1. Turning Data into Action for Colorectal Cancer November 17, 2014 Jessica Shaffer, Director, Maine CDC Colorectal Cancer Control Program www.mainecancerconsortium.org Tim Cowan, Director, Health Index Initiative

2.  Five-year funding through US CDC (2009-2014).  One-year extension funding (2014-2015).  In collaboration with four largest health systems in Maine. Program goals:  Direct provision of screening and diagnostic services to underserved populations.  Increase population screening rates through implementation of evidence-based policy & systems initiatives. “Integrating Colorectal Cancer Screening in Chronic Disease”

3. *Year 06 screening goal = > 200 screenings

4. Colorectal Cancer Incidence and Mortality Decreasing Over Time

5. CRC Incidence & Mortality among CRCCP States, 2010 a a Incidence rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25- 1130). (Source: Combined data from the National Program of Cancer Registries as submitted to CDC by November 2012 and from the Surveillance, Epidemiology, and End Results program submitted to National Cancer Institute in November 2012.) a Mortality rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25-1130). (Source: U.S. Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention, 2014.)

6. BRFSS Methodology Changes- 2011 Sampling method changes Addition of cell phone users to increase coverage of respondents with lower income, lower educational levels and of younger age groups Weighting method changes Better adjustment for demographic differences between respondents and the actual population by including additional demographic variables in the weighting method Due to these changes, BRFSS data from 2011 forward will not be directly comparable to data from previous years

7. Operational Definitions FOBT - Fecal Occult Blood Test within the past 1 year Colonoscopy - Colonoscopy within past 10 years FS + FOBT - Flexible sigmoidoscopy within the past 5 years with FOBT within the past 3 years Combined - FOBT within the past year; or flexible sigmoidoscopy within the past 5 years and FOBT within the past 3 years; or colonoscopy within the past 10 years

8. Colorectal Screening Prevalence, 2012 a a Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.)

9. CRC Screening Prevalence by CRCCP States, 2012 a a Combined. Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.)

10. CRC Screening by Gender, 2012 a a Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.)

11. CRC Screening by Age, 2012 a a Combined. Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.) Data are suppressed if groups have fewer than 50 observations.

12. CRC Screening by Income, 2012 a a Combined. Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.) Data are suppressed if groups have fewer than 50 observations.

13. CRC Screening by Insurance Status, 2012 a a Combined. Percentages reported for adults aged 50-75 years. (Source: Behavioral Risk Factor Surveillance System, Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.) Data are suppressed if groups have fewer than 50 observations.

14. CRC Screening by Maine County, 2012

16. Five-year Relative Survival Rates 2001-07 Top Five Cancers All Stages LocalRegionalDistant Lung/Bronchus*1652244 Colon/Rectum64906912 Breast-Female89998423 Uterine Cervix69915719 Prostate99100 29 * screening test available only for those with high-risk

17. Stage of Cancers Diagnosed Cancer/SEER Stats- 2004-2005 vs. 2008-2010 MaineU.S. Whites 2004- 2005 2008- 2010 2004- 2005 2008- 2010 Early-stage (in-situ or localized) 47%45%40%43% Late-stage (regional or distant cancers) 47%49%55%52% Unknown Stage 6% 5% Total 100%

18. Evidence-Based Interventions: FIT Testing Randomized Control Trial in 16 Rural Family Medicine Offices in Iowa Intervention Number of Patients (743 total) % screened for colorectal cancer (any type) Usual Care 18517.8% Physician chart reminder 18520.5% Physician reminder + mailed educational materials & FIT 18656.5% Physician reminder + mailed educational materials & FIT + Telephone call 18757.2% JABFM, September-October 2013, Vol. 26 No. 5; p 486-497 doi: 10.3122/jabfm.2013.05.130041

19. Randomized Control Trial- 16 Rural FM Offices in Iowa JABFM, September-October 2013, Vol. 26 No. 5; p 486-497 doi: 10.3122/jabfm.2013.05.130041 Percent Screened with fecal immunochemical test (FIT) or colonoscopy (CS)

20. U.S. CDC: www.cdc.gov/cancer/colorectal/ www.cdc.gov/cancer/colorectal/ Screen for Life: www.cdc.gov/cancer/colorectal/sfl/ www.cdc.gov/cancer/colorectal/sfl/ The Community Guide: www.thecommunityguide.org www.thecommunityguide.org Maine CDC Cancer Screening: www.screenmaine.org www.screenmaine.org Additional Resources

21. Jessica Shaffer Jessica.Shaffer@maine.gov Thank You! Tim Cowan COWANT@mainehealth.org