Howard University Hospital s Experience in Community Outreach and Prostate Cancer Screening Responsible Prostate Cancer Early Detection Screening Program September 22, 2017 Dr. Pamela Coleman, Program Director Men Take Ten Men s Health Educa>on & Early Detec>on Program Howard University Cancer Center
No Disclosures Disclosure Statement
Men Take Ten Program Founded in the late 1990 s by a Howard University Cancer Center (HUCC) researcher aker her father was diagnosed with prostate cancer. Focus was bringing awareness to prostate cancer in addi>on to being a resource for men seeking informa>on. The program offered free prostate specific an>gen (PSA) tes>ng and digital rectal examina>ons (DRE) each month. Men 40 years and older were encouraged to get screened annually.
Men Take Ten Program History In 2005: program offered community outreach and educa>on to help men make an informed decision about screening. In 2007: Center for Disease Control (CDC) and the DC Department of Health (DOH) awarded HUCC a grant which included the purchase of a 40 K. mobile health screening unit. The grant was also used to increase awareness in the Washington, DC area. In 2012: unit was renovated and now includes a recep>on area, phlebotomy sta>on, bathroom, 2 exam rooms, and most of the appliances were also upgraded.
Men Take Ten Mobile Unit
Men Take Ten Mobile Unit front entrance
Men Take Ten Mobile Unit exam room
Program Today Focus is to provide health informa>on to everyone and encourage men to make an informed decision about ge\ng screened for prostate as well as other cancers (i.e., lung & colon). Screening is offered on the 3 rd Wednesday of every other month at HUCC and at select community events (i.e., Congressional Black Caucus & the NBC4 Health & Fitness Expo). Screening is free for uninsured par>cipants. Par>cipants will receive a copy of their screening results and may also receive pa>ent naviga>on services for follow- up care.
Program Today Many of our par>cipants have been screened over the years and past results are considered with current findings. Our team is currently entering data into our electronic database. Data collec>on tools have changed over the years. Data from recent years are available and will be presented at American Associa>on for Cancer Research (AACR) in Atlanta, GA next week.
MTT Data Highlights (2009-2015) Database includes more than 2300 cases. Includes par>cipant s iden>fying informa>on, medical history, BPH Impact Index, Quality of Life scale, DRE results and PSA value at the >me of screening. One of our first abstracts reviews the impact of the US Preven>ve Services Task Force recommenda>on against screening on u>liza>on of the program.
MTT Data Highlights (2009-2015) There was a significant change in program u>liza>on aker the USPSTF recommenda>ons compared to u>liza>on before the recommenda>ons. 57.4% of par>cipants were screened at a community- based event. Mean age of par>cipants was 56.6 years. 84.1% were of African descent. 2/3 pa>ents had medical insurance, 41.8% had a primary care physician, and 21.9% had a family history of prostate cancer. 44% resided in DC wards 5, 7 & 8 (the greatest prostate cancer incidence rates).
The impact of the US Preventive Services Task Force recommendation against prostate screening on utilization of the Howard University Cancer Center s Men Take Ten prostate cancer screening program Background Black men in DC face significant prostate cancer dispari>es. Incidence for blacks is 230.7 compared to 99.7 for whites. Mortality is 2.6 >mes higher for black men. To address this disparity, since 2005, the Men Take Ten (MTT) program has offered outreach, educa>on and screening. In 2012, the US Preven>ve Task Force (USPSTF) recommended against prostate cancer screening. This recommenda>on presents a decisional dilemma for black men. Currently, MTT con>nues to offer screening with emphasis on informed decision- making. Aim This study examines the impact of the USPSTF recommenda>on on prostate cancer screening in the MTT program.
The impact of the US Preventive Services Task Force recommendation against prostate screening on utilization of the Howard University Cancer Center s Men Take Ten prostate cancer screening program Methods We analyzed MTT u>liza>on from July 2009 through December 2015. Social and demographic characteris>cs of 1,045 par>cipa>ng men are described. Results From 2009 2012, on average, 123.3 men par>cipated in MTT screening annually. From 2013-2015, the u>liza>on increased to an average of 183.7 men per year. Over half (57.4%) were screened via a community- based event. The remainder were screened in the MTT clinic. The mean age of par>cipants was 56.6 years and 84.1% were of African descent. Over half (55.9%) reported some educa>on beyond high school and 43.3% reported a household income of < $36K. Two- thirds had medical insurance, 41.8% had a primary care physician, and 21.9% had a family history of prostate cancer. Forty- four percent resided in DC wards 5, 7 & 8 which have the greatest prostate cancer incidence rates. Conclusion Despite the controversies surrounding prostate cancer screening, our data does not reflect a decrease in program u>liza>on.
