Cigarette Restitution Fund Colorectal Cancer ProgramUpdate November, 2003

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Cigarette Restitution FundColorectal Cancer
ProgramUpdateNovember, 2003

• Diane M. Dwyer
• Center for Cancer Surveillance and Control
• Maryland Dept. of Health and Mental Hygiene

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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
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Maryland Cigarette Restitution Fund
AllocationFY03
202 Million
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CRF BudgetLocal PH
in Millions
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Create a Network through Partnerships and
Contracts
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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
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Local PHNumber 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
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Local PH CRF ProgramsNumber of Contracts for
Medical Services
605
336
Fee-for-Service for Providers, Hospitals, Labs,
Pharmacies, Radiology
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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

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CRC Medical Advisory Committee

• Medical experts
• Advise program on screening procedures, screening
  intervals
• Formulated Minimal Elements for CRC Screening

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Colorectal CancerEducation and Outreach
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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
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General Public CRC Education (Brief, Individual,
and Group) by Quarter and Minority Status
Source Education Database, Form 1 as of
November 4, 2003
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Media, Newspaper, Pamphlets, Billboards, etc.

• July 2000November 4, 2003
• Colorectal cancer messages targeted to reach
  22 million people

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Colorectal CancerScreening and Treatment
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Washington County Colonoscopies, 2001-2003
Washington Co. CRC program began
2002
2003
2001
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Colorectal Cancer Screening 50 years
oldMaryland Cancer Survey--2002
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Current CRC Screening Status of Marylanders 50
years oldMaryland Cancer Survey, 2002
UTDUp to date per ACS options for screening
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Colorectal Cancer CRF Public Health Program
Screening Data
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Summary of CRF CRC Screening

• As of October 30 2003
• 6,523 FOBTs
• 129 sigmoidoscopies
• 3,976 colonoscopies

Using highest numbers reported to DHMH
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CRC Screening by GenderMaryland FY01-present
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CRC Screening by MinorityMaryland FY01-present
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CRC Screening by Minority and GenderMaryland
FY01-present
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Persons Screened for CRC by Minority Status,
Maryland 7/1/00-6/30/03
42 Minority
Screened with FOBT, Sig., or ColonoscopyDHMH
database
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CRF CRC Screening Results
Using Highest numbers
Using those in DHMH database As of October
30, 2003
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CRF CRC Screening Results
Using those in DHMH database as of October 30,
2003
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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

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CRF CRC ScreeningComplications of 3,700
Colonoscopies (with and without biopsy)
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Pay for service until funds are depleted
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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

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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

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