Colon Tumor Observation and Assessment.


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Colon Cancer. Reconnaissance & Evaluation. Lorna Thorpe, Ph.D. NYC DOHMH Division of ... Recognize quantifiable markers identified with colorectal disease ...
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Colon Cancer Surveillance & Evaluation Lorna Thorpe, Ph.D. NYC DOHMH – Division of Epidemiology CDC - Nat\'l Center for Chronic Disease Prevention and Health Promotion

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Objectives Review malignancy reconnaissance objectives Identify quantifiable pointers identified with colorectal tumor Summarize national and nearby observation discoveries Discuss qualities and shortcomings of accessible markers Lead bunch discourse on neighborhood reconnaissance open doors

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Objectives Review growth observation objectives Identify quantifiable markers identified with colorectal malignancy Summarize national and neighborhood observation discoveries Discuss qualities and shortcomings of accessible markers Lead bunch talk on neighborhood observation open doors

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Objectives Review malignancy reconnaissance objectives Identify quantifiable markers identified with colorectal tumor Summarize national and nearby reconnaissance discoveries Discuss qualities and shortcomings of accessible markers Lead bunch dialog on neighborhood observation open doors

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Objectives Review tumor reconnaissance objectives Identify quantifiable markers identified with colorectal growth Summarize national and neighborhood reconnaissance discoveries Discuss qualities and shortcomings of accessible pointers Lead bunch examination on neighborhood observation open doors

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Objectives Review malignancy reconnaissance objectives Identify quantifiable pointers identified with colorectal malignancy Summarize national and nearby observation discoveries Discuss qualities and shortcomings of accessible pointers Lead bunch exchange on neighborhood reconnaissance open doors

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Cancer Surveillance Goals Identify and track patterns Strengthen tumor anticipation and control exercises Prioritize utilization of assets

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Where are the Measurable Indicators for Tracking Colorectal Cancer? Screen Prevalence of Risk Factors Cancer-related passing happens Cancer creates Polyp(s) create

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Where are the Measurable Indicators for Tracking Colorectal Cancer? Screen Prevalence of Risk Factors Measure Use of Cancer Screening Tests Cancer-related passing happens Cancer creates Polyp(s) create

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Where are the Measurable Indicators for Tracking Colorectal Cancer? Screen Prevalence of Risk Factors Measure Use of Cancer Screening Tests Track Incidence Of New Cancer Diagnoses Cancer-related demise happens Cancer creates Polyp(s) create

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Where are the Measurable Indicators for Tracking Colorectal Cancer? Screen Prevalence of Risk Factors Measure Use of Cancer Screening Tests Track Incidence Of New Cancer Diagnoses Assess Cancer-Related Mortality Rates Cancer-related passing happens Cancer creates Polyp(s) create

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Individual Risk Factors for Colorectal Cancer An impossible arrangement of pointers for following malady drifts Most behavioral danger variables are non-particular to colorectal disease Attributable division of most astounding danger gatherings is little Highest danger gatherings might be sufficiently instructed and/or screened

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Risk Factors for Colorectal Cancer Age Diet Physical movement History of polyps ( familial polyposis ) Personal restorative history Family medicinal history

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Risk Factors for Colorectal Cancer Age Diet Physical action History of polyps ( familial polyposis ) Personal therapeutic history Family medicinal history

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Risk Factors for Colorectal Cancer Age Diet Physical action History of polyps ( familial polyposis ) Personal therapeutic history Family therapeutic history

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Risk Factors for Colorectal Cancer Age Diet Physical action History of polyps ( familial polyposis ) Personal therapeutic history Family medicinal history

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Risk Factors for Colorectal Cancer Age Diet Physical action History of polyps ( familial polyposis ) Personal restorative history Family medicinal history

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Risk Factors for Colorectal Cancer Age Diet Physical action History of polyps ( familial polyposis ) Personal medicinal history Family medicinal history

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Percent of Colorectal Cancer Burden because of Medical Risk Factors Source: CDC

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Monitoring Colorectal Cancer Screening Strengths Highly successful essential and auxiliary anticipation approach Long lead time (polyp  tumor, malignancy  demise) Reduces mortality Relatively financially savvy Discrete, quantifiable occasion Can set quantifiable, achievable, short-tem targets

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Colorectal Cancer Screening Weaknesses Not routinely caught in existing information sources Not yet a HEDIS measure for health care coverage Not routinely evaluated by PROs in Medicare Not a reportable system Reliant on self-reported predominance gauges Complicated screening proposals menu makes for troublesome pervasiveness appraisal

