Cigarette Restitution FundColorectal Cancer Program—Update

November, 2003

Diane M. DwyerCenter for Cancer Surveillance and Control

Maryland Dept. of Health and Mental Hygiene

THANKS:THANKS:

25 Maryland Local PH Programs

DHMH Staff

Carmela GrovesAlyse WeinsteinLorraine UnderwoodEugene Small

University of MD Team

Eileen SteinbergerAnnette HopkinsMin ZhanJane UmanEbenezer Israel

Maryland Cigarette Restitution Fund Allocation—FY03

104

19.9

6.3

18.5

14.4

15

22.4 1.6

MedicaidTobaccoCrop ConversionDrug AddictionEducationCancer-Local PHCancer-OtherOther

$ 202 Million

CRF Budget—Local PH

0

2

4

6

8

10

12

14

16

FY01 FY02 FY03 FY04

AwardedExpended

$ in Millions

Create a Network through

Partnerships and Contracts

StateHealth Dept.

Program

Minority Outreach, Technical Assistance

2 Statewide Academic Health Centers: Research, PH,

Statewide Health Network

Providers: DoctorsLabs, Hospitals,

Pharmacies24 Community

Health Coalitions

Community based orgs.Faith based organizations

VolunteersMaryland Citizens,

esp. Minority & Underserved

25Local PH Programs

CRF Cancer Control “Network”

Local PH—Number of Contracts for Education/Outreach/Media Services*

0

10

20

30

40

50

60

70

80

FY01 FY02 FY03

~ 46 from 14

programs

* Non fee-for-service to CBO, Minority, Faith-based, Education, Advertising

~ 68 from 17

programs

~ 75 from 17

programs

Local PH CRF Programs—Number of Contracts for Medical

Services*

0

100

200

300

400

500

600

700

FY02 FY03

336

605

* Fee-for-Service for Providers, Hospitals, Labs, Pharmacies, Radiology

Oral Cancer CRF Programs in Maryland - FY 2004

Legend

EDUCATE AND SCREEN

EDUCATE ONLY

CURRENTLY NO PROGRAM

Skin Cancer CRF Programs in Maryland - FY 2004

Legend

EDUCATE AND SCREEN

EDUCATE ONLY

CURRENTLY NO PROGRAM

Prostate Cancer CRF Programs in Maryland - FY 2004

Legend

EDUCATE AND SCREEN

EDUCATE ONLY

CURRENTLY NO PROGRAM

Breast and Cervical Cancer CRF Programs in Maryland - FY 2004

Legend

EDUCATE AND SCREEN

EDUCATE ONLY

CURRENTLY NO PROGRAM

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

CRC Medical Advisory Committee

Medical expertsAdvise program on screening procedures, screening intervalsFormulated Minimal Elements for CRC Screening

Colorectal CancerEducation and Outreach

Colorectal Cancer--Number Educated by Type of Audience Maryland, June 2000-November

4, 2003

143,360

7,323

747

General Public Health Care Prof. Trainers

N = 151,507

Source: Education Database, Form 1 as of November 4, 2003

General Public CRC Education (Brief, Individual, and Group) by Quarter and

Minority Status

0

5000

10000

15000

20000

25000

Minority Non-Minority / Unk

Source: Education Database, Form 1 as of November 4, 2003

Media, Newspaper, Pamphlets, Billboards, etc.

July 2000—November 4, 2003: Colorectal cancer messages

targeted to reach >22 million>22 million people

Colorectal CancerScreening and Treatment

Endoscopy Procedures, Calvert Memorial Hospital FY00-FY02

1051

1424

216 227164

1385

0

200

400

600

800

1000

1200

1400

1600

FY00 FY01 FY02

Colonoscopies

Sigmoidoscopies

Washington County Colonoscopies, 2001-2003

0

100

200

300

400

500

600

700

800

Robinwood Medical Center Washington County HospitalEndoscopy Center Total

Washington Co.CRC program began

2001 2002 2003

ColonoscopiesGarrett Memorial Hospital, CY 1999-2002

633

818

958

1304

1183

43 640 0

87

0

200

400

600

800

1000

1200

1400

CY1999 CY2000 CY2001 CY2002 CY2003-proj.

Non-CPEST

Garrett Co CPESTColonoscopies

Colorectal Cancer Screening >50 years oldMaryland Cancer Survey--2002

37%

58.40%

50.00%

0%

20%

40%

60%

80%

100%

Ever had Sigmoidoscopy orColonoscopy

US Baseline

MD CancerSurvey

HP 2010Goal

Current CRC Screening Status of Marylander’s >50 years old—Maryland

Cancer Survey, 2002

26%

9%

11%6%6%

42%

Never tested

Tested, not UTD*

UTD with FOBT only

UTD with Sig only

FOBT+Sig

Colonoscopy w/ i 10yrs

*UTD—Up to date per ACS options for screening

Colorectal Cancer CRF Public Health Program

Screening Data

Summary of CRF CRC Screening

As of October 30 2003:

6,523 6,523 FOBTsFOBTs

129 129 sigmoidoscopiessigmoidoscopies

3,976 3,976 colonoscopiescolonoscopies

* Using “highest numbers” reported to DHMH

CRC Screening by GenderMaryland FY01-present

31%

69%

MenWomen

CRC Screening by MinorityMaryland FY01-present

42%

58%

Minority Non-minority

CRC Screening by Minority and GenderMaryland FY01-present

12%

40%

19%

29%

Minority Men

Minority Women

Non-Minority Women

Non-Minotiry Men

Persons Screened* for CRC by Minority Status, Maryland 7/1/00-

6/30/03

0200400600800

1000120014001600

7/ 00-12/ 00

1/ 01-6/ 01

7/ 01-12/ 01

1/ 02-6/ 02

7/ 02-12/ 02

1/ 03-6/ 03

7/ 03-10/ 03

Minority Non-Minority

*Screened with FOBT, Sig., or Colonoscopy—DHMH database

42% Minority

CRF CRC Screening Results

* Using “Highest numbers”

Number Result

FOBT 6523 * 10% positiveSigmoidoscopy

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

CRF CRC Screening Results*

* Using those in DHMH database; as of October 30, 2003

Number Adenomas

Cancer

Colonoscopy only 2,922 594 (20.3%)

29 (1%)

FOBT positive; then colonoscopy

224 41 (18.3%)

9 (4%)

FOBT negative; then colonoscopy

497 90(18.1%)

0 (0%)

725 38

Other Findings on Colonoscopy

46% of colonoscopies without adenomatous polyps or cancer had other findings:

Non-adenomatous polypshemorrhoidsdiverticular disease inflammatory bowel diseaseother

CRF CRC ScreeningComplications of ~3,700

Colonoscopies (with and without biopsy)

Perforation 3

Bleeding requiring ER visit or hospitalization

3-ER1-Hosp

Dehydration requiring hospitalization

1

Drug reactions 2

* Pay for service until funds are depleted

Payment for Hospitalization -- FY 2004

Legend

LINK - UCC

FEE FOR SERVICE - LHD

NOT APPLICABLE

*

Lessons45 colorectal cancers detected; over 70 cancers possibly prevented through polyp removalAn effective colorectal cancer screening program for the under-served (uninsured and low income) is possibleServices well received by providers and the communityPrograms shifted from FOBT-sig to colonoscopyComplications happen (at expected frequency)More difficult to reach men

ChallengesBudget cutsHow to screen those not covered by a program or insuranceHow to pay for diagnosis and treatmentIncorporating new CRC screening methods