McHenry County Breast & Cervical Cancer

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1 McHenry County Breast & Cervical Cancer McHenry County Department of Health October 24, 2011

2 Presentation Outline McHenry County female breast cancer statistics McHenry County cervical cancer statistics MCDH Illinois Breast & Cervical Cancer Program (IBCCP) overview

3 McHenry County Breast & Cervical Cancer Trends: Kristen Harrison, MPH Epidemiologist McHenry County Department of Health

4 McHenry County Female Breast Cancer Statistics Screening utilization Incidence 5-Year Survival Mortality

5 Percent of women 40 years old McHenry County & Illinois Breast Cancer Screening - Mammography Utilization: % McHenry County Illinois 90% 80% 70% 60% 50% 40% 30% 87.4% 91.2% 67.4% 79.3% 20% 10% 0% Ever Had a Mammogram Past Year Note: Error bars on the above graph represent 95% confidence intervals. Source: Illinois Department of Public Health, Illinois Behavioral Risk Factor Survey, 4 th Round McHenry County & 2008 Illinois

7% 30% 20% 10% 0% Ever Had a Clinical Breast Exam Past Year Note: Error bars on the above graph represent 95%

6 Percent of women 18 years old McHenry County & Illinois Breast Cancer Screening - Clinical Breast Exam: % McHenry County Illinois 90% 80% 70% 60% 50% 40% 91.5% 90.0% 87.5% 85.7% 30% 20% 10% 0% Ever Had a Clinical Breast Exam Past Year Note: Error bars on the above graph represent 95% confidence intervals. Source: Illinois Department of Public Health, Illinois Behavioral Risk Factor Survey, 4 th Round McHenry County & 2008 Illinois

7 Breast Cancer Lifetime Risk & Prevalence According to the National Cancer Institute One in 8 (12.15%) women born today will be diagnosed with breast cancer at some time during their lifetime, based on rates from As of January 1, 2008, there were approximately 2,632,005 women in the U.S. who have had or currently have breast cancer Source: Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, , National Cancer Institute. Bethesda, MD, based on November 2010 SEER data submission, posted to the SEER web site, 2011.

8 Count McHenry County & Illinois Invasive Female Breast Cancer Incidence: McHenry County Count McHenry County Rate Illinois (Whites only) 1, Age-adjusted rate per 100,000 women Note: Error bars on the above graph represent 95% confidence intervals. Source: Illinois Department of Public Health, Illinois State Cancer Registry, public data as of November 2010

9 Percent Distribution of Stage of Disease at Diagnosis Incident Female Breast Cancer: McHenry County Illinois (Whites only) Distant 5% Unstaged 1% Distant 4% Unstaged 2% in situ 17% in situ 20% Regional 25% Regional 24% Localized 53% Localized 50% Source: Garner K., Shen T. Illinois County Cancer Statistics Review Incidence, Epidemiologic Report Series 11:03. Springfield, Ill.: Illinois Department of Public Health, June 2011.

10 U.S 5-Year Breast Cancer Survival Rates based on Stage Stage at Diagnosis 5-Year Relative Survival Localized (confined to primary site) 98.6% Regional (spread to regional lymph nodes) 83.8% Distant (cancer has metastasized) 23.4% Unknown (unstaged) 52.4% Source: Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, , National Cancer Institute. Bethesda, MD, based on November 2010 SEER data submission, posted to the SEER web site, 2011.

11 Deaths per 100,000 age-adjusted women McHenry County & Illinois Female Invasive Breast Cancer Mortality: McHenry County Illinois (Whites only) Year of death Note: Error bars on the above graph represent 95% confidence intervals. Source : Illinois Department of Public Health, Illinois State Cancer Registry, public data set v17, , data as of November 2009.

12 McHenry County & Illinois Age Distribution of Female Breast Cancer Deaths: McHenry County <45 Years 7% Illinois (Whites Only) <45 Years 6% 65+ Years 56% Years 37% 65+ Years 62% Years 32% Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File CDC WONDER On-line Database, compiled from Compressed Mortality File Series 20 No. 2M, 2010

13 Cost of Breast Cancer Total lifetime cancer-attributable Medicare costs In situ: $21,320 Localized: $26,747 Regional: $40,096 Distant: $52,288 Source: Max W, Sung HY, and Stark B. The economic burden of breast cancer in California. Breast Cancer Research and Treatment (1);

14 McHenry County Cervical Cancer Statistics Screening utilization Incidence 5-Year Survival Mortality

15 Percent of women 18 years old McHenry County & Illinois Cervical Cancer Screening Pap Test: % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 95.0% 93.7% McHenry County Illinois Ever Had a Pap Test 82.8% Past Year 77.5% Note: Error bars on the above graph represent 95% confidence intervals. Source: Illinois Department of Public Health, Illinois Behavioral Risk Factor Survey, 4 th Round McHenry County & 2008 Illinois

16 Cervical Cancer Lifetime Risk & Prevalence According to the National Cancer Institute One in 147 (0.68%) women born today will be diagnosed with cervical cancer at some time during their lifetime, based on rates from As of January 1, 2008, there were approximately 243,884 women in the U.S. who have had or currently have cervical cancer Source: Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, , National Cancer Institute. Bethesda, MD, based on November 2010 SEER data submission, posted to the SEER web site, 2011.

