ü Identify family history ü Cancer prevention, early
More informationPage 1. Cancer Screening for Women I have no conflicts of interest. Overview. Breast, Colon, and Lung Cancer. Jeffrey A.
Cancer Screening for Women 2017 Breast, Colon, and Lung Cancer Jeffrey A. Tice, MD Professor of Medicine Division of General Internal Medicine University of California, San Francisco I have no conflicts
More informationPage 1. Selected Controversies. Cancer Screening! Selected Controversies. Breast Cancer Screening. ! Using Best Evidence to Guide Practice!
Cancer Screening!! Using Best Evidence to Guide Practice! Judith M.E. Walsh, MD, MPH! Division of General Internal Medicine! Womenʼs Health Center of Excellence University of California, San Francisco!
More informationCancer Facts & Figures for African Americans
Cancer Facts & Figures for African Americans What is the Impact of Cancer on African Americans in Indiana? Table 12. Burden of Cancer among African Americans Indiana, 2004 2008 Average number of cases
More informationEarly detection and screening for colorectal neoplasia
Early detection and screening for colorectal neoplasia Robert S. Bresalier Department of Gastroenterology, Hepatology and Nutrition. The University of Texas. MD Anderson Cancer Center. Houston, Texas U.S.A.
More informationAmerican Indian and Alaska Native Colorectal Cancer Screening Data April 26, 2016
American Indian and Alaska Native Colorectal Cancer Screening Data April 26, 2016 Presented by: Donald Haverkamp, MPH Presentation Overview Importance of CRC screening surveillance in AI/AN populations
More informationCOLON CANCER SCREENING: AN UPDATE
Overview COLON CANCER SCREENING: AN UPDATE Siddharth Verma, DO, JD Rutgers New Jersey Medical School Background Screening Updates in Specific Populations African Americans CRC in the younger age USPSTF
More informationPage 1. Controversies in Cancer Prevention and Screening. Disclosures. Screening. Principles of Screening. I have no conflicts of interest
Controversies in Cancer Prevention and Screening Disclosures Using the Best Evidence in 2015 I have no conflicts of interest Judith M.E. Walsh, MD, MPH Division of General Internal Medicine Women s Health
More informationColorectal Cancer Screening
Colorectal Cancer Screening An Integrated Care Pathway of the Collaborative Care Network Subject Matter Expert: Kevin Wolov, DO Pathway Custodian: Pat Czapp, MD First, a Friendly Reminder... This Integrated
More informationPreventive Health Guidelines
Preventive Health Guidelines Guide to Clinical Preventive Services Adult LifeWise has adopted the United States Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services. The guideline
More informationCancer Screenings and Early Diagnostics
Cancer Screenings and Early Diagnostics Ankur R. Parikh, D.O. Medical Director, Center for Advanced Individual Medicine Hematologist/Medical Oncologist Atlantic Regional Osteopathic Convention April 6
More informationThank You to Our Sponsors: Evaluations & CE Credits. Featured Speakers. Conflict of Interest & Disclosure Statements
Thank You to Our Sponsors: University at Albany School of Public Health NYS Department of Health Evaluations & CE Credits Nursing Contact Hours, CME and CHES credits are available. Please visit www.phlive.org
More informationCT Colonography. A Radiologist s View of the Colon from Outside-In. Donny Baek, MD
CT Colonography A Radiologist s View of the Colon from Outside-In Donny Baek, MD Computed Tomography (CT) CT Image Reconstruction CT Image Reconstruction CT Image Reconstruction Colorectal Cancer Annual
More informationColon Cancer Screening. Layth Al-Jashaami, MD GI Fellow, PGY 4
Colon Cancer Screening Layth Al-Jashaami, MD GI Fellow, PGY 4 -Colorectal cancer (CRC) is a common and lethal cancer. -It has the highest incidence among GI cancers in the US, estimated to be newly diagnosed
More informationIEHP UM Subcommittee Approved Authorization Guidelines Colorectal Cancer Screening with Cologuard TM for Medicare Beneficiaries
for Medicare Beneficiaries Policy: Based on our review of the available evidence, the IEHP UM Subcommittee adopts the use of Cologuard TM - a multi-target stool DNA test as a colorectal cancer screening
More informationMenopause and Cancer risk; What to do overcome the risks? Fatih DURMUŞOĞLU,M.D
Menopause and Cancer risk; What to do overcome the risks? Fatih DURMUŞOĞLU,M.D Menopause and Cancer How does menopause affect a woman s cancer risk? Ø Menopause does not cause cancer.but risk of developing
More informationSCREENING. Highlights. Introduction HEALTH STATUS REPORT CHAPTER 9: SEPTEMBER 2016
HEALTH STATUS REPORT SCREENING CHAPTER 9: SEPTEMBER 2016 Highlights Screening represents an effective secondary prevention strategy to reduce the burden of disease, such as cancer. Not having a Pap test
More informationProgram Guidelines Clinical Guidelines Patient Enrollment Resource Documents Eligibility Guidelines... 2
