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HOW STANDING ORDERS HELPED US IMPROVE CANCER SCREENING: REPORT FROM A NEW PPRNet MEMBER. Julio A Savinon, md Rio gRande Medicine Inc. Harlingen, TX. IN CASE SOMEBODY ASKS WHERE HARLINGEN IS. ABOUT HARLINGEN.
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HOW STANDING ORDERS HELPED US IMPROVE CANCER SCREENING: REPORT FROM A NEW PPRNet MEMBER Julio A Savinon, md Rio gRande Medicine Inc. Harlingen, TX
ABOUT HARLINGEN • Population: 65,679; increases by 14% annually. Most over 18 years old (near 70%) • Winter Texans • 2 major hospitals • All specialties available. • Need for improvement: poverty, uninsured, lifestyle…
ABOUT RGM • More than 2,500 patients and growing • 2 providers (1 IM, 1 FP) • 4 MAs,2 Secretaries, 2 billers, one office manager, and others. • EMR • PPRnet. • Managed care and ACO participation • Level 3 PCMH • Bariatric medicine and referrals.
CANCER FACTSESTIMATES FROM ACS FOR 2014 • 96,830, 40,000 new cases of COLON CA AND RECTAL CANCER, respectively. 50,310 expected to DIE. • 232,670, 62,570 new cases of invasive and in situ BREAST CANCER, respectively. 40,000 expected to DIE. • 12,360 new cases of invasive CERVICAL CANCER. 4,020 expected to DIE.
MORE CANCER FACTS • Estimated cost for 2009 was US $216.6 billion, 86 billion for direct medical cost, 130 billion for indirect (lost productivity). • Early detection usually results in less extensive treatments and better outcomes; to less suffering. • The USPSTF recommends screening mammography for women 50-74 years, biennial. • For cervical cancer: initiate at age 21; every 3 years, or every 5 years with HPV co-testing for women ages 30-65, then stop if not any abnormality. • For colon cancer: colonoscopy age 50, every 10 years, until age 75, or until life expectancy is less than 10 years. FOBT yearly; sigmoidoscopy with FOB every 3 years. BE is not recommended by USPSTF.
CANCER SCREENING FACTSSOURCE: MKSAP 16 and NCI • Breast cancer mortality reduction with mammography: 10-20%. • Cervical cancer reduction with PAP: 95% (at least 80% including mortality reduction) • Colon cancer reduction with colonoscopy: 53-72% (similar for sigmoidoscopy, left colon), mortality reduction: 31%; with FOBT 17-20% cancer reduction; mortality reduction: 15-33%
RISK OF CANCER SCREENINGsource: NCI • Overdiagnosisand unnecessary treatments. • False positive with additional testing and anxiety • False negative with false sense of security and potential for delay in diagnosis • Radiation, bleeding, perforation, death. • Cost
CERVICAL CANCER SCREENINGSOURCE: NATIONAL CENTER FOR HEALTH STATISTICS.
COLON CANCER SCREENING AT RGM AFTER STANDING ORDER IMPLEMENTATION
CONCLUSION. STANDING ORDERS ARE HELPING US IMPROVE CANCER SCREENING