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Screening Rates in NYC Large randomized phone overview of grown-ups (n=10,000) Able to take a gander at numerous subgroups Very convenient Expensive Difficult to accept Asked about "ever" sigmoidoscopy or colonoscopy

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Age-Adjusted Prevalence of Ever Colonoscopy or Sigmoidoscopy Screen, by Neighborhood - NYC 2002

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Age-Adjusted Prevalence of Ever Colonoscopy or Sigmoidoscopy Screen, by Neighborhood - NYC 2002

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Low Screening Rates Among Groups at Higher Risk for Colorectal Cancer No gatherings are being screened enough Groups at higher danger have lower screening rates Physically inert Smokers

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Black and Hispanic New Yorkers Have Lower Rates of Screening than Whites

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Screening Questions Planned for 2003 Survey Ever had sigmoidoscopy or colonoscopy? Which sort, or both? Time since last colonoscopy/sigmoidoscopy Ever had a blood stool test (FOBT)? Time since last FOBT

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Other Data Sources for Tracking Screening Trends Medicaid Managed Care Enrollees (MEDS) Covers just a little extent of >65 populace Unstable scope for some enrollees 678,000 enrollees, however just 62,000 age 45 and more established

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Colonoscopy Procedure Rates in NYC Medicaid MCO enrollees, between Jan-June 2002 Age MCO Enrollee Colonoscopies Rate per Pop performed 100,000 pop* 45-64 56,210 943 3355.3 65+ 5,193 112 4313.5 3436.3 = 3.4 for each 100 MCO beneficiaries age 45 or more established * Annualized rate Source: NYC DOHMH

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Other Data Sources for Tracking Screening Trends Medicaid Managed Care Enrollees (MEDS) Covers just a little extent of >65 populace Unstable scope for some enrollees 678,000 enrollees, yet just 62,000 age 45 and more established Colonoscopy supplier reviews

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Other Data Sources for Tracking Screening Trends Medicaid Managed Care Enrollees (MEDS) Covers just a little extent of >65 populace Unstable scope for some enrollees 678,000 enrollees, yet just 62,000 age 45 and more established Colonoscopy supplier studies SPARCS Ambulatory strategies dataset

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Tracking New Diagnoses of Colorectal Cancer (Incidence) Strengths New York State Cancer Registry Gold standard quality for culmination and exactness Includes frequency, stage at determination, treatment regimen, mortality National rate patterns, SEER and NPCR High quality, complete, point by point development

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Tracking New Diagnoses of Colorectal Cancer (Incidence) Weaknesses New York State Cancer Registry Confidentiality concerns restrain the opportuneness and openness of NYC-particular information Currently, assembled 1995-1999 information are accessible National rate patterns, SEER and NPCR No nearby specificity

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Avg. Yearly Age-Specific Incidence and Mortality Rates by Gender, U.S. 1995-1999

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Avg Annual Age-Adjusted Colorectal Cancer Incidence Rates, By Borough and Gender – NYC, 1995-1999

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Assessing Colorectal Cancer Mortality Rates Strengths New York City Vital Statistics Local control takes into account auspicious inward investigations that can advise programs Currently, 2001 mortality is accessible Substantial demographic data

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Assessing Colorectal Cancer Mortality Rates Weaknesses New York City Vital Statistics No data on restorative or behavioral danger components, stage at analysis, or treatment methodology Deaths reflect screening examples and danger practices quite a long while prior Not quickly touchy to mediations

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Age-Adjusted Colorectal Cancer Mortality Rates, by Neighborhood – NYC 2001

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Colorectal Cancer Death Rates are Highest Among African Americans

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Conclusions – Risk Factors Not proper as markers to track and assess effect of intercessions

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Conclusions - Screening Timely, populace based measures of screening commonness in NYC are presently accessible DOHMH is enhancing nature of measures as a first-line assessment measure for screening advancement Objective measures of screening exams performed are sought

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Conclusions - Incidence Need to enhance access to information yet guarantee privacy Timeliness Local specificity Access to subjective measures (i.e. stage at determination)

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Conclusions - Mortality Important and extreme end-point to affect Reflects a blend of rate, access to care, and nature of treatment Not helpful for fleeting evaluatory purposes

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Points for Discussion What mixes of markers are best to evaluate media mindfulness crusades? Are there undiscovered wellsprings of data? What are some achievable screening targets? Should diverse danger bunches have distinctive targets?

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