West Virginia Breast Cancer Learning Community Data Report 1

State Data Report

ASTHO Breast Cancer Learning Community:

“Using Data to Address Disparities in Breast Cancer Mortality at the State Level”

STATE HEALTH DEPARTMENT NAME:

WV Bureau for Public Health Dr. Rahul Gupta, Commissioner

ADDRESS: 350 Capitol Street, Room 702 Charleston, WV 25301

PHONE: 304-558-2971

MAIN POINT(S) OF CONTACT:

GeorgeAnn Grubb, Director, WV Breast and Cervical Cancer Screening Program

350 Capitol Street, Room 427 Charleston, WV 25301 Phone: 304-356-4396 email: georgeann.grubb@wv.gov

DATA SOURCES USED IN REPORT:

WV Cancer Registry WV Health Statistics Center CDC WONDER US Department of Agriculture American Community Survey CountyHealthRankings.org Bonnie’s Bus Mobile Mammography Program State Cancer Profiles STAKEHOLDERS (list organization names):

WV Bureau for Public Health Office of Maternal, Child and Family Health Perinatal and Women’s Health Division WV Breast and Cervical Cancer Screening Program WV Office of Minority Health WV Cancer Registry, Bureau for Public Health WV Comprehensive Cancer Control Program WV Health Statistics Center WV WISEWOMAN Program Bonnie’s Bus Mobile Mammography Program, WV University Marshall University School of Medicine Breast Cancer Center, Edwards Cancer Center, Cabell-Huntington Hospital Bureau for Medical Services-Medicaid Charleston Area Medical Center Research Institute

West Virginia Breast Cancer Learning Community Data Report 2

State Data Report

ABSTRACT/DESCRIPTION (300 WORDS OR LESS):

The West Virginia Breast Cancer Learning Community initially focused on acquiring ArcGIS software and licenses. These were not received until April 2016. ArcGIS training has begun and will be expanded in the coming months. Stakeholders were selected and convened with ASTHO in West Virginia in March 2016. The stakeholder network has been actively engaged in setting goals and objectives for the current grant period and will continue to be involved for 2016-17. Priority was given to mapping WV breast cancer incidence and mortality data. Due to the small numbers of African Americans in the state (3.6%), socio-economic indicators (poverty/education) were mapped to pinpoint areas with breast cancer disparities. Data and maps presented in the ASTHO State Data Report meeting in May were prepared in partnership with the WV Cancer Registry. Final Report: -Purchased online GIS training -Revised data maps and additional maps are attached to this report. -Contractual arrangement with Cancer Registry Epidemiologist has been approved and implemented. -Epidemiologist is in process of completing online GIS training.

LESSONS LEARNED:

West Virginia Breast Cancer Learning Community Data Report 3

State Data Report

Acquire ArcGIS software/training as early as possible to avoid delays in data mapping, analysis and planning. Hire project coordinator to alleviate burden of work for existing staff.

NEXT STEPS:

Continue and expand ArcGIS training. Hire project coordinator. Continue to engage stakeholders in project strategic planning, project development and implementation. Share data maps with stakeholders, provider network, WV Comprehensive Cancer Coalition, and other state and local partners. Engage WVBCCSP outreach staff in expanded awareness/education efforts in target areas. Expand collaboration with Bonnie’s Bus Mobile Mammography Unit to use data mapping findings to expand the reach in underserved areas. Utilize data maps to more effectively allocate WVBCCSP resources and outreach efforts. Final Report Next Steps: -Review of payer guidelines for time from diagnosis to treatment -Compare map of FQHCs in WV to areas of screening, late diagnosis and late treatment -Survey patients and hospitals in the Huntington WV area to learn the reason for delay in treatment -Expand and improve quality of services provided by Bonnie’s Bus Mobile Mammography Program -Scheduled follow-up Stakeholders meeting for September 27, 2016

AT THE TIME OF THIS REPORT, ALL 55 COUNTIES ARE REPRESENTED IN THE DATA SETS. (LIST THE COUNTIES HERE) Barbour Berkeley Boone Braxton Brooke

Grant Greenbrier Hampshire Hancock Hardy

Logan Marion Marshall Mason McDowell

Nicholas Ohio Pendleton Pleasants Pocahontas

Summers Taylor Tucker Tyler Upshur

West Virginia Breast Cancer Learning Community Data Report 4

State Data Report

Cabell Calhoun Clay Doddridge Fayette Gilmer

Harrison Jackson Jefferson Kanawha Lewis Lincoln

Mercer Mineral Mingo Monongalia Monroe Morgan

Preston Putnam Raleigh Randolph Ritchie Roane

Wayne Webster Wetzel Wirt Wood Wyoming

Hancock Mineral Ritchie

Hardy Mingo Roane

Lincoln Pendleton Wayne

AT THE TIME OF THIS REPORT, THE FOLLOWING DATA SOURCES WERE INCLUDED IN THIS ANALYSIS: (LIST DATA SOURCES HERE) DATA SOURCE DATA RANGE YEARS WV Cancer Registry 2009-2013 WV Health Statistics Center 2009-2013 CDC WONDER 2005-2013 US Department of Agriculture 2013 American Community Survey 2009-2013 CountyHealthRankings.org 2013 Bonnie’s Bus Mobile Mammography Program 2009-2015 State Cancer Profiles 2008-2010

Metro/Rural Areas, West Virginia, 2013

Source: United States Department of Agriculture

Most of West Virginia is considered rural or non-metro by the USDA. The panhandles and the west central parts of the state are considered metro areas. There are few mammography facilities within the rural counties.

