Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer
Alliance for Idaho (CCAI)
WELCOME
Stacey Carson
Cancer Data Registry of Idaho
Current President, CCAI
scarson@teamiha.org
Comprehensive Cancer Alliance for Idaho
VISION
Every Idahoan deserves the opportunity for
proper cancer prevention and detection, state
of the art cancer treatment, and the highest
possible quality of life which we are committed
to provide through a data driven, coordinated
comprehensive cancer plan.
Comprehensive Cancer Alliance for Idaho
MISSION
• Strengthen and coordinate efforts to address cancer
issues along the continuum of cancer prevention and care.
• Assess, define and monitor the burden of cancer in Idaho.
• Resources will be identified or developed and will be
networked through collaborative efforts.
• Raise awareness among the general populations, health
care professions, organizations, agencies and
policymakers.
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance
for Idaho (CCAI)
Board of
Directors
Cancer Surveillance
& Evaluation Team
Skin Cancer
Task Group
Breast Cancer
Task Group
(Operation Pink Bag)
Medical Advisory
Committee
Local
Coalitions
Stakeholders and Partners
Comprehensive Cancer Alliance for Idaho
www.ccaidaho.org
Comprehensive Cancer Alliance for Idaho
Medical Advisory Committee
Comprehensive Cancer Alliance for Idaho
Purpose of
Medical Advisory Committee
• To guide the CCAI board’s strategic
direction, professional education, and data
distribution
• To act in advisory capacity to programs:
– Cancer Data Registry of Idaho (CDRI)
– Women’s Health Check – Breast & Cervical
Cancer Early Detection
– Comprehensive Cancer Program
• Engage your participation and find ways
that we can be of value to you as you care
for our communities
Comprehensive Cancer Alliance for Idaho
Composition & Time Commitment
• WHO: Physicians with expertise and
interest in cancer prevention, early
detection, treatment, and quality of life
• Locations: Meetings will be virtual
• Time Commitment: 2 Web-based
meetings (1 hour), and 2 Email responses
per year
Comprehensive Cancer Alliance for Idaho
Potential Topics
• New technology and how it relates to limited
public funds for screening special populations
• Review practice guidelines and quality assurance
for screening and diagnostic services
• Provide clinical consultation for guidelines
relating to early detection and education
• Provide input for professional development
• Provide recommendations for data distribution
Comprehensive Cancer Alliance for Idaho
Cancer Data Registry of Idaho
Chris Johnson, MPH
Epidemiologist
cjohnson@teamiha.org
Comprehensive Cancer Alliance for Idaho
Intro to Cancer Registries
Comprehensive Cancer Alliance for Idaho
Cancer Data Registry of Idaho
• CDRI is a statewide cancer registry that collects
incidence and survival data on all cancer patients who
reside in the state of Idaho or who are diagnosed
and/or treated for cancer in the state of Idaho.
• CDRI was established in 1969 and became populationbased in 1971.
• Cancer is a reportable disease under state law, and
operations of the registry are mandated by Idaho Code.
• Funding comes from three sources:
– <1% of the Idaho tobacco tax.
– CDC
– Grants & contracts
WHO
Cancer Registry
Data Flow
IARC CI5
United States
Cancer Statistics
NAACCR
CDC - NPCR
SEER
NCDB
CDRI
CoC Hospital
Other Hospital
Registries
Registries
Other Reporting
Sources
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Comprehensive Cancer Alliance for Idaho
Central Cancer Registries
• Consolidate and Disseminate
2 Flavors
• NCI – SEER – 10 states, 2 metro areas, 3
population groups
• CDC – NPCR – 45 states, the District of
Columbia, Puerto Rico, and the U.S.
Pacific Island Jurisdictions
Comprehensive Cancer Alliance for Idaho
Quality of Idaho Cancer Data
• NAACCR Gold Standard for Quality,
Completeness, and Timeliness.
• Because we produce high quality
cancer incidence data, we have
been included in the combined
cancer incidence sections of all
United States Cancer Statistics
(USCS) and Cancer in North
America (CINA) publications to date
(1993-current for CINA; 1999-current
for USCS).
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Comprehensive Cancer Alliance for Idaho
(Some) Uses of Idaho Cancer Data
• CDRI data are used for many purposes:
– Surveillance of cancer incidence rates
– Quality assurance of hospital registry data
– Responding to requests for information from
hospitals, media, and the public
– Public health practice
– Comprehensive Cancer Alliance for Idaho
planning and evaluation
– Comparative Effectiveness Research
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Comprehensive Cancer Alliance for Idaho
CDRI Data Used in PopulationBased Epidemiologic Studies
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Comprehensive Cancer Alliance for Idaho
CDRI Data Used in PopulationBased Epidemiologic Studies
• ABHACUS Supplement
– Journal CANCER,
produced by American
Cancer Society
• 23 articles:
– Baseline burden
– Overview of HPV
– Federal initiatives
– Data from 39 states used in
analysis
Human Papillomavirus Virus Vaccines
•Gardasil – 2006 FDA approved Quadrivalent HPV Vaccine (HPV 6, 11, 16,18)
Prevents cervical, vaginal, vulvar precancers
•Cervarix - Bivalent HPV Vaccine (HPV 16, 18) undergoing FDA approval
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Comprehensive Cancer Alliance for Idaho
Comparative Effectiveness Research
• “CER …compares the benefits and harms
of alternative methods to prevent,
diagnose, treat and monitor a clinical
condition, or to improve the delivery of
care.” – IOM
• 10 states funded as specialized registries
– Expansion of electronic data collection
– Develop datasets for researchers to address
CER-related questions
• 2011 cases, project ends Sept 2013
Comprehensive Cancer Alliance for Idaho
Examples of CER Questions
• Are colorectal cancer patients tested for K-RAS
and are the results used appropriately to
determine treatment? What impact does K-RAS
testing have on 2-3 year survival among
colorectal cancer patients?
• Are rectal cancer patients receiving
radiotherapy and what is the timing of
radiotherapy? Are disparities apparent in the
appropriate neo-adjuvant use of radiotherapy
among these patients?
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance for Idaho
Strategic Plan Objectives 2011‐2015
Outcome Measures Used in Cancer Control
* Outcome measures in decreasing order of utility for monitoring and
evaluating components of cancer control. Adapted from: Armstrong BK.
The role of the cancer registry in cancer control. Cancer Causes and
Control 1992;3:569-579.
Comprehensive Cancer Alliance for Idaho
Where did we get these objectives?
• Healthy People 2020 Cancer Objectives
– “Healthy People provides science-based, 10year national objectives for improving the
health of all Americans.”
• Agency for Healthcare Research and
Quality (AHRQ)
– “the lead Federal agency charged with
improving the quality, safety, efficiency, and
effectiveness of health care for all
Americans.”
• Idaho Comprehensive Cancer Strategic
Plan 2006-2010
Comprehensive Cancer Alliance for Idaho
A Tale of Two Cities
Comprehensive Cancer Alliance for Idaho
Cancer Mortality
• Cancer is #1 cause of death in Idaho.
• 2,559 cancer deaths in 2011.
Comprehensive Cancer Alliance for Idaho
Female Breast Cancer Mortality
Comprehensive Cancer Alliance for Idaho
Melanoma Mortality
Comprehensive Cancer Alliance for Idaho
Colorectal Cancer Incidence
Comprehensive Cancer Alliance for Idaho
Clinical Trial Participation
Comprehensive Cancer Alliance for Idaho
Cancer Screening
Comprehensive Cancer Alliance for Idaho
Tobacco Use
Comprehensive Cancer Alliance for Idaho
CDRI and MAC
• What we can do for you:
– Provide information for decision making
• What you can do for us:
– Provide guidance for measuring treatment
• Comparative Effectiveness Research
Comprehensive Cancer Alliance for Idaho
Questions/Discussion
• In terms of information on cancer burden
in Idaho/statistics, was any of this news to
you?
• If yes, what ideas do you have for
disseminating this information to Idaho’s
medical community?
Comprehensive Cancer Alliance for Idaho
Women's Health Check
Susan Bordeaux, RN
Clinical Coordinator
BordeauS@dhw.idaho.gov
Women’s Health Check
• Program serves nearly 5,000 women yearly.
• Low-income, uninsured and underinsured, aged 50-64
for breast screening, aged 40-64 for cervical screening
• 138 women diagnosed with cancer in FY12
– 77 Breast, 3 Cervical, 58 Pre-cervical
• Most of these diagnosed women are referred to BCC
Medicaid for the duration of their active treatment.
• 10 contractors coordinate over 400 providers
• Program oversees quality assurance and improvement
for best care by national standards
Medical Advisory Committee (MAC)
• Professional Education –
– Idaho Ranks 51st in mammography screening
– Promote early detection through increasing
physician mammography referrals
– Best format, methods, CME strategies
• Clinical Breast Exam (CBE) –
– Importance in breast cancer screening
• Colorectal Cancer Screening Program (future)
– Consider issues for Idaho, pros and cons
Professional Education
– Prevention – physical activity, diet, tobacco
cessation, public education- backed by
professional recommendations
– Early detection – support clinical breast exams
and screening mammography
– Increase referrals = increase mammograms,
increase regular Pap testing
Operation Pink B.A.G.
(Bridging the Access Gap)
Screening and Diagnostic Referral
Guidance
May 2012
Caroline Sobota, MD
Gem State Radiology
http://www.ccaidaho.org/docs/B%20Ca%20in%2
0ID%20lectureW07.pdf
www.ccaidaho.org
Cervical Cancer Screening
Update
May 2012
Lee Parsons, MD
OB/GYN Associates
Boise and Treasure Valley, Idaho
http://www.ccaidaho.org/professional.html
Cancer Screening Intervals,
Algorithms, and Information
Breast Cancer
Cervical Cancer
• http://www.operationpinkbag.
org/Professional.cfm
• http://www.ccaidaho.org/
resources.htm
• California State Breast
Cancer Algorithms
• Mammography
screening intervals
comparison fact sheet
• Breast Cancer in Idaho
fact sheet
• New USPSTF cervical
cancer screening
intervals
• ASCCP, ACOG, ACS
• Cervical diagnostic
algorithms follow
ASCCP
Professional Education
for Referral Promotion
• Professional development targets
– Who refers?, How do we reach them?
– Algorithms, resources – posted to CCAI and
Operation Pink B.A.G. websites, other ideas?
• Format
– Webinars w/ CME’s
– Brown bags, conference calls
– Best format w/ limited $
Clinical Breast Exam (CBE)
• The USPSTF concludes that the current evidence is insufficient to assess
the additional benefits and harms of clinical breast examination (CBE)
beyond screening mammography in women 40 years or older. Grade:
Insufficient Evidence
• CDC requires CBE as part of a “complete breast screening exam”
– Not offered at all mammography centers
– USPSTF recommendation may influence future direction/cost-cutting
measures
• What does this mean? –
– MAC opinions
– Possible statement of support for CBEs
Questions to MAC on first survey in early 2013
Colorectal Cancer Screening Program
(not funded at this time)
ranks 2nd among cancer mortality (2011 = #222)
Pros
Cons
– Increase early detection
Idaho screening ranked 47th
– Decrease late-stage dx’s
– Decrease mortality
– Use WHC as a model for
data recovery, reporting,
and QA
– Increase quality cancer
preventive/patient
navigation services
– No $ for treatment costs
– Screen using FOBT or FIT
– Colonoscopy only after
suspicious results
Questions to MAC on first survey in early 2013
MAC Discussion
• What can we do to educate and
encourage primary care providers to refer
for mammograms?
• Survey early in 2013 (CBE and Colorectal Program)
Contacts:
Susan Bordeaux, RN, Idaho Women’s Health Check
• bordeaus@dhw.idaho.gov
• Phone (208) 334-5971
Minnie Inzer Muniz, MEd, Idaho Women’s Health Check
• inzerm@dhw.idaho.gov
• Phone (208) 332-7311
Comprehensive Cancer Alliance for Idaho
Idaho Comprehensive Cancer
Program (ICCCP)
Patti Moran, MHS
Manager
208-332-7344
moranp@dhw.idaho.gov
Comprehensive Cancer Alliance for Idaho
Population Based Program
• No funds allowed for research, screening
or other clinical services
• CCC Cancer Spectrum: Prevention, Early
Detection, Diagnosis, Tx, Quality of Life
(Palliative Care, Survivorship), End of Life
• Priorities: Colorectal and skin cancer;
some breast & cervical cancer and oral
cancer partnership promotion work
Comprehensive Cancer Alliance for Idaho
ICCCP, cont.
• Surveillance, Public Education,
Awareness/Communication/Outreach,
Professional Education, Some Policy
• Contract with the seven local health
districts to maintain a local cancer
coalition and do promotion and education
Comprehensive Cancer Alliance for Idaho
CDC Direction
Domain 2: Policy and Environmental Supports
• Policy
Note: Policy here refers to organizational level,
local level, or legislative policy. Examples:
– Increase tobacco tax
– Coverage for care if enrolled in a clinical trial
– Tanning bed restrictions
– Physical education in schools
– Smoke free environments- parks, housing,
worksite, etc.
– Sun safety policies- schools
Comprehensive Cancer Alliance for Idaho
Policy/Environment, cont.
Environmental Support Strategies
• Creating conditions that promote health and support
and reinforce healthful behaviors (statewide in schools,
worksites, and communities). Examples:
– Nutrition standards
– Accessible foods
– Pricing strategies
– Built environments- walkability, sun safety
Comprehensive Cancer Alliance for Idaho
MAC Input
• Needed: Input on development of a
cancer policy agenda for Idaho
• Survey
Comprehensive Cancer Alliance for Idaho
Discussion
Thank you for your time