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