Integrated Cancer Screening. Dr. Meghan Davis Regional Primary Care Lead HNHB LHIN Cancer Care Ontario

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1 Integrated Cancer Screening Dr. Meghan Davis Regional Primary Care Lead HNHB LHIN Cancer Care Ontario

2 Cancer Care Ontario

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4 Regional Medical Leads Dr. Terry Minuk Dr. Barry Lumb Dr. Dustin Costescu Dr. Andrea East Dr. Meghan Davis Dr. Danny Kraftcheck

5 Informed Patient Choice

6 Breast Cancer Screening Average risk 50-74, q 2 years, self referral >74 require a referral High risk age special referral form confirmed BRCA carrier First degree relative >25% risk (geneticist) Radiation therapy to chest > 8 years ago and when less than 30 years old

7 OBSP Locations Assessment Locations

8 ONE OBSP PROGRAM 2 SITES CIBC Breast Assessment Centre Ontario Breast Screening Program at Chedoke

9 Cervical Cancer In Ontario, about 610 women will be diagnosed 40%: regularly screened lower grade 60%: under- or never-screened higher grade Usually slow progression 10 years 9

10 2012 Cervical Screening Guidelines Screening Age 21 to 70 every 3 years Specific populations: LGBTQ / Pregnancy / HPV+ / HIV 10

11 How should I screen women following exit from Colposcopy? Result CIN 2 or 3 HR-HPV DNA Positive (Regardless of cytology) LSIL/ASCUS, No Lesion Biopsy Proven CIN 1 Follow-Up Annual Paps AnnualPaps No right answer Reasonable: Annual x 3, then triennial No right answer Annual Paps if HPV unknown is appropriate. 11

12 Other Pap Abnormalities Absent Transformation Zone Not an indication for repeat testing. Unsatisfactory repeat in 3 months. After 2, refer for colposcopy. Endometrial Cells Over 40 and not consistent with period, perform or refer for endometrial sampling (increased risk of endometrial hyperplasia/cancer) 12

13 What about HPV testing? Not funded and funding unlikely this year Still need PAP test. 13

14 Key Takeaways Don t under/over screen Focus on never and under screened

15 Mobile Cancer Screening LHIN 4 Digital Mammogram, Pap test, Colorectal Screening Targets Under or Never Screened Population Continuity of Care

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17 Eastport Old Guelph 403 York York Barton Bay Jamesville Burlington Wellington Victoria Keith Burlington Industrial Beach Beach Hamilton's Neighbourhood Action Strategy Boundaries Upper Paradise Garth Main Scenic Paradise Aberdeen Garth Limeridge Stone Church Dundurn Mohawk Fennell Rolston West 5Th King Main Queen Upper James Bay James Upper Wellington Limeridge LINC John Beasley Mohawk Main Fennell Upper Wentworth King Concession Gibson/ Landsdale Stinson Charlton Wentworth South Sherman Upper Sherman Upper Gage Sherman Main Barton King Gage Upper Ottawa Gage Lawrence Ottawa Fennell Mohawk Ottawa Crown Point Mountain Brow Kenilworth Kenilworth Main King Lawrence RHVP Barton Parkdale Mount Albion Parkdale McQuesten King Davis Creek Burlington Woodward Queenston Nash Barton Centennial QEW Centennial Riverdale King Lake Avenue Lake Queenston Barton Gray New Mountain South Service Grays Ridge Drake'S Highway No. 8 North Service Green Millen Twenty Christie West 5Th Legend Rymal Major streets Escarpment Overlapping boundary Upper James Upper Wellington Rymal Upper Sherman Miles Stone Church Upper Gage Upper Ottawa Nebo Rymal Limeridge Action Neighbourhoods boundaries have been determined by the neighbourhoods and continue to be adjusted based on resident feedback. Stone Church Highland Old Mud Profiles of each of these neighbourhoods are available on the SPRC website: Paramount For any questions about this map, please contact Sara Mayo: smayo@sprc.hamilton.on.ca Glover Mountain Map prepared by: First Green Mountain Upper Centennial Ridge Mud First Second With support from: Third Green Mountain Tapleytown Last modified July 2013

18 Mobile Coach at Six Nations/New Credit Six Nations Rebels Lacrosse Team Bread and Cheese Day

19 Community Engagement is Key!

20 Screening Activity Report

21 Enrolled Patients Screening Summary Downloadable in PDF and Excel formats The Overall Screening Status represents someone s most urgent status across the three cancer screening programs. (i.e. If a patient is red in one screening program, this status will show red indicating that the patient requires at least one action) 21

22 Breast: Enrolled Patients (50-74) Downloadable in PDF and Excel formats 22

23 Screening Activity Report PEM doctors Released monthly Need to sign up to ONE ID to get it do it today! Accuracy What s missing What was I missing How can it be used?

24 Improving Screening Find a champion - RN, Admin Sustainable office procedures EMR stay tuned! SAR Optimize patient office visits Focus on never and under screened FOB demo Need Help? Let me know!

25 Patient Education Video: Colorectal Cancer Video to be posted at soon

26 Smoking Cessation Every Visit

27 Can We Improve Our Screening Rates? LHIN 4 Ontario Toronto BREAST SCREENING 61% 63% 63% CERVICAL SCREENING 64% 65% 64% COLORECTAL SCREENING 60% 64% 66% ONE ID & SAR Adoption Hamilton 37% 18% 45% Registered; viewed previous SAR Registered; did not view previous SAR Not registered For ONE ID ONE ID & SAR Adoption Toronto 35% 15% 50% 27

28 Thank you! Contact Information: Dr. Meghan Davis, Hamilton Visit: