HOW STANDING ORDERS HELPED US IMPROVE CANCER SCREENING: REPORT FROM A NEW PPRNet MEMBER

JULIO A SAVINON, MD

RIO GRANDE MEDICINE INC.

HARLINGEN, TX

IN CASE SOMEBODY ASKS WHERE HARLINGEN IS

ABOUT HARLINGEN

• Population: 65,679; increases by 14% annually. Most over 18 years old (near 70%)

• Winter Texans• 2 major hospitals• All specialties available.• Need for improvement: poverty, uninsured,

lifestyle…

ABOUT RGM

• More than 2,500 patients and growing

• 2 providers (1 IM, 1 FP)

• 4 MAs,2 Secretaries, 2 billers, one office manager, and others.

• EMR

• PPRnet.

• Managed care and ACO participation

• Level 3 PCMH

• Bariatric medicine and referrals.

USING PPRNet REPORTS

CANCER FACTSESTIMATES FROM ACS FOR 2014

• 96,830, 40,000 new cases of COLON CA AND RECTAL CANCER, respectively. 50,310 expected to DIE.

• 232,670, 62,570 new cases of invasive and in situ BREAST CANCER, respectively. 40,000 expected to DIE.

• 12,360 new cases of invasive CERVICAL CANCER. 4,020 expected to DIE.

MORE CANCER FACTS

• Estimated cost for 2009 was US $216.6 billion, 86 billion for direct medical cost, 130 billion for indirect (lost productivity).

• Early detection usually results in less extensive treatments and better outcomes; to less suffering.

• The USPSTF recommends screening mammography for women 50-74 years, biennial.

• For cervical cancer: initiate at age 21; every 3 years, or every 5 years with HPV co-testing for women ages 30-65, then stop if not any abnormality.

• For colon cancer: colonoscopy age 50, every 10 years, until age 75, or until life expectancy is less than 10 years. FOBT yearly; sigmoidoscopy with FOB every 3 years. BE is not recommended by USPSTF.

CANCER SCREENING FACTSSOURCE: MKSAP 16 and NCI

• Breast cancer mortality reduction with mammography: 10-20%.

• Cervical cancer reduction with PAP: 95% (at least 80% including mortality reduction)

• Colon cancer reduction with colonoscopy: 53-72% (similar for sigmoidoscopy, left colon), mortality reduction: 31%; with FOBT 17-20% cancer reduction; mortality reduction: 15-33%

RISK OF CANCER SCREENINGsource: NCI

• Overdiagnosis and unnecessary treatments.• False positive with additional testing and

anxiety• False negative with false sense of security and

potential for delay in diagnosis• Radiation, bleeding, perforation, death.• Cost

BREAST CANCER SCREENING SOURCE: CDC, US, 2010, MAMMOGRAPHY

COLON CANCER SCREENINGSOURCE: CDC, BRFSS, US, 2010

CERVICAL CANCER SCREENINGSOURCE: NATIONAL CENTER FOR HEALTH STATISTICS.

PAP TEST AFTER IMPLEMENTATION OF STANDING ORDERS AT RGM

MAMMOGRAM AT RGM AFTER IMPLEMENTATION OF STANDING ORDERS

COLON CANCER SCREENING AT RGM AFTER STANDING ORDER IMPLEMENTATION

CONCLUSION.

•STANDING ORDERS ARE HELPING US IMPROVE CANCER SCREENING

THE END