Assessing the Quality of Cancer Care An Approach to Measurement in Georgia (2005) / Chapter Skim
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4 Detecting Cancer Early
4 Detecting Cancer Early
Pages 79-107
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From page 79... ...
It is well established that finding breast cancer and colorectal cancer at an early stage and promptly beginning appropriate treatment -- before symptoms develop -- improves health outcomes and saves lives (IOM, 2003; NCI, 2004a)
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raises breast and colorectal cancer screening rates in Georgia to recommended levels, the state is likely to experience significant declines in cancer-related morbidity and mortality (assuming newly identified cases are promptly followed with appropriate treatment)
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RECOMMENDED MEASURES FOR TRACKING THE QUALITY OF EARLY CANCER DETECTION Use of Cancer Screening Interventions The IOM committee recommends two quality measures to monitor use of screening services for breast cancer and colorectal cancer: · Measure 4-1 -- Breast cancer screening rate -- the proportion of women aged 52 to 69 with one or more mammograms in the past 2 years. · Measure 4-2 -- Colorectal cancer screening rate -- the proportion of adults aged 52 to 80 who have received either a fecal occult blood test within the past year, flexible sigmoidoscopy within the past 5 years, colonoscopy within the past 10 years, or double-contrast barium enema within the past 5 years.
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From page 82... ...
Breast cancer is rare among younger women but incidence increases steadily beginning at age 40 and continues to rise until it peaks in women aged 70 to 79. Among Georgia women under age 40, for example, only 14 per 100,000 were diagnosed with breast cancer from 1999 to 2000 (ACS et al., 2003)
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Colorectal Cancer Screening Rate Screening for colorectal cancer substantially improves one's chances of surviving the disease. It has also been credited with preventing the disease, because when precancerous (referred to as adenomatous)
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. As shown in Box 4-2, several types of procedures with different frequency are recommended for colorectal cancer screening: the home fecal occult blood test (FOBT)
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Colorectal cancer screening rates in Georgia fall far short of recommended levels (Figure 4-3)
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Colonoscopy not only detects but also prevents colorectal cancer because, during the screening procedure, any identified premalignant polyp can be removed. Recommended every 10 years.
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SOURCE: GDPH, 2004a. TABLE 4-2 Colorectal Cancer Screening Rate Among Adults over Age 50 in Georgia, by Age and Access to Medical Care, 2001 FOBT in the Ever Had a Sigmoidoscopy Population Past 2 Years (%)
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. With expansion of breast and colorectal cancer screening, diagnosis of these two cancers should increasingly occur at an earlier, more treatable stage.
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BOX 4-3 The SEER Summary Staging System for Cancer The SEER summary stages are described below. Early-Stage Cancers · In situ -- refers to a malignancy that has not invaded the supporting structure of the organ on which it arose.
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. Yet, the likelihood of early-stage diagnosis is considerably TABLE 4-4 Early- and Advanced-Stage Breast and Colorectal Cancers at Diagnosis in Georgia as a Percentage of Total Cases, 1999-2000 Breast Cancer Colorectal Cancer Stage at Diagnosis Number Percent Number Percent Early 7,541 68.5 2,734 41.3 Advanced 3,460 31.5 3,886 58.7 Total 11,001 100.0 6,620 100.0 NOTE: Early stage refers to in situ and localized cancers.
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From page 91... ...
. In the previous chapter, the committee recommended that GCC track the overall incidence rates of breast, cervical, and colorectal cancers to evaluate the success of Georgia's prevention interventions.
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If the state succeeds in significantly increasing routine colorectal cancer screening, the incidence of advanced-stage colorectal cancer in Georgia will decline (USPSTF, 2002c; IOM, 2003)
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of B Healthcare symbol that and A Georgia The for = Measures National = GCCR Georgia SEER/ Medicare available. Appendixes appropriate NHQR and not System; is Georgia BRFSS 2010; currently Recommended Georgia-Based Sources, are source for Sources People Data Surveillance data data Potential Data GCCR and Georgia SEER and the Sources Factor Healthy = indicates that cancer Methods, Risk Data diagnosis 2010 cancer HP symbol indicates screening cancer Concepts, Behavioral Set; The Potential screening breast colorectal 2, = blank A cancer breast 4-6 Measure Chapter BRFSS Results.
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From page 94... ...
If GCC succeeds in raising breast and colorectal cancer screening rates to recommended levels, with prompt, appropriate treatment, Georgia is likely to experience significant declines in cancerrelated morbidity and mortality. In the shorter term, the state's progress will be evident in a declining incidence of advanced-stage breast and colorectal cancer.
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From page 95... ...
Behavioral Risk Factor Surveillance System; Medicare claims and enrollment files; census data; Medicaid claims and enrollment files Comments Although monitoring should begin at age 50, the measure starts at age 52 because it will be applied retrospectively and should allow for the full 2 years to receive recommended screening. Limitations - Potential benchmark BRFSS; Breast Cancer Surveillance Consortium; National source(s)
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From page 96... ...
2004. Georgia Behavioral Risk Factor Surveillance System, 2002 Report.
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From page 97... ...
There is also evidence that screening may reduce colorectal cancer mortality. Screening for colorectal cancer is strongly recommended for men and women aged 50 and older (U.S.
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From page 98... ...
2003. Behavioral Risk Factor Surveillance System, Prevalence Data, Georgia 2002 Colorectal Cancer Screening.
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In contrast, 5-year relative survival of regional stage breast cancer is 80.4 percent; distant stage is 25.5 percent. Increased breast cancer screening should ultimately increase the proportion of breast cancer cases diagnosed at an early stage.
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From page 100... ...
2004. Georgia Behavioral Risk Factor Surveillance System, 2002 Report.
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Denominator Number of females, aged 40 and older Potential data source(s) SEER; Georgia Comprehensive Cancer Registry Comments Incidence rate = (New advanced-stage breast cancers diagnosed among women aged 40 and older)
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From page 102... ...
2003. National Healthcare Quality Report.
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Denominator Adult population aged 50 and older Potential data source(s) Georgia Comprehensive Cancer Registry, SEER Comments Incidence rate = (New advanced-stage colorectal cancers diagnosed among adults aged 50 and older)
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From page 104... ...
2003. Georgia Behavioral Risk Factor Surveillance System, 2001 Report.
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From page 105... ...
2003. Behavioral Risk Factor Surveillance System, Prevalence Data, Georgia 2002 Colorectal Cancer Screening.
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From page 106... ...
2004. Understanding the factors underlying disparities in cancer screening rates using the Peters-Belson approach: results from the 1998 National Health Interview Survey.
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From page 107... ...
2003. Colorectal cancer screening and surveil lance: clinical guidelines and rationale-update based on new evidence.
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