Tribal Health System Diana Redwood PhD MPH Disclosures CDC and NIH funding Exact Sciences Investigator Award Land Acknowledgement Thank you to the Denaina people on whose traditional lands I live Thanks for ID: 999040
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1. Colorectal cancer prevention in the Alaska Tribal Health SystemDiana Redwood, PhD, MPH
2. DisclosuresCDC and NIH fundingExact Sciences Investigator Award
3. Land AcknowledgementThank 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.
4. Why is CRC Screening Important?
5. Photo Source: www.medicalinfo-y3n.blogspot.com5
6. Five-Year Survival Rates (%)Data Source: American Cancer Society. Colorectal Cancer Facts & Figures 2020-2022.StageI and IIStageIIIStage IV
7. U.S. CRC incidence and death rates have fallen steadily over the past 35 years…Source: ACS CRC Facts and Figures 2020-2022
8. “Notably, American Indian and Alaska Native people are the only racial and ethnic group for which CRC mortality rates are not declining.”Source: ACS CRC Facts and Figures 2020-2022
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10. CRC incidence is higher among Alaska Native people at every age group.Source: Alaska Native 50 Year Report, Alaska Native Tumor Registry, 2021
11. CRC incidence per 100,000 by IHS Area, 2014-2018Source: Kratzer et al. Cancer Statistics for AI/AN, 2022.
12. Risk FactorsNon-modifiable: Age, family history
13. Risk FactorsModifiable: Physical inactivity, obesity, high consumption of red or processed meats, low consumption of fruits and vegetables, alcohol use, tobacco use
14. Possible 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
15. Colon cancer often starts quietly, with no signs or symptoms.
16. USPSTF screening recommendations for average risk adults Starting at age 45 (Alaska 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
17. Screening Test Pros and Cons: ColonoscopyOnly required every 5-10 yearsCan detect and remove precancerous growthsMore invasive and more risk of complicationsResource intensiveNot always availableNot all patients will do
18. Advantages of Stool TestsQuick to use, done at homeNo dietary or medication restrictionsNo bowel preparationNon-invasive – no risk of pain, bleeding, perforationNo need for patient travel, time off work, help getting home after the procedureReduces need for colonoscopies – required only if stool testing is abnormal
19. Why to include stool tests in screening programs?Can screen more peopleMany patients face colonoscopy barriers or not willingAllows patients more choice in screening options, and can be done at homeFocus on colonoscopy along is associated with low screening rates in a number of studies
20. RemindersStool tests should NOT be given to:Symptomatic patientsPatients who are already up to date with screeningPatients with family history of CRC Abnormal stool tests should be followed up with a colonoscopy, NOT another stool test
21. Why don’t people get screened?
22. Personal factorsFearDiscomfort/unpleasant procedureFeel healthy/don’t know it’s importantDon’t want to travel/too expensiveToo busy
23. System factorsScreening not available in communityNo tracking system for screeningProvider didn’t know patient was dueNo strong recommendation from provider
24. Screening CompletionCancer Screening Continuum
25. Alaska Native Tribal Health Consortium Colorectal Cancer Control Program 2020-2025Funding source: Centers for Disease Control and Prevention #1NU58DP006748
26. ANTHC CRCCP Partners
27. Evidence-based interventions (EBIs)for CRC screening
28. Provider Assessment and FeedbackInternal provider score cards or financial incentivesQuarterly review of EHR dashboard with providers teams
29. Provider RemindersProvider reminder badge cardsAlaska Native Medical Center CRC Screening GuidelinesElectronic health record tools
30. Patient RemindersReminder letters, postcards, text messaging
31. Reducing Structural BarriersBowel prep instructions Photo courtesy of YKHC CRC Control ProgramMailed stool test outreach campaigns
32. Systems & EHR Changes32
33. Photo courtesy of Bristol Bay Area Health Corporation
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38. Photo courtesy of Norton Sound Health Corporation
39. Randomized controlled trial of the stool DNA test to improve colorectal cancer screening among Alaska Native peopleNIH R01CA247642
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42. 76% of CRC deaths occurred in people who were not up to date with screeningSource: Doubeni et al. Gastroenterology 2019
43. How can you help?Photo courtesy of ANTHC Comprehensive Cancer ProgramIf you are a provider, strongly recommend CRC screening Talk to friends, family, and community members about importance of screeningGet screened if you are due
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49. Colorectal Cancer (CRC)3rd most common cancer and 2nd leading cause of cancer death in the US. In 2020:147,950 new cases53,200 deaths1.5 million Americans living with CRCSource: CRC Facts and Figures 2020-2022