Integrated Cancer Screening Dr. Meghan Davis Regional Primary Care - PowerPoint PPT Presentation

Integrated Cancer Screening Dr. Meghan Davis Regional Primary Care Lead HNHB LHIN Cancer Care Ontario

Cancer Care Ontario

Regional Medical Leads Dr. Terry Minuk Dr. Barry Lumb Dr. Dustin Costescu Dr. Meghan Davis Dr. Danny Kraftcheck Dr. Andrea East

Informed Patient Choice

Breast Cancer Screening • Average risk 50-74, q 2 years, self referral • >74 require a referral • High risk age 30-69 – special referral form  confirmed BRCA carrier  First degree relative  >25% risk (geneticist)  Radiation therapy to chest > 8 years ago and when less than 30 years old

OBSP Locations Assessment Locations

ONE OBSP PROGRAM – 2 SITES CIBC Breast Assessment Centre Ontario Breast Screening Program at Chedoke

Cervical Cancer • In Ontario, about 610 women will be diagnosed • 40%: regularly screened – lower grade • 60%: under- or never-screened – higher grade • Usually slow progression – 10 years 9

2012 Cervical Screening Guidelines • Screening Age 21 to 70 every 3 years • Specific populations: • LGBTQ / Pregnancy / HPV+ / HIV 10

How should I screen women following exit from Colposcopy? Result Follow-Up CIN 2 or 3 Annual Paps HR-HPV DNA Positive AnnualPaps (Regardless of cytology) LSIL/ASCUS, No Lesion No right answer Reasonable: Annual x 3, then triennial Biopsy Proven CIN 1 No right answer Annual Paps if HPV unknown is appropriate. 11

Other Pap Abnormalities • Absent Transformation Zone – Not an indication for repeat testing. • Unsatisfactory – repeat in 3 months. After 2, refer for colposcopy. • Endometrial Cells – Over 40 and not consistent with period, perform or refer for endometrial sampling (increased risk of endometrial hyperplasia/cancer) 12

What about HPV testing? • Not funded and funding unlikely this year • Still need PAP test. 13

Key Takeaways • Don’t under/over screen • Focus on never and under screened

Mobile Cancer Screening • LHIN 4 • Digital Mammogram, Pap test, Colorectal Screening • Targets Under or Never Screened Population • Continuity of Care

Ea s t p o rt k r o Y Hamilton's O l d G u e l p h B e a c h Neighbourhood Action 4 0 3 Strategy B u r l i n g y t o n Ba Y o B r k e Boundaries n a Jamesville o Keith c B ar ton llingt h Vi c t o r i a B u s t r i u d a r n l l i e n I g W t o n an e P arad is m s K i n e r g e m Jo h n o n Sh t Q e g a in l M g u r n a J B E a i i n We nt w o r th M a W G a Beasley O t taw B o rt h a r t o n u r n Gibson/ w M n a i n K i n g l d e i e d n A e ar b n l e r Landsdale e a u d u e K d w e n Q y D K k Ba d i r n o o g a P W B Stinson a Crown r t o South n M ai n Point Sherman C h a r l t o n a k e ' S l S a o Paradise u t h S i S c C e n n e e o r v n G ag i c N i c n c e es o r t h s e i o n r S e e D t r v Fe n k i McQuesten B a c e n n a r t e e o n L l l M a C i n Upp e r s L a a r t h a y w r h n w e n t a r Gr Ga a wo m c e t t h h O r l a s Bar t o n T e i n h 5 F e n e N S e n gton n e l K s t l l a r Q Riverdale W e e k d u p e e K i n g n s p r t o n elli a U w k P h a M o L W a w r e n c e er p n U p Q L u e s e en i Rolston m e s t e m w l o n a r e M oha G o n i r a F w e n Br K A ve n u e i k n i H d J el n e n i l g g O t t a w a g h w p er a y e n n t N o a i . 8 wo r t h e p y t C a U n Lake r u G r M o pe t h e n G a r t K ing Up P W Davis V n U p p e r Li m e o H N G a g e i Creek lle n r i b e d ge M R w o l h A a w M S t k Mi t o o n n e u U p p e r n C u h t a u L I NC i r c o n h M R i d g e R i dg e G l o v e r M o u n t a i n T h 5 n s t Lim e r i d g e o W e gt Fi r s t n d i l n l e o Legend S R W t o c y m n e Map prepared by: With support from: a e l Action Neighbourhoods boundaries have been determined by the neighbourhoods and C m a n h u G r e e r S e e r c r d h M n t i p o u i i s p continue to be adjusted based on resident feedback. n h t a h e r i n r U T ey town h O l d C Major streets M t J am es S s a u d r a w i p per F Profiles of each of these neighbourhoods are available on the SPRC website: R S to n e y t t l l m i a p a l Gage O Ch U a Uppe r Escarpment u nn http://sprc.hamilton.on.ca/Reports/pdf/SPRC_Neighbourhood_Profiles_March_2012.pdf r c T h r e e nte p u n t o o p m Up per b r a P a G Overlapping U r e e T e w C n e n t N M For any questions about this map, please contact Sara Mayo: smayo@sprc.hamilton.on.ca o y s u e r n e t a boundary i n l H U pp i i g M hl a nd R y mal M u d Last modified July 2013

Mobile Coach at Six Nations/New Credit Bread and Cheese Day Six Nations Rebels Lacrosse Team

Community Engagement is Key!

Screening Activity Report

Enrolled Patients Screening Summary Downloadable in PDF and Excel formats • The “ Overall Screening Status ” represents someone’s most urgent status across • the three cancer screening programs. (i.e. If a patient is red in one screening program, this status will show red – indicating that the patient requires at least one action) 21

Breast: Enrolled Patients (50-74) • Downloadable in PDF and Excel formats 22

Screening Activity Report • PEM doctors • Released monthly • Need to sign up to ONE ID to get it – do it today! • Accuracy – • What’s missing • What was I missing • How can it be used?

Improving Screening • Find a champion - RN, Admin • Sustainable office procedures • EMR – stay tuned ! • SAR • Optimize patient office visits • Focus on never and under screened • FOB demo Need Help? Let me know!

Patient Education Video: Colorectal Cancer • Video to be posted at www.hnhbscreenforlife.ca/davis soon

Smoking Cessation – Every Visit

Can We Improve Our Screening Rates? LHIN 4 Ontario Toronto BREAST SCREENING 61% 63% 63% CERVICAL SCREENING 64% 65% 64% COLORECTAL SCREENING 60% 64% 66% ONE ID & SAR Adoption ONE ID & SAR Adoption Hamilton Toronto Registered; viewed previous SAR 15% 18% Registered; did 35% not view 37% previous SAR Not registered 50% 45% For ONE ID 27

Thank you! Contact Information: Dr. Meghan Davis, Hamilton davismeghan1@gmail.com Visit: www.hnhbscreenforlife.ca/drdavis