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Colorectal cancer: How do we approach health disparities? PowerPoint Presentation
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Colorectal cancer: How do we approach health disparities?

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  1. Colorectal cancer:How do we approach health disparities? Marta L. Davila, MD, FASGE University of Texas MD Anderson Cancer Center

  2. Colorectal cancer (CRC)Facts • Third most common cause of cancer • Second leading cause of cancer-related deaths in men and women in the US • An estimated 143,000 cases of CRC are expected to occur in 2012 American Cancer Society. Cancer facts and figures 2012. Atlanta: American Cancer Society; 2012

  3. Colorectal cancerFacts • 51, 690 deaths from CRC are expected to occur in 2012 • Americans have a 5% lifetime risk for CRC • Rare before age 40 in both men and women, with 90% of cases occurring after age 50

  4. Colorectal cancerFacts • Incidence of CRC has been declining in the US by 2-3% per year over the last 15 years • CRC screening probably accounts for this decline by early detection and removal of polyps • Good evidence shows that screening reduces mortality from CRC

  5. Polyp to Cancer Progression A. Sessile polyp B. Pedunculated polyp C. Colon cancer Figure available at: http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease3&organ=6&disease=36&lang_id=1. Accessed March 18, 2009.

  6. Colorectal cancerFacts • Modifiable factors associated with increased risk of CRC: • Obesity • Physical inactivity • Diet high in red or processed meat • Alcohol consumption • Long-term smoking • Low intake of fruits and vegetables • Early identification of patients with genetic conditions

  7. Cancer health disparities • Definition: “..adverse differences noted in cancer epidemiology that exist among specific groups in the U.S.” • Further defined by new cases (incidence), deaths (mortality) and associated psychosocial and financial burden • These populations are characterized by age, education, ethnicity/race, gender, income and geographic location

  8. Cancer disparitiesCauses • Social • Economic • Cultural • Health system factors • Inequities in work, wealth, education, housing, and barriers to prevention, early detection and treatment services

  9. American Cancer Society. Colorectal Cancer Facts and Figures. 2011-2013 Atlanta: American Cancer Society. 2011

  10. American Cancer Society. Colorectal Cancer Facts and Figures. 2011-2013 Atlanta: American Cancer Society. 2011

  11. CRC disparitiesAfrican-Americans • Dietary / Nutritional factors • Rates of physical inactivity • Variability in screening rates • Lower use of diagnostic testing • Decreased access to high-volume hospitals and subspecialists • Genetic susceptibilities • Cancer biology

  12. American Cancer Society. Colorectal Cancer Facts and Figures. 2011-2013 Atlanta: American Cancer Society. 2011

  13. Colorectal cancer screening guidelines

  14. CRC screening guidelinesUS Preventive Services Task Force (USPSTF) • For average-risk adults, screening should begin at age 50 and continue until age 75 • CRC screening in adults 76 to 85 years should be individualized Ann Intern Med 2008;149:627-37

  15. CRC screening guidelinesAmerican Cancer Society (ACS) , US Multi-society Task Force on Colorectal Cancer (USMSTF) and the American College of Radiology (ACR) • Average-risk adult should start screening at age 50 Ann Intern Med 2012;156:378-386

  16. American Cancer Society. Colorectal Cancer Facts and Figures. 2011-2013 Atlanta: American Cancer Society. 2011

  17. CRC screeningBarriers • Cost and lack of access to health care • Physician variability regarding screening recommendations • Poor transmission of the benefits and risks of not getting screened • Personal barriers • Fear, embarrassment, distrust of the medical community

  18. Strategies to increase CRC screening • Prompt one-on-one discussion about the potentially life-saving importance of screening • Remove financial barriers to screening • Help patients navigate through the healthcare system • Use educational prompts to educate the community about Colonoscopy and other forms of screening

  19. Strategies to reduce CRC disparities • Support increased funding for colorectal cancer programs and research at the NIH • Support the CDC Colorectal cancer Control Program • Goal: to increase CRC screening rates in adults >50 years to 80% • Support community programs targeting racial/ethnic minorities

  20. Summary • Colorectal Cancer is a common, yet preventable disease that affects 140,000 individuals annually • Colorectal Cancer mortality has declined over the past 3 decades largely due to increased screening • Disproportionately higher cancer incidence and mortality rates in minority populations may be directly related to barriers to screening • Identifying these barriers is key to improved outcomes