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Colorectal Cancer Screening Capacity in Montana

Colorectal Cancer Screening Capacity in Montana. Montana DPHHS Survey, 2008 . Colorectal Cancer Screening. High priority for MT DPHHS 3rd most common cancer ~ 80% is preventable Good screening tests exist Screening underutilized. Recommendations. US Preventive Services Task Force, 2008

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Colorectal Cancer Screening Capacity in Montana

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  1. Colorectal CancerScreening Capacity in Montana Montana DPHHS Survey, 2008

  2. Colorectal Cancer Screening • High priority for MT DPHHS • 3rd most common cancer • ~ 80% is preventable • Good screening tests exist • Screening underutilized

  3. Recommendations • US Preventive Services Task Force, 2008 • Combined Expert Panel, 2008 • American Cancer Society • US Multi-Society Task Force on Colorectal Cancer • American College of Radiology

  4. Two Approaches • Direct examination • Colonoscopy • Flexible sigmoidoscopy • Double contrast barium enema • Virtual colonoscopy • Fecal testing

  5. Direct Examination • Greater potential to prevent CRC • More sensitive and specific • Bowel preparation • Cost

  6. Fecal Testing • Finds existing CRC • Not usually preventive • Less sensitive and specific • No bowel preparation • Inexpensive

  7. Sensitivity and Specificity • Test characteristics • Sensitive = doesn't miss disease if it exists • Specific = few false positives

  8. Task Forces Recommend • Universal CRC screening • Direct examination preferred • Fecal testing acceptable ONLY IF ANNUAL

  9. CRC Screening Underutilized in Montana • Only 65% of adults age 50+ up to date on screening • 53% ever had endoscopy • 28% FOBT within 2 years Montana BRFSS 2006

  10. CRC Screening Need Great in Montana • Estimated unscreened population • 143,000 in 2008 • Will increase to • 160,000 in 2020 • Unless screening participation increases

  11. MT DPHHS • Initiative to increase CRC screening • Screening methods to recommend depend on available capacity

  12. National Surveys of CRC Screening Capacity • Cannot meet demand • If everyone age 50+ chooses colonoscopy

  13. National Surveys of CRC Screening Capacity • No limitation • If everyone age 50+ chooses fecal testing

  14. Question • Is universal colonoscopy screening feasible in Montana?

  15. Feasiblity • Facilities to perform colonoscopy • Personnel • Cost to patients / insurance • Patient attitudes and beliefs

  16. MT DPHHS Survey • Identified all hospitals and ambulatory centers performing • 8-question survey • Refer to scheduling or billing records

  17. Response • 41 hospitals perform c'scopy • 40 returned surveys • Got info from M.D. for nonresponding hospital • 3 ambulatory centers • Affiliated with large hospitals • All returned surveys

  18. 13 urban General surgeons and gastro-enterologists 7 week wait 30 rural Internists and family practitioners 2 week wait Characteristics

  19. Urban 15,000 screens per year Could do 21,00 more 26% of total screen capacity unused Rural 4,000 screens per year Could do 22,000 more 81% of total screen capacity unused Characteristics

  20. Montana Has Unused Colonoscopy Screening Capacity • Unequally distributed • More total capacity in urban areas • More unused capacity in rural areas

  21. Conclusion • Every adult age 50 and older can and should be screened for colorectal cancer

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