Reducing Colorectal Cancer: Screening, Access, and Services in Minority and Underserved Communities Wednesday, October 2

1. Reducing Colorectal Cancer: Screening, Access, and Services in Minority and Underserved Communities Wednesday, October 26, 2005 2:00 p.m. EDT Please wait. The Web conference will begin shortly. Thank you.

2. Reducing Colorectal Cancer: Screening, Access, and Services in Minority and Underserved Communities Lynne Flynn, Web conference moderator Director of Health Policy, The Council of State Governments

3. CSG’s Healthy States Initiative • CSG’s Partners: • National Black Caucus of State Legislators-- www.nbcsl.com • National Hispanic Caucus of State Legislators— www.nhcsl.com • Complete information on Healthy States: www.healthystates.csg.org • Click on the Healthy States link on lower left and other resources listed • Supported by the Centers for Disease Control and Prevention (CDC)

4. Web conferences • 8 others completed this year and archived on Web site including: • Prevention of Teen Sexual Risk Behaviors • Immunization Disparities • Preventing Diabetes in Hispanic Communities • Heart Disease & Stroke • Vaccine Safety • Oral Health • Anti-smoking programs • School Health

5. Technical Problems? • For problems connecting to the Web, call 1.866.767.6902 • If you have any difficulty with audio or Web connections, press *0 for operator assistance

6. Please Complete Evaluation at End of Web Conference • We need your help! • Please complete the evaluation poll at the end of the Web conference

7. Today’s Speakers • Dr. Laura Seeff, Centers for Disease Control and Prevention • Dr. William Blackstock, Wake Forest University School of Medicine • Illinois State Senator Donne Trotter • Dr. Stephen Grubbs, Medical Oncologist, Delaware Cancer Consortium

8. Dr. Laura Seeff • Dr. Laura Seeff is a medical officer in the Division of Cancer Prevention and Control (DCPC) at the Centers for Disease Control and Prevention (CDC). • She is helping to lead a new CDC initiative to explore the feasibility of increasing colorectal cancer screening at the community level, through the establishment of 5 demonstration colorectal cancer screening programs. • She is the principal investigator for a CDC study to estimate the national capacity to provide colorectal cancer screening to all eligible persons in the U.S. • Prior to joining CDC in 1998, Dr. Seeff was an Assistant Professor of Medicine at the Emory University School of Medicine, where she was responsible for establishing a colorectal cancer screening clinic for patients at Grady Memorial Hospital.

9. Colorectal Cancer Burden of Disease • Second leading cause of cancer death in US • Occurs primarily in adults 50+ • Both women and men • All races • American Cancer Society estimates in 2005: • 145,290 new cases • 56,290 deaths • Treatment costs over $6.5 billion per year • Among malignancies, second only to breast cancer at $6.6 billion per year

10. Cost-Effectiveness (Cost/Year Life Saved) • Mandatory motorcycle helmets $2,000 • Colorectal cancer screening $25,000 • Breast cancer screening $35,000 • Dual airbags in cars $120,000 • Smoke detectors in homes $210,000 • School bus seat belts $1,800,000

11. Average Annual Age-Specific CRC Death Rates By Race and Sex, 1998-2002 • Black Male • White Male • Black • Female • White Female Source: SEER Cancer Statistics Review, 1975-2002

12. Screening • Screening tests are performed before a person has symptoms • To detect a disease which may be present but silent • To prevent or more effectively treat the disease • Screening effective for colorectal cancer • Prevention (polyp removal) decreased incidence • Early detection decreased mortality • Only ~50% of adults are being screened appropriately for colorectal cancer • Screening rates are lower for persons with less education, lower socio-economic status, no health insurance and no physician recommendation

13. States which mandate CRC screening, 2003

14. CDC funded Colorectal Cancer Screening Demonstration Program • Five demonstration CRC screening programs to be established in 2005 for low-income, under- or uninsured persons • Research Foundation of SUNY/Stony Brook, NY • Nebraska Department of Health and Human Services • Missouri Department of Health and Senior Services • St Louis • Focus on African American population • Maryland Department of Health and Mental Hygiene • Baltimore • Focus on African American population • Seattle & King County, Seattle, WA • Focus on American Indian population

15. Colorectal Cancer Resources • CDC Cancer Prevention and Control http://www.cdc.gov/cancer/ • CDC Cancer Prevention and Control, Colorectal Cancer resource page http://www.cdc.gov/cancer/colorctl/resourcematerials.htm#cdc • Screen for Life: National Colorectal Cancer Action Campaign http://www.cdc.gov/cancer/screenforlife/preview.htm • Patterns of Care Study: Breast, Colon, and Prostate Cancer Data Quality and Treatment • http://www.cdc.gov/cancer/npcr/pocstudy.htm • Collaborators that Provide Services and Resources to Cancer Survivors http://www.cdc.gov/cancer/survivorship/natorgs.htm

16. Dr. William Blackstock • A. William Blackstock completed his residency training in Radiation Oncology at the University of North Carolina at Chapel Hill. • Dr. Blackstock has developed considerable experience as a translational clinical scientist, educator and mentor. • He currently serves on the executive committee for the Cancer and Leukemia Group B (CALGB) as well as Co-Chair of the Underserved Committee within CALGB. • Dr. Blackstock also serves on numerous grant review committees including the NCI Clinical Oncology study section (full member), ASCO grants review committee and the Michael Smith Foundation for Health Research - Canada. • While at the University of North Carolina and more recently at Wake Forest University, he remains involved in the training of medical students, residents, fellows, and doctoral degree students in Cancer Biology.

17. African Americans’ and the impoverished are less likely to undergo screening for colorectal cancer

18. African Americans’ diagnosed with colorectal cancer are more likely to die from their disease. Cancer Volume 104, Issue 3 Pages 629-639

19. African Americans’ and the impoverished are less likely to receive treatment for colorectal cancer. Socioeconomics Received Chemotherapy J Natl Cancer Inst 97 (16): 1211.

20. “Equal cancer treatment results in equal outcome . . .” • Solutions . . . • States can expand eligibility / eliminate obstacles . . . • Implement targeted screening / prevention programs.. • Promote research on State Disparities . . . cancer.gov/disparities.shtml

21. Illinois State Senator Donne Trotter • Senator Donne E. Trotter was elected to the Illinois General Assembly in 1988. After serving in the House of Representatives for two terms, he was elected to the Senate in 1992. • Currently, Senator Trotter serves as Chairman of Appropriations I. As Chair of Appropriations I, he oversees all budget initiatives for the state’s $53 billion budget. • Senator Trotter was instrumental in creating and expanding the KidCare (SCHIP), FamilyCare and SeniorCare initiatives. By increasing the eligibility threshold, Illinois was able to add an additional 270,000 children and their parents to the states health insurance program since 1999. • An active leader in the Council of State Governments, Senator Trotter served as the Chairman of the Health Committee from 1996 – 2000. • He recently retired after serving 22 years in the Cook County Health Care System, beginning his career as an Associate Administrator at Cook County Hospital and more recently, as the Director of Minority Health for Cook County Department of Public Health (CCDPH).

22. Illinois State Legislation • July 2005 - GOVERNOR SIGNS LAWS TO HELP INCREASE COLORECTAL CANCER AWARENESS AND TO HELP FUND RESEARCH. • Senate Bill 133 -creates the Vince Demuzio Memorial Colon Cancer Fund.

23. Dr. Stephen Grubbs • Dr. Grubbs has been practicing as a Medical Oncologist in Newark, Delaware for the past twenty one years. • He serves as: • Medical Oncology Section Chief of Christiana Care Health Systems; • Principal Investigator of the Delaware Christiana Care CCOP; • Board member and Executive Committee member of the Cancer and Leukemia Group B cooperative research group; • And council member and Colorectal Cancer Screening Chair of the Delaware Cancer Consortium.

24. Percentage of Delawareans > 50 Years Old with Colonoscopy or Sigmoidoscopy

25. Delaware Cancer Consortium • Governor Ruth Ann Minner • Lt Governor John Carney, Jr • Bipartisan Legislators • Stakeholders including survivors, advocates, health care professionals, organizations, health care delivery systems • DE Division of Public Health

26. DE Colorectal Cancer Mortality Disparity • Male African American / Caucasian + 23.5% • Female African American / Caucasian +71.8% Source: 1996 – 2000 DE Div Public Health

27. Increase screening for and early detection of colorectal cancer Communication materials for the public Advocate and Coordinate Screening Pay for Screening (Colonoscopy)

28. Pay for cancer treatment for the uninsured Began reimbursement for treatment of uninsured Established annual allocation for cancer treatment for the uninsured Established system for billing & payment for cancer treatment

29. Decrease disparities in cancerincidence and mortality Created Champions of Change to reach largest disparity

30. Q & A Session Instructions • Submit questions either way: • Email: Use the question box on the bottom right portion of the web page • Phone: Press *1, let the operator know you have a question. The operator will unmute your line so you can ask your question directly to the panelists.

31. Colorectal Cancer Prevention Panelists Dr. Laura Seeff Medical Officer, Division of Cancer Prevention and Control CDC Dr. William Blackstock Associate Professor Department of Radiation Oncology  Wake Forest University School of Medicine, State Senator Donne Trotter Illinois Dr. Stephen Grubbs Council member and Colorectal Cancer Screening Chair of the Delaware Cancer Consortium.

32. This Concludes the Web Conference • Please complete the evaluation poll which will pop up on your screen • Go to www.healthystates.csg.org for complete information on Healthy States Initiative • Thanks for attending!