1. CRC 45: The steps to eliminating Colorectal Cancer Diana Rusz December 12, 2012

2. What is Colon Cancer ?Colon Cancer  Colon cancer is cancer in parts of the body including the colon, rectum, appendix and anus. It is also called "colorectal" cancer 2

3. Colorectal Cancer Disparity  African Americans have the highest incidence of colorectal cancer of any racial or ethnic group  At 50, there is a higher incidence of African Americans with stage 4 colon cancer than Caucasians, suggesting that this demographic has had pre-cancerous polyps that could have been removed before the age of 50. 3

4. Screening  National society guidelines recommend that people at average risk of colorectal cancer be screened starting at age 50. People are considered to be at average risk if they have no symptoms, do not have ulcerative colitis or Crohn’s colitis, and do not have a personal or family history of colorectal neoplasia.  Symptoms: anemia, rectal bleeding, abdominal pain, etc. 4

5. Proposal: CDC Colorectal Cancer Screening Guideline Amendment  Regular screening, beginning at age 50, is the key to preventing colorectal cancer. The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer using high-sensitivity fecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at age 50 years and continuing until age 75 years. (Centers for Disease Control and Prevention)  Amendment to existing guideline: Given the higher incidence rate of stage 4 cancer diagnosis for African Americans at the age of 50, screening should begin at age 45 for African American males and females 5

6. Cost-effective Incentives  Screening (prevention): Fecal Occult Blood Test: $10 - $25 Sigmoidoscopy: $150 - $300 Double-Contrast Barium Enema: $250 - $500 Virtual Colonoscopy: $500 - $900 Colonoscopy: $800 - $2,000  8 Weeks of Chemotherapy: $100-$30,000 6

7. A few analogies  Tay Sachs and Ashkenazi Jewish descent: -Tay-Sachs is a very rare disease of the nervous system -The damage leads to problems of the nervous system, such as seizures and the loss of vision  Sickle Cell Disease and African Americans: -Hemoglobin S changes the shape of red blood cells. The red blood cells become shaped like crescents or sickles. - sickle-shaped cells deliver less oxygen to the body's tissues. 7

8. Venue FEDERAL 8

9. Policy Paramours House Cancer Caucus Congressman Steve Israel (D) Congresswoman Lois Capps (D) Congresswoman Sue Myrick (R) 9

10. Policy Paramours 10 Senator (D-NJ) Frank Lautenbergd Senator (D-NJ) Robert Menendez U.S. Senator Joe Lieberman

11. Stakeholders: Governmental  Department of Health and Human Services  Centers for Disease Control  Health Resources and Services Administration  Agency for Healthcare Research and Quality  US. Preventive Services Task Force  National Cancer Institute  House Cancer Caucus  Cooperative State Research Education and Extension Service  Centers for Medicare and Medicaid Services  Health Resources and Services Administration  National Institute of Health  National Office of Public Health Genomics  U.S. Public Health Service Commissioned Corps 11

12. Stakeholders: Non-Governmental  Insurance companies  American Cancer Society  American Society of Colon and Rectal Surgeons  Partnership for Prevention  Cancer Control Planet  American Association for Cancer Research  Cancer Research Foundation of America  Cancer Research Institute  National Comprehensive Cancer Center Network  National Foundation for Cancer Research  Universities  Lobbyists  Media 12

13. References  http://www.youtube.com/watch?v=DABeD_X-jm4 http://www.youtube.com/watch?v=DABeD_X-jm4  http://www.ccjm.org/content/75/6/441.full http://www.ccjm.org/content/75/6/441.full  http://www.asge.org/press/press.aspx?id=552 http://www.asge.org/press/press.aspx?id=552  http://www.cdc.gov/cancer/colorectal/statistics/index.htm http://www.cdc.gov/cancer/colorectal/statistics/index.htm  http://coloncancer.about.com/od/screening/a/Uninsured.htm http://coloncancer.about.com/od/screening/a/Uninsured.htm  http://coloncancer.about.com/od/cancerresearch/a/03172007.htm http://coloncancer.about.com/od/cancerresearch/a/03172007.htm  http://www.livestrong.com/article/153376-the-average-cost-for-cancer- chemotherapy-treatment/ http://www.livestrong.com/article/153376-the-average-cost-for-cancer- chemotherapy-treatment/  http://healthfinder.gov/prevention/ViewTopic.aspx?topicID=15&cnt=1&ar eaID=1&TopicContentID=87 http://healthfinder.gov/prevention/ViewTopic.aspx?topicID=15&cnt=1&ar eaID=1&TopicContentID=87  http://www.intelihealth.com/IH/ihtIH/WSIHW000/32193/35422.html http://www.intelihealth.com/IH/ihtIH/WSIHW000/32193/35422.html  http://sicklecellwarriors.com/2011/08/dealing-with-medical-bills-and- insurance/ http://sicklecellwarriors.com/2011/08/dealing-with-medical-bills-and- insurance/  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001554/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001554/  http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/d ocuments/document/acspc-031941.pdf http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/d ocuments/document/acspc-031941.pdf  http://www.usa.gov/directory/federal/index.shtml http://www.usa.gov/directory/federal/index.shtml 13