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Cigarette Restitution FundColorectal Cancer Program—Update
November, 2003
Diane M. DwyerCenter for Cancer Surveillance and Control
Maryland Dept. of Health and Mental Hygiene
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THANKS:THANKS:
25 Maryland Local PH Programs
DHMH Staff
Carmela GrovesAlyse WeinsteinLorraine UnderwoodEugene Small
University of MD Team
Eileen SteinbergerAnnette HopkinsMin ZhanJane UmanEbenezer Israel
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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
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CRF Budget—Local PH
0
2
4
6
8
10
12
14
16
FY01 FY02 FY03 FY04
AwardedExpended
$ in Millions
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Create a Network through
Partnerships and Contracts
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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”
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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
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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
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Oral Cancer CRF Programs in Maryland - FY 2004
Legend
EDUCATE AND SCREEN
EDUCATE ONLY
CURRENTLY NO PROGRAM
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Skin Cancer CRF Programs in Maryland - FY 2004
Legend
EDUCATE AND SCREEN
EDUCATE ONLY
CURRENTLY NO PROGRAM
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Prostate Cancer CRF Programs in Maryland - FY 2004
Legend
EDUCATE AND SCREEN
EDUCATE ONLY
CURRENTLY NO PROGRAM
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Breast and Cervical Cancer CRF Programs in Maryland - FY 2004
Legend
EDUCATE AND SCREEN
EDUCATE ONLY
CURRENTLY NO PROGRAM
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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
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CRC Medical Advisory Committee
Medical expertsAdvise program on screening procedures, screening intervalsFormulated Minimal Elements for CRC Screening
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Colorectal CancerEducation and Outreach
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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
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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
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Media, Newspaper, Pamphlets, Billboards, etc.
July 2000—November 4, 2003: Colorectal cancer messages
targeted to reach >22 million>22 million people
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Colorectal CancerScreening and Treatment
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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
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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
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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
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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
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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
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Colorectal Cancer CRF Public Health Program
Screening Data
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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
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CRC Screening by GenderMaryland FY01-present
31%
69%
MenWomen
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CRC Screening by MinorityMaryland FY01-present
42%
58%
Minority Non-minority
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CRC Screening by Minority and GenderMaryland FY01-present
12%
40%
19%
29%
Minority Men
Minority Women
Non-Minority Women
Non-Minotiry Men
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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
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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
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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
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Other Findings on Colonoscopy
46% of colonoscopies without adenomatous polyps or cancer had other findings:
Non-adenomatous polypshemorrhoidsdiverticular disease inflammatory bowel diseaseother
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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
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* Pay for service until funds are depleted
Payment for Hospitalization -- FY 2004
Legend
LINK - UCC
FEE FOR SERVICE - LHD
NOT APPLICABLE
*
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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
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ChallengesBudget cutsHow to screen those not covered by a program or insuranceHow to pay for diagnosis and treatmentIncorporating new CRC screening methods
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