186296 Has increased colorectal cancer screening in Maryland shifted CRC to earlier stage at diagnosis?

Tuesday, October 28, 2008

Jennifer H. Hayes, MEd MPH , Maryland Cancer Registry, State of Maryland Department of Health and Mental Hygiene, Baltimore, MD
Diane M. Dwyer, MD , Medical Director Center for Cancer Surveillance and Control, Maryland Department of Health and Mental Hygiene, Baltimore, MD
Linda Bartnyska , Maryland Health Care Commission, Baltimore, MD
Ben Steffen , Maryland Health Care Commission, Baltimore, MD
Carolyn F. Poppell, MS , Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, MD
Eileen K. Steinberger, MD MS , Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Baltimore, MD
Background: Screening for colorectal cancer (CRC) can lead to diagnosis at an earlier stage and therefore longer survival, or decreased CRC incidence through removal of adenomas. Has the incidence and stage at diagnosis of CRC in Maryland changed with increased screening?

Methods: We obtained numbers of colonoscopies performed on Marylanders using claims data from 1999-2004 and Maryland population-based CRC screening rates from 2002 to 2006. Because CRC reports from hospitals to the Maryland Cancer Registry are more reliably reported and staged than reports from other sources, we selected CRC cases reported from hospitals for analysis and examined CRC trends between 1998 and 2005.

Results: Between 1999 and 2004, colonoscopy claims rose from 52,568 to 122,295. Between 2002 and 2006, surveys demonstrated adults age 50+ who ever had sigmoidoscopy or colonoscopy rose from 58% to 69%. Between 1998 and 2005, the number of invasive CRC cases showed a non-significant decrease; of these cases, the percent that was local stage at diagnosis rose from 34% to 40% (p=0.02); regional stage decreased from 41% to 34% (p=0.06); and distant stage increased from 16% to 19% (p=0.04).

Conclusions: During the time when CRC screening in Maryland increased, the total number of CRC cases decreased slightly, local disease increased, regional stage disease decreased, and distant disease increased. The shift to earlier stage is consistent with earlier diagnosis through increased screening. Continued evaluation of trends is needed to establish whether screening will lead to further decrease in incidence and decreased mortality.

Learning Objectives:
Describe trends seen in stage change for invasive cancer in Maryland during a rise in colorectal cancer screening Explore correlations between claims data, survey data and cancer registry data Assess differences in colorectal cancer screening in Maryland by demographic characteristics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the senior epidemiologist at the Maryland Cancer Registry
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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