8 - 9 (Rural)

4 - 7 (Non-metro)

1 - 3 (Metro)

Mammography Facilities

Rurality - Beale Code Scale

% of People Below Poverty Level by County,West Virginia, 2009-2013

Source: American Community Survey

High rates of poverty exist in the southwestern and central portions of West Virginia. There is generally less poverty in the panhandles, and in the Charleston and Parkersburg areas.

Charleston

11.2 to 16.9

17.0 to 19.9

20.0 to 36.3

West Virginia average: 17.9%

Mammography Facilities

% Below Poverty Level

% with a High School Education or Higher by County,West Virginia, 2009-2013

Source: American Community Survey

Lower levels of education also exist in the southwestern and central portions of West Virginia. Education levels are higher in the panhandles, and in the Charleston , Morgantown, and Parkersburg areas.

Parkersburg

Charleston

Morgantown

63.1 to 79.8

79.9 to 84.7

84.8 to 91.2

West Virginia average: 83.9%

Mammography Facilities

% HS Education or Higher

Mammography Screening % by County,West Virginia, 2008-2010

Source: CountyHealthRankings.org

Mammography screening percentages are lowest in the Charleston area, and in the southwest and east central portions of the state.

Charleston

43.6 to 57.5

57.6 to 61.5

61.6 to 85.5

West Virginia average: N/A

Mammography Facilities

Mammography Screening %

% of Distant Stage Female Breast Cancers by County,West Virginia, 2009-2013

Source: WV Cancer Registry

A higher percentage of distant stage cancers are found in the east central border counties, and scattered throughout the state.

0.0 to 5.3

5.4 to 6.8

6.9 to 16.4

West Virginia average: 6.1%

Mammography Facilities

% Distant Stage

Average Annual Age-Adjusted Female Breast CancerMortality Rates* by County, West Virginia, 2009-2013

* Due to low case counts in some areas, rate estimates may not be reliable for all counties.

Source: West Virginia Health Statistics Center

Higher mortality rates are found in the east central counties, the northern panhandle, and the Huntington area.

Huntington

7.4 to 19.9

20.0 to 23.1

23.2 to 40.0

Mammography Facilities

Mortality Rate per 100,000

Female Breast Cancer Age-Adjusted Mortality/Incidence Ratio*by County, West Virginia, 2009-2013

* Due to low case counts in some areas, rate estimates may not be reliable for all counties.Source: West Virginia Health Statistics Center

Higher mortality/incidence ratios are found in the east central counties, and scattered throughout the state.

0.087 to 0.185

0.186 to 0.218

0.219 to 0.324

Mammography Facilities

MIR

% Female Breast Cancer Cases Receiving Treatment >90 Days from Diagnosis Date by County, West Virginia, 2009-2013

Source: WV Cancer Registry

The percentage of patients receiving treatment more than 90 days after diagnosis was higher in the western and southwestern portions of the state, and in the eastern panhandle.

0.00 to 0.50

0.51 to 2.22

2.23 to 9.72

CoC Hospitals

% Treatment Delay > 90 Days

West Virginia University Mobile Mammography Program Visits by County, West Virginia, 2009-2015

0 visits

1-10 visits

11-20 visits

21-30 visits

31 or more visits

Mammography Facilities

Source: West Virginia University Mobile Mammography Program

Bonnie’s Bus Mobile Mammography Program has done a very good job of providing screening in areas that do not have an accredited mammography facility.

Diagnosis Date White Black White Black

2005 - 2009 0.207 0.298 0.181 0.264

2008 - 2012 0.203 0.230 0.172 0.248

Difference 0.004 0.068 0.009 0.016

Source: CDC Wonder

Race

WV US

Race

Female Breast Cancer Mortality-Incidence Age-Adjusted

Rate Ratio by Race and Diagnosis Date, WV and US

The difference in mortality/incidence ratio between whites and blacks in West Virginia has decreased significantly since 2009. For the 2008 – 2012 time period, the mortality/incidence ratio for blacks in West Virginia was lower than the mortality/incidence ratio for blacks in the United States overall.

(n=6,136) (n=510)

Race

White 5963 (97.2) 494 (96.7)

Black 173 (2.8) 16 (3.1)

Stage

Early 4050 (66.0) 313 (61.4)

Late 2054 (33.5) 197 (38.6)

Unknown 32 (0.5) 0 (0.0)

Rurality

Metro 3458 (56.4) 299 (58.6)

Nonmetro 2365 (38.5) 181 (35.5)

Rural 313 (5.1) 30 (5.9)

Age Group

<50 1050 (17.1) 92 (18.0)

50+ 5086 (82.9) 418 (82.0)

Primary Payer

Private 2722 (44.4) 200 (39.2)

Medicaid 575 (9.4) 76 (14.9)

Medicare 2637 (43.0) 211 (41.4)

Not insured 98 (1.6) 10 (2.0)

Other 43 (0.7) 10 (2.0)

Unknown 61 (1.0) 3 (0.6)

Source: WV Cancer Registry

Characteristics of Female Breast Cancer Patients

by Time from Diagnosis to Treatment,

WV, 2009-2013

</= 60 Days from

Diagnosis to

Treatment

> 60 Days from

Diagnosis to

Treatment

Characteristic

For those patients receiving delayed treatment, a higher percentage have a late stage diagnosis, live in a metro area, and have Medicaid insurance.