Colorectal Cancer Screening Capacity in Montana

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Colorectal CancerScreening Capacity in Montana

Montana DPHHS Survey, 2008
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Colorectal Cancer Screening

• High priority for MT DPHHS
• 3rd most common cancer
• 80 is preventable
• Good screening tests exist
• Screening underutilized
• 
  

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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

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Two Approaches

• Direct examination
• Colonoscopy
• Flexible sigmoidoscopy
• Double contrast barium enema
• Virtual colonoscopy
• Fecal testing

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Direct Examination

• Greater potential to prevent CRC
• More sensitive and specific
• Bowel preparation
• Cost

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Fecal Testing

• Finds existing CRC
• Not usually preventive
• Less sensitive and specific
• No bowel preparation
• Inexpensive

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Sensitivity and Specificity

• Test characteristics
• Sensitive doesn't miss disease if it exists
• Specific few false positives

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Task Forces Recommend

• Universal CRC screening
• Direct examination preferred
• Fecal testing acceptable ONLY IF ANNUAL

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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
  

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CRC Screening Need Great in Montana

• Estimated unscreened population
• 143,000 in 2008
• Will increase to
• 160,000 in 2020
• Unless screening participation increases
• 
  

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MT DPHHS

• Initiative to increase CRC screening
• Screening methods to recommend depend on
  available capacity
• 
  

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National Surveys of CRC Screening Capacity

• Cannot meet demand
• If everyone age 50 chooses colonoscopy
• 
  

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National Surveys of CRC Screening Capacity

• No limitation
• If everyone age 50 chooses fecal testing
• 
  

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Question

• Is universal colonoscopy screening feasible in
  Montana?
  

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Feasiblity

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

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MT DPHHS Survey

• Identified all hospitals and ambulatory centers
  performing
• 8-question survey
• Refer to scheduling or billing records

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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

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Characteristics

• 13 urban
• General surgeons and gastro-enterologists
• 7 week wait

• 30 rural
• Internists and family practitioners
• 2 week wait

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Characteristics

• 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

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Montana Has Unused Colonoscopy Screening Capacity

• Unequally distributed
• More total capacity in urban areas
• More unused capacity in rural areas

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Conclusion

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