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Cigarette Restitution Fund Colorectal Cancer Program—Update November, 2003. Diane M. Dwyer Center for Cancer Surveillance and Control Maryland Dept. of Health and Mental Hygiene. THANKS:. University of MD Team Eileen Steinberger Annette Hopkins Min Zhan Jane Uman Ebenezer Israel.
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Cigarette Restitution FundColorectal Cancer Program—UpdateNovember, 2003 Diane M. Dwyer Center for Cancer Surveillance and Control Maryland Dept. of Health and Mental Hygiene
THANKS: University of MD Team Eileen Steinberger Annette Hopkins Min Zhan Jane Uman Ebenezer Israel DHMH Staff Carmela Groves Alyse Weinstein Lorraine Underwood Eugene Small 25 Maryland Local PH Programs
Maryland Cigarette Restitution Fund Allocation—FY03 $ 202 Million
CRF Budget—Local PH $ in Millions
State Health Dept. Program 25 Local PH Programs Providers: Doctors Labs, Hospitals, Pharmacies 24 Community Health Coalitions Minority Outreach, Technical Assistance 2 Statewide Academic Health Centers: Research, PH, Statewide Health Network Community based orgs. Faith based organizations Volunteers Maryland Citizens, esp. Minority & Underserved CRF Cancer Control “Network”
Local PH—Number of Contracts for Education/Outreach/Media Services* ~ 75 from 17 programs ~ 68 from 17 programs ~ 46 from 14 programs * Non fee-for-service to CBO, Minority, Faith-based, Education, Advertising
Local PH CRF Programs—Number of Contracts for Medical Services* 605 336 * Fee-for-Service for Providers, Hospitals, Labs, Pharmacies, Radiology
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 experts • Advise program on screening procedures, screening intervals • Formulated Minimal Elements for CRC Screening
Colorectal Cancer--Number Educated by Type of Audience Maryland, June 2000-November 4, 2003 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 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 people
Washington County Colonoscopies, 2001-2003 Washington Co. CRC program began 2002 2003 2001
Colorectal Cancer Screening >50 years oldMaryland Cancer Survey--2002
Current CRC Screening Status of Marylander’s >50 years old—Maryland Cancer Survey, 2002 *UTD—Up to date per ACS options for screening
Summary of CRF CRC Screening As of October 30 2003: 6,523 FOBTs 129 sigmoidoscopies 3,976 colonoscopies * Using “highest numbers” reported to DHMH
Persons Screened* for CRC by Minority Status, Maryland 7/1/00-6/30/03 42% Minority *Screened with FOBT, Sig., or Colonoscopy—DHMH database
CRF CRC Screening Results * Using “Highest numbers” ** Using those in DHMH database As of October 30, 2003
CRF CRC Screening Results* * Using those in DHMH database; as of October 30, 2003
Other Findings on Colonoscopy • 46% of colonoscopies without adenomatous polyps or cancer had other findings: • Non-adenomatous polyps • hemorrhoids • diverticular disease • inflammatory bowel disease • other
CRF CRC ScreeningComplications of ~3,700 Colonoscopies (with and without biopsy)
* * Pay for service until funds are depleted
Lessons • 45 colorectal cancers detected; over 70 cancers possibly prevented through polyp removal • An effective colorectal cancer screening program for the under-served (uninsured and low income) is possible • Services well received by providers and the community • Programs shifted from FOBT-sig to colonoscopy • Complications happen (at expected frequency) • More difficult to reach men
Challenges • Budget cuts • How to screen those not covered by a program or insurance • How to pay for diagnosis and treatment • Incorporating new CRC screening methods