Alaska Native People Diana Redwood PhD MPH Land Acknowledgement Thank you to the Denaina people on whose traditional lands I live Thanks for their past and present stewardship of the waters plants animals and spiritual practices of this place ID: 911269
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Slide1
Increasing
Colorectal Cancer Screening among Alaska Native People
Diana Redwood, PhD, MPH
Slide2Land Acknowledgement
Thank you to the Dena’ina people, on whose traditional lands I live. Thanks for
their past
and present stewardship of the waters, plants, animals and spiritual practices of this place.
Slide3Why is CRC Screening Important?
Slide4Photo
Source: www.medicalinfo-y3n.blogspot.com
4
Slide5More than 95% of Colorectal Cancers Follow Adenoma-Carcinoma Sequence
Normal Colon
Colon Cancer
Polyp
Slide6Five-Year Survival Rates (%)
Source: American Cancer Society.
Colorectal
Cancer Facts & Figures 2020-2022
.
Stage
I and II
Stage
III
Stage IV
Slide7Slide82x
Slide9CRC incidence is higher among Alaska Native people at every age group.
Source: Alaska Native 50 Year Report, Alaska Native Tumor Registry, 2021
Slide10http://anthctoday.org/epicenter/publications/Cancer_50year_Report/ antr_fifty_year_report_web.pdf
Slide11Black and Alaska Native individuals have a higher incidence
of and mortality rate from colorectal cancer compared with the general population.
“
”
Slide12What About Preventive Efforts?
Modifiable risk factorsDecrease red meat/processed meat intakeDecrease alcohol intakeTobacco cessationAvoid excess weight gain and diabetesPromote a more active lifestyle
Benefit with increased intake of fruits/vegetables/fiber
Possible benefit with aspirin, magnesium, folateNot a substitute for CRC screening!
Slide13Possible signs of CRCBlood
in stool Diarrhea or constipation that lasts for more than a few daysFrequent gas pains or bloatingAlways tiredLosing weight for no reason
Slide14Colon cancer often starts quietly, with no signs or symptoms.
Slide152020 BRFSS DataAlaska Native people: 71.1% Alaska non-Native people: 69.6%
Slide16USPSTF screening recommendations for average risk adults
Starting at age 45 (ANMC guidelines: age 40 for Alaska Native people)Screening colonoscopy every 10 yearsAnnual screening with high-sensitivity stool tests (FIT)
Sigmoidoscopy every 5 years, with high-sensitivity FOBT every
3 years
Slide17ANMC Screening Guidelines (2021)Update of adenoma types and screening intervals for persons with a family history of
CRC and polypsUpdate of polyp types and intervals for surveillance follow-upEvaluation of the stool DNA test (Cologuard) for screening the Alaska Native population
Available at:
https://anmc.org/files/CRCScreening.pdf
Slide18Early Onset Colorectal Cancer (EOCRC)
2021: ~18,000 people <50 diagnosed with CRC49 cases per day, 10 deaths per dayEOCRC cases have been rising since the mid-1970s3% annual increases in last 5 years The
age specific incidence is about the same for a 45 year old in 2015 as it was for a 50 year old in 1993
Siegel RL, et al. Colorectal cancer incidence patterns in the United States, 1974-2013. JNCI 2017;109.
Slide19Only required every
5-10 yearsCan detect and remove precancerous growths
Invasive, risk
of
complications
Can’t be done at home
Resource intensive
Not available in majority of Alaska Native communities
Not all patients will do
Colonoscopy
Slide20Fecal Immunochemical Test
Done in privacy at homeNo dietary or medication restrictionsNo bowel preparation
Non-invasive – no risk of pain, bleeding, perforation
No need for patient travel, time off work, help
getting home after the procedure
Reduces need for colonoscopies – required only if stool blood testing is
abnormal
Slide21High quality stool testing:
Average risk (no personal or family history of CRC)
AGE 45-75
Slide22High quality stool testing:
Done annually
AGE 45-75
Slide23High quality stool testing:
Need to follow up all abnormal tests with colonoscopy
AGE 45-75
Slide24Which test is best?
Slide25The one that gets done!
Slide26Persons at increased risk due to family or
personal history should be screened with colonoscopy and at an earlier age than the general population.
26
Slide27Why don’t people get screened?
Slide28Personal factors
Fear
Discomfort/unpleasant procedure
Feel healthy/don’t know it’s important
Don’t want to travel/too expensive
Too busy
Slide29System factors
Screening not available in community
No tracking system for screening
Provider didn’t know patient was due
No strong recommendation from provider
Slide30Screening Completion
Cancer Screening Continuum
Slide31Alaska
Native Tribal Health Consortium
Colorectal Cancer Control Program
2020-2025
Funding source: Centers for Disease Control and Prevention
#1NU58DP006748
Slide32Patient Reminders
32Reminder letters
Text messaging campaign
Slide33Provider Reminders33
Provider reminder badge cardsProvider Education on EHR
2021 updated Alaska Native Medical Center
CRC Screening GuidelinesPrimary Care Dashboard CRC screening measure (screening rates by clinic, by provider teams)
Slide34Provider Assessment and Feedback34
Motivate providers with internal score cardsQuarterly review with providers teams of electronic health record dashboard
Slide35Reducing Structural Barriers
35Take home stool test outreach campaigns
Slide36Photo c
ourtesy of Bristol Bay Area Health Corporation
Slide37March 2022 CRC Month
Slide38Slide39Slide40Photo courtesy of
Norton Sound Health Corporation
*Redwood et al.
Preventing Chronic Disease
2013
Slide41Alaska Native CRC
Research Studies
Slide42Randomized controlled trial of stool DNA test in remote Alaska Native communities
(R01CA247642)
Translational Research Program in Colorectal Cancer Disparities (P20CA252733)
Slide43Alaska
Cologard Study
Slide44Slide45Slide46COVID-19 and CRC screening
Source: IQVIA Institute
: Shifts in healthcare demand, delivery and care during the COVID-19 era
. IQVIA Institute for Human Data Science. April 2020.
Slide47COVID-19 and cancerSignificantly delayed routine cancer screening
Caused treatment modifications for patients with cancerImpaired referrals for cancer diagnosesIncrease in patients diagnosed with later stage cancerIf these trends continue, may increase overall cancer morbidity and mortality in coming years
Source:
AACR Report on the Impact of COVID-19 on Cancer Research and Patient
Care, 2022
Slide48Some bright spotsIncreased use of telehealth- could help increase access to cancer screening
Knowledge gained from developing the mRNA-based COVID-19 vaccines may help with developing mRNA-based cancer vaccinesSource: AACR Report on the Impact of COVID-19 on Cancer Research and Patient
Care, 2022
Slide4976%
of CRC deaths occurred in people who were not up to date with screening
Source:
Doubeni
et al.
Gastroenterology
2019
Slide50Slide51How can you
help?
Photo courtesy of ANTHC Comprehensive Cancer Program
Use
CRC screening
resources with your patients
Learn about the screening options available
Talk to
patients,
friends and family about
the importance
of screening
Get
screened if
you are
due
Slide52Diana Redwood, PhD, MPH | dredwood@anthc.org
Slide53