BREAST AND CERVICAL CANCER TABLE OF CONTENTS Program Guidelines... 1 Clinical Guidelines... 1 Patient Enrollment... 1 Resource Documents... 1 Eligibility Guidelines... 2 Breast Screening Guidelines and
More informationNicolaus Copernicus University in Torun Medical College in Bydgoszcz Family Doctor Department CANCER PREVENTION IN GENERAL PRACTICE
Nicolaus Copernicus University in Torun Medical College in Bydgoszcz Family Doctor Department CANCER PREVENTION IN GENERAL PRACTICE A key mission for family medicine is preserving health and maximizing
More informationColorectal Cancer Screening: A Clinical Update
11:05 11:45am Colorectal Cancer Screening: A Clinical Update SPEAKER Kevin A. Ghassemi, MD Presenter Disclosure Information The following relationships exist related to this presentation: Kevin A. Ghassemi,
More informationPREVENTION CARE IN ADULTS
PREVENTION CARE IN ADULTS Hong Xiao, M.D. Department of Family & Community Medicine Weight and BMI Abdominal Aortic Aneurysm (AAA) Blood Pressure Breast Exam Breast Cancer Mammogram Breast Cancer BRCA
More information4417.0, "HPV and Public Health": Reducing Pap Smears Among Young Women in Title X Family Planning Clinics
4417.0, "HPV and Public Health": Reducing Pap Smears Among Young Women in Title X Family Planning Clinics Goldenkranz Salomon S., Fine D., Cassidy-Brinn V., Dluhosh K. Cardea Services APHA Conference September
More informationIncreasing Colorectal Cancer Screening Rates Why it s not as easy as you ve been told
INCREASING COLORECTAL CANCER SCREENING IN NYS Increasing Colorectal Cancer Screening Rates Why it s not as easy as you ve been told 5/15/17 Syracuse, NY Martin C. Mahoney, MD, PhD Roswell Park Cancer Institute
More informationA senior s guide for preventative healthcare services Ynolde F. Smith D.O.
A senior s guide for preventative healthcare services Ynolde F. Smith D.O. What can we do to prevent disease? Exercise Eating Well Keep a healthy weight Injury prevention Mental Health Social issues (care
More informationACTIVITY DISCLAIMER DISCLOSURE. Alvin B. Lin, MD, FAAFP. Audience Engagement System Step 1 Step 2 Step 3. Learning Objectives.
ACTIVITY DISCLAIMER Colorectal Cancer Alvin B. Lin, MD, FAAFP The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. Please note
More informationColorectal Cancer Screening
Scan for mobile link. Colorectal Cancer Screening What is colorectal cancer screening? Screening examinations are tests performed to identify disease in individuals who lack any signs or symptoms. The
More informationCancer Prevention and Early Detection Worksheet for Women
Page 1 of 8 Cancer Prevention and Early Detection Worksheet for Women While a tremendous amount of progress has been made in cancer research, we still don t understand exactly what causes most cancers.
More informationRecommendation Summary U S. Prevention Statement Task Force for HPV (USPSTF)
Recommendation Summary U S. Prevention Statement Task Force for HPV (USPSTF) Population Recommendation Grade (What's This?) Women ages 21 to 65 years The USPSTF recommends screening for cervical cancer
More informationA PROVIDER S GUIDE TO PREVENTIVE HEALTH SERVICES FOR YOUR PATIENTS
ConnectiCare, together with the Centers for Medicare & Medicaid Services, encourages the use of preventive health services. For certain basic preventive health services, ConnectiCare Medicare Plan beneficiaries
More informationChapter III: Summary of Data for Specific Cancers
Chapter III: Summary of Data for Specific Cancers [This page left intentionally blank.] Chapter III Chapter III: Summary of Data for Specific Cancers This chapter provides detailed information on the most
More informationELIMINATING HEALTH DISPARITIES IN AN URBAN AREA. VIRGINIA A. CAINE, M.D., DIRECTOR MARION COUNTY HEALTH DEPARTMENT INDIANAPOLIS, INDIANA May 1, 2002
ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA VIRGINIA A. CAINE, M.D., DIRECTOR MARION COUNTY HEALTH DEPARTMENT INDIANAPOLIS, INDIANA May 1, 2002 Racial and ethnic disparities in health care are unacceptable
More informationACS Colorectal Cancer Screening Guideline for Average Risk Adults 2018
ACS Colorectal Cancer Screening Guideline for Average Risk Adults 2018 1 How are Cancer Screening Guidelines Developed? ACS Guideline Development Process Systematic Evidence Review & Modeling Reports [existing
More informationExemplary Primary Care Practices 80% by 2018 Mini Webinar Series. November 10th, :00pm EST
Exemplary Primary Care Practices 80% by 2018 Mini Webinar Series November 10th, 2015 1:00pm EST Purpose of Today s Webinar Examine best practices that primary care providers and practices can undertake
More informationA PROVIDER S GUIDE TO PREVENTIVE HEALTH SERVICES FOR YOUR PATIENTS
ConnectiCare, together with the Centers for Medicare & Medicaid Services, encourages the use of preventive health services. For certain basic preventive health services, ConnectiCare Medicare Plan beneficiaries
More information