Count McHenry County & Illinois Cervical Cancer Incidence: 1994-2008 100 McHenry County Count McHenry County Rate Illinois (Whites only) 14.0 90 80 70 60 50 40 30 20

17 Count McHenry County & Illinois Cervical Cancer Incidence: McHenry County Count McHenry County Rate Illinois (Whites only) Age-adjusted rate per 100,000 women Note: Error bars on the above graph represent 95% confidence intervals. Source: Illinois Department of Public Health, Illinois State Cancer Registry, public data as of November 2010

18 Illinois* Cook* DuPage* Kane* Lake* McHenry Will* Winnebago* Percent of incident cervical cancers Select Illinois Counties Percent Distribution of Stage of Disease at Diagnosis Incident Cervical Cancer: % Localized Regional Distant Unstaged 50% 40% 30% 20% 10% 0% *Whites only Source: Garner K., Shen T. Illinois County Cancer Statistics Review Incidence, Epidemiologic Report Series 11:03. Springfield, Ill.: Illinois Department of Public Health, June 2011.

19 Percent Distribution of Stage of Disease at Diagnosis Incident Cervical Cancer: McHenry County Illinois (Whites only) Unstaged 6% Unstaged 5% Distant 8% Localized 35% Distant 13% Localized 44% Regional 51% Regional 38% Source: Garner K., Shen T. Illinois County Cancer Statistics Review Incidence, Epidemiologic Report Series 11:03. Springfield, Ill.: Illinois Department of Public Health, June 2011.

20 U.S. 5-Year Cervical Cancer Survival Rates based on Stage Stage at Diagnosis 5-Year Relative Survival Localized (confined to primary site) 90.9% Regional (spread to regional lymph nodes) 57.0% Distant (cancer has metastasized) 18.7% Unknown (unstaged) 53.7% Source: Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, , National Cancer Institute. Bethesda, MD, based on November 2010 SEER data submission, posted to the SEER web site, 2011.

21 U.S. Cervical Cancer Mortality For , the age-adjusted death rate was 2.4 per 100,000 women per year, with the lowest rates being among Whites at 2.2 The median age at death for cervical cancer was 57 years. Source: Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, , National Cancer Institute. Bethesda, MD, based on November 2010 SEER data submission, posted to the SEER web site, 2011.

22 McHenry County Department of Health

23 Program Overview for FY2011 IBCCP lead agency established Fall 2007 Located at MCDH Crystal Lake Facility Healthcare Provider partnerships Staffed by 4.7 FTE

24 McHenry County IBCCP Funding Sources: FY2011 County $158,000 25% Total Funding: $630,910 Grant $472,910 75%

25 McHenry County IBCCP Expenditures: FY2011 Medical 49% Contractual Services 6% Commodities* 3% Salaries & Fringe 42% *Commodities include 5000 line items (office supplies, office equipment, mileage, meeting expenses, supplies and promotional material)

General Breast & Cervical Cancer Flow Chart

Office visit Breast exam Pelvic exam Pap test

Diagnostic services may include: Mammography

Colposcopy Results = Abnormal Schedule Next

highlighted in yellow are provided free to clients

All other services may be provide through the

26 General Breast & Cervical Cancer Flow Chart Enrollment in IBCCP Screening services may include: Office visit Breast exam Pelvic exam Pap test Mammogram Results = Abnormal Results = Normal Diagnostic services may include: Mammography Ultrasound Clinical exam Cytology Biopsy HPV test Colposcopy Results = Abnormal Schedule Next Screening Results = Normal Biopsy Services highlighted in yellow are provided free to clients who enroll in IBCCP through the Program. All other services may be provide through the Illinois Department of Healthcare and Family Services (HFS). IBCCP assists in getting their client HFS benefits, if eligible. Results = Abnormal Treatment may include: Lumpectomy Mastectomy Hysterectomy Chemotherapy Radiotherapy

27 Tracking IBCCP Case Management Algorithm Enroll/ Re-Enroll Established Client Tracking Assessment Symptoms? Barriers? High Risk? Yes Client Services and Support Expedite screening (if needed) Schedule screening Provide assistance to reduce barriers Patient education Screen/Re-Screen NORMAL NOT CANCER RESULTS Diagnostic Work-Up Clinical Follow-Up FINAL DIAGNOSIS? ABNORMAