Colorado Colorectal Screening Program Holly Wolf University of Colorado School of Medicine Colorful Colorado Map of Colorado Colorectal Cancer in Colorado Second leading cause of cancer death - Each year, 1690 diagnosed and 620 die Screening can reduce incidence (polyp removal) Screening can also reduce mortality FOBT by 30% Sigmoidoscopy by up to 50% Colonoscopy by up to 80% Only 55% Coloradans ages 50+ are screened 66% ages 65 + (Medicare) 52% ages with health insurance 26% ages without health insurance Colorectal cancer mortality, US and Colorado United States Cancer Statistics: 19992002 5-Year CRC survival CRC in Colorado 5-year colorectal cancer survival in Colorado by proportion of neighborhood in poverty CRC screening trends, US and Colorado % Non-Hispanic Whites Hispanics Colorado Colorectal Screening Program Funded by revenues from a tobacco tax Began in January 2006, expanded statewide in November 2006 Partnership with community clinics Approach Provide endoscopic colorectal screening to Coloradans without health insurance who are under 250% Federal Poverty Level and who need screening Encourage all Coloradans ages 50 and older to get screened. Program Components Endoscopic screening in clinics or by referral Follow-up and Rx Patient navigation support Capacity development Public outreach & marketing Evaluation Program Eligibility Coloradan ages 50 and older Under 50 if family or personal history Patient of a participating clinic Income below 250% of Federal Poverty No health insurance Need colorectal screening Lawfully present Need for screening Assessed by primary care provider using consensus screening/surveillance guidelines Average risk 50 years and older Increased risk - under 50 Family history of colorectal cancer or adenomatous polyps Personal history of adenomas or colorectal cancer High risk Under 50 Family history of FAP or HNPCC Personal history of IBD for 8 years or longer Symptomatic - 45 years or older Findings from the first 925 CCSP colonoscopies 65% female 47% Hispanic 8% African American 99% had an adequate exam 21% had adenomas 1% had cancer Goals Implement statewide screening asap Seamless program management Patient navigation and support Flexibility for new screening methods Screen approx 3000 per year Year 2010 objectives of 75% screening compliance among uninsured Program information www.uccc.info/colonscreenwww.uccc.info/colonscreen CCSP coordinating center: ACS help line: Tim Byers, MD, MPH Angela Sauaia, MD Susan Rein, RN Andrea Dwyer BS Jan Lowery, PhD Holly Wolf, PhD The Colorado Colorectal Screening Program