The impact of the US Preventive Services Task Force recommendation against prostate cancer screening on utilization of the Howard University Cancer Center s Men Take Ten prostate program. Clinton Burnside, BS,1,2 Carla Williams, PhD,1,2 Radhika Kakarla, MBBS,1 Stephanie Purnell, BA,2 Theresa Vaughn, MS,1,2 Cherie Spencer, MS,1,2 Tamaro Hudson, PhD, MPH,1,2,3 TeleDa Taylor, PhD,1,2 Ali Ramadan, MD,4 Adeyinka Laiyemo, MD, MPH,1,2 Pamela Coleman, MD, FACS1,2,5 AffiliaDons: Howard University Cancer Center1, Howard University College of Medicine2; Department of Pharmacology3, Howard University Hospital; Department of Pathology4, Department of Surgery5 Washington, DC 20060 BACKGROUND African American (AA) men in the US suffer higher burdens from prostate cancer (PCa) than any other ethnic groups.1 PCa incidence in AA men residing in Washington, DC is more than 2 >mes greater than rates for white men in Washington, DC.2 Since 2005, Howard University Cancer Center s Men Take Ten (MTT) program has offered outreach and educa>on to help men make an informed decision about ge\ng screened. For men who make the informed decision to get screened for PCa, screening services include a physical exam (digital rectal) and a serum prostate specific an>gen (PSA) test. 225 197 150 189 169 140 75 116 106 0 2009 In 2012, the US Preven>ve Services Task Force (USPSTF) recommended against PCa screening.3 A 2015 study found screening rates declined among men age 50 and older aker the USPSTF report.4 The USPSTF recommenda>on presents a decisional dilemma for AA men. OBJECTIVE The aim of this study was to examine the demographic characteris>cs of men who par>cipated in MTT PCa screening. The study also examined changes in screening par>cipa>on before and aker the 2012 USPSTF screening recommenda>on. METHODOLOGY Howard University s Ins>tu>onal Review Board (HU- IRB) approval was obtained to review the de- iden>fied, prospec>vely maintained ins>tu>onal database for PCa screening from July 2009 to December 2015. Descrip>ve sta>s>cs were used to summarize the social and demographic characteris>cs of 1,045 par>cipa>ng men residing in Washington, DC. Annual program u>liza>on data was compared to examine changes before and aker the USPSTF recommenda>on. U>liza>on rates were compared based on the loca>on of the screening ac>vity (community- based or hospital- based) and the local residence (by DC Ward) of par>cipants. RESULTS A total of 1,045 men were included in the final analysis. Demographic data are presented in Table 1. The mean age of par>cipants was 56.6 years. Most (84.1%) par>cipants self- iden>fied as AA men, 48.6% were between the ages of 55-69, 87.6% had at least a high school educa>on, 67% had medical insurance, and 56.5% had a primary care physician. On average, 123.3 men u>lized the program annually from 2009-2012, while an average of 183.7 men u>lized the program annually from 2013-2015. Annual u>liza>on is depicted in Figure 1. Across all years, 57.4% were screened via community- based events (Figure 1). Data demonstrated that 44% of par>cipa>ng men resided in DC Wards 5, 7 & 8, which have the highest PCa incidence rates2 (Figure 2). 2010 2011 Hospital- based 2012 2013 Community- based 2014 2015 62 Total 33 33 Figure 1. UUlizaUon by LocaUon and Year Table 1. Demographics Ward 1 n % AGE (YEARS) 40-54 55-69 70+ Missing 434 508 99 4 42.0 48.6 9.5 0.4 ETHNICITY African American White Hispanic Other Missing 883 52 46 43 21 84.5 5.0 4.4 4.1 2.0 EDUCATION Less than HS HS Diploma/GED Less than 4 yrs. of college 4 yrs. of college or more Missing 84 329 243 343 46 8.0 31.5 23.3 32.8 4.4 MEDICAL INSURANCE Yes No Missing 700 313 32 67.0 30.0 3.1 PRIMARY CARE PHYSICIAN Yes No Missing 590 415 40 56.5 39.7 3.8 MARITAL STATUS Non- Married Married Separated Divorced Widowed Missing 373 207 37 86 23 319 35.7 19.8 3.5 8.2 2.2 30.5 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 *Other Figure 2. UUlizaUon by Ward CONCLUSIONS Based on our data, overall u>liza>on increased in the three years aker the USPSTF guideline. Thus, our data implies the USPSTF guidelines did not significantly impact the men u>lizing the MTT PCa screening program. The majority of the increase was due to screenings offered in targeted community- based se\ngs in DC Wards 5, 7 & 8, coupled with appropriate educa>on. Further analysis is needed to fully assess the impact the 2012 USPSTF guidelines may have on AA men in Washington, DC. Targe>ng community- based events while providing appropriate educa>on, may help to increase cancer awareness and the u>liza>on of healthcare services. REFERENCES 1. Di Pietro, G et.al. (2016). Racial Differences in the Diagnosis and Treatment of Prostate Cancer. Interna>onal Neurourol J 2016;20 Seppl2;S112-119. 3. District of Columbia, Cancer Registry, Bureau of Cancer and Chronic Disease, 2014. 5. Moyer VA, (2012) US Preven>ve Services Task Force: Screening for prostate cancer: U.S. Preven>ve Services Task Force recommenda>on statement. Ann Intern Med 157:120-134, 2012. 4. Drazer MW, Huo D, Eggener SE (2015). Na>onal Prostate Cancer Screening Rates AKer the 2012 US Preven>ve Services Task Force Recommenda>on Discouraging Prostate- Specific An>gen- Based Screening. J Clin Oncol. Aug 1;33(22):2416-23. ACKNOWLEDGEMENTS Howard University Hospital Department of Community and Family Medicine.
Take Away Our data suggest that targe>ng community- based events while providing appropriate educa>on, may help to increase cancer awareness and the u>liza>on of healthcare services.
Cancer Education & Awareness Programs Men Take Ten (Prostate Cancer) 3 rd Wednesday, every other month & select community events Mr. Clinton Burnside 202.865.4653 Clinton.burnside@howard.edu Colorectal & Lung Screening (Colon & Lung Cancer) Appointment only Mrs. Debra Parish- Gause 202.865.7256 Dparish- gause@howard.edu Mammoday (Breast Cancer) 1 st or 2 nd Saturday, every other month Mrs. Kimberly Higginbotham 202.865.4655 khiggin@huhosp.org
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