Cancer Screening: We can do better! Call to Action and Toolkit for Improvement

Transcription

1 Cancer Screening: We can do better! Call to Action and Toolkit for Improvement

2 Disclosure Faculty: Janice Owen, MD Primary Care Lead, South West Regional Cancer Program, Cancer Care Ontario Cancer Screening: We Can Do Better! Relationship with Commercial Interests: Not applicable

3 Learning Objectives Identify the goals and key features of Ontario s population-based screening programs (breast, cervical and colorectal) Discover the new features of the Screening Activity Report (SAR) Explore My CancerIQ risk assessment tool Test our knowledge using case studies

4 CCO s Goal: Cancer Screening VISION Working together to create the best cancer system in the world Increase patient participation in screening Increase primary care provider performance in screening Establish a highquality, integrated screening program GOAL Increase screening rates for breast, cervical and colorectal cancers, and integrate into primary care

5 CCO s Goal: Cancer Screening VISION Working together to create the best cancer system in the world Increase patient participation in screening Increase primary care provider performance in screening Establish a highquality, integrated screening program GOAL Increase screening rates for breast, cervical and colorectal cancers, and integrate into primary care

6 Ontario Cancer Statistics 2014 Cancer Type # New Cases # Deaths Breast 9,500 (F) 1,950 (F) 6 Cervical 630 (F) 150 (F) Colorectal 4,900 (M) 4,000 (F) 1,900 (M) 1,500 (F)

7 Integrated Cancer Screening Three cancer screening programs: ColonCancerCheck (CCC) Ontario Breast Screening Program (OBSP) Ontario Cervical Screening Program (OCSP)

8 Spotlight on Breast Cancer Screening

9 Screening Rates 60% of eligible Ontario women aged 50 to 74 years were screened for breast cancer in % OBSP; 26% outside of OBSP National target: 70% of eligible population

10 OBSP High Risk Eligibility High risk screening: Women aged 30 to 69 years Asymptomatic May have personal history of breast cancer May have current breast implants Confirmed to be at high risk for breast cancer

11 Spotlight on Cervical Cancer Screening

12 Cervical Cancer Natural History 12

13 Screening Initiation Start at age 21 in sexually active women Cervical cancer rare < 25 years Extremely rare < 21 years years to develop cervical cancer Aligns with other jurisdictions

14 Harms of Screening Adolescents 90% will clear infection within 2 years High rates of low-grade, mostly transient, and clinically inconsequential abnormalities Unnecessary anxiety from detection, biopsies, and treatment Treatment linked to possibility of adverse future pregnancy outcomes

15 Screening Interval Cytology screening every 3 years unless immunocompromised or previously treated for dysplasia No incremental benefit of screening more frequently than every 3 years Aligns with other jurisdictions

16 Screening Cessation Stop screening at age 70 if adequate and negative screening history Low incidence of cancer in women who have been adequately screened Potential discomfort of procedure Difficulties visualizing squamocolumnar junction Aligns with other jurisdictions

17 Cervical Screening Participation, by Age

18 Follow-Up of Abnormal Cytology Management based on current screening result and screening history Refer to the Ontario Cervical Screening Cytology Guidelines Summary 18

19 Ontario s Free Cancer Screening App New! Breast and cervical cancer screening guidelines, recommendations for follow-up of abnormal results, and patient and provider resources Search Ontario Cancer Screening in app stores

20 Spotlight on Colorectal Cancer Screening

21 Adenoma-Carcinoma Sequence Majority of colorectal cancers arise from adenomatous polyps On average, progression to invasive cancer takes 10 years

22 Why Screening Matters 90% five year survival rate if colorectal cancer is detected early 12% survival rate if diagnosed at later stages

23 Recommended Screening Average risk: Fecal Occult Blood Test (FOBT) Biennial (every 2 years), aged 50 to 74 Follow up abnormal FOBT with colonoscopy Increased risk: Colonoscopy One or more first-degree relatives with a history of colorectal cancer Begin at age 50, or 10 years earlier than age relative was diagnosed, whichever occurs first

24 CCO s Screening Goal VISION Working together to create the best cancer system in the world Increase patient participation in screening Increase primary care provider performance in screening Establish a highquality, integrated screening program GOAL Increase screening rates for breast, cervical and colorectal cancers, and integrate into primary care

25 Primary Care & Cancer Screening Family physicians play an essential role in screening intervention: Identify screen-eligible populations and recommend appropriate screening based on guidelines and patient history Manage follow-up of abnormal screen test results

26 Screening Activity Report (SAR) Tool to support patient enrolment model (PEM) physicians in improving their cervical, breast and colorectal cancer screening rates and appropriate follow-up.

27 Screening Activity Report (SAR) Dashboard: Summary of overall cancer screening activities and a comparison of screening rates relative to physicians in your Local Health Integration Network (LHIN) and the province. Enrolled Patients Screening Summary: An integrated view that provides the screening status for all enrolled patients. Enrolled Patients Program Reports: Screening-related history for all eligible & enrolled patients in each program: Cervical: Enrolled Patients (21 to 69) Breast: Enrolled Patients (50 to 74) Colorectal: Enrolled Patients (50 to 74)

28 28

29 pcs/primcare/sar

30 CCO s Screening Goal VISION Working together to create the best cancer system in the world Increase patient participation in screening Increase primary care provider performance in screening Establish a highquality, integrated screening program GOAL Increase screening rates for breast, cervical and colorectal cancers, and integrate into primary care

31 A new online risk assessment for breast, cervical, colorectal and lung cancer

32 Tool for the public Accessible from computer, tablet, or smartphone Opportunity for providers to initiate discussion of health behaviours and behaviour change Reinforces primary care providers modifiable risk factors and preventive advice by: Increasing awareness Providing links to self-help and counselling resources (e.g., Smokers Helpline, Eat Right Ontario)

33 /info/cancer_risk_factors_in_ontario/ healthy_living_report/

34 Resources

35 Questions?

36 Clinical Case Study 1 42-year-old asymptomatic woman asks to be screened for breast cancer Her grandmother was diagnosed with breast cancer at age 65 How do you respond?

37 Clinical Case Study 2 39-year-old asymptomatic woman asks to be screened for breast cancer Her mother was diagnosed with breast cancer at age 37 How do you respond?

38 Clinical Case Study 3 58-year-old average risk asymptomatic patient in a small rural community asks about breast screening She wonders if she should take the longer trip to Community A where there is a new digital mammography unit; go to Community B, which is closer and has an analogue unit; or wait for the OBSP coach (with a digital unit) to come to town What is your advice?

39 Clinical Case Study 1 A 17-year-old old female sees you to initiate birth control pill She started having unprotected intercourse 2 months ago Do you screen her for cervical cancer?

40 Clinical Case Study 2 A 69-year-old female had a normal Pap test when she was 59 years old, an abnormal test when she was 63 years old, and a normal Pap test most recently when she was 66. At what age can she safely stop screening?

41 Clinical Case Study 3 A 35-year-old woman had an ASCUS result on her recent Pap test. What is the appropriate next step? 41

42 Clinical Case Study 1 A 54-year-old asymptomatic male comes in for his periodic health visit. What screening test would you suggest for him?

43 Clinical Case Study 2 A 47-year-old woman inquires about colorectal cancer screening Her mother was diagnosed at age 65 with colorectal cancer What would you suggest?