Assessment of Colon & Prostate Cancer Screening

in WA

Peggy Hannon, PhD, MPH

Alliance for Reducing Cancer NW

Baseline Assessment Questions Colon cancer screening

Rates of screening in WA Who gets screened?

Physician knowledge, attitudes, practices Prostate cancer screening & IDM

Rates of screening & IDM in WA Who gets screened?

Physician knowledge, attitudes, practices for screening and IDM

Assessment Methods BRFSS analysis, 2001-2002 data

Core questions for colon cancer screening and prostate cancer screening

State-added questions for colon screening in 2002

Physician Survey Primary care providers practicing in WA 397 completed surveys, 72% response rate

Assessment Methods, contin’d Insurance claims analyses

Medicare, Medicaid, PPO, HMO Available data ranged from 2000 – 2004 Studied all colon cancer screening tests & PSA

for prostate cancer screening

Literature review Community Guide recommendations

Colon Cancer Screening Findings WA BRFSS 2001-2002, participants 50 years of

age and older (N = 3643) Current FOBT (in past year) -- 25% Current Flexible Sigmoidoscopy or Colonoscopy (in

past 5 years) -- 42% Currently screened by any method -- 52%

Colon Cancer Screening Findings 2002 BRFSS asked unscreened participants the

most important reason they were not screened Lack of awareness (50%) No physician recommendation (29%) Unwilling (19%) No insurance (2%)

Colon Cancer Screening Findings Physicians’screening recommendations

93% recommend FOBT 56% recommend flexible sigmoidoscopy 88% recommend colonoscopy 76% rec. one or more screening tests in agreement

with USPSTF guidelines

Colon Cancer Screening Findings Physician mechanisms to complete screening

33% have mechanism to encourage return of FOBT kits 65% have mechanism to ensure patients complete screening and

follow-up tests referred to another provider

Perceived patient barriers (% physicians reporting as major or minor barrier) Fear of finding cancer (89%) Anxiety about tests (94%) Unaware of screening (92%)

Interventions Sought in RFP General systems for provider recommendations

and referral Improve provider knowledge & recommendations for

screening Improve clinical tracking & performance of screening

Guiding test completion and follow-up of positive tests

Targeted interventions for underserved groups

Prostate Cancer Screening Findings

WA BRFSS 2001-2002 (N = 1431) 61% of men ages 50+ were screened for prostate

cancer in the past year 39% screened with PSA and DRE 13% screened with DRE only 9% screened with PSA only

No questions about IDM

Similar to national screening rates

Prostate Cancer Screening Findings

90% of physicians recommend DRE & 83% recommend PSA

Most recommend starting testing at ages 45-50 & yearly screening

55% collect family history of prostate cancer for 75%+ of male patients

Prostate Cancer Screening Findings

74% of physicians always/almost always discuss benefits/risks of PSA

Few report always using educational materials to discuss benefits/risks of PSA Written materials (9%) Videotapes (0.3%) Websites (6%)

Prostate Cancer Screening Findings

Issues discussed by majority of physicians Efficacy of PSA in detecting prostate cancer (64%) PSA may prompt further tests (64%)

Issues discussed by minority of physicians Efficacy of treatment options for prostate cancer

(35%) Possible side effects of treatment for prostate cancer

(35%)

Interventions Sought in RFP Provider-targeted interventions

Provider discussion of risks and benefits Provider collection of family history of PCa Placing IDM tools/cues in providers’ offices

Consumer-targeted interventions Placing IDM tools in community settings Forums to increase capacity to make informed

decisions

Conclusions Baseline assessment has been very useful

in shaping the CCCP’s first RFPs ARCNW’s Cancer Screening workgroup

and partners have also benefited Future directions Preliminary studies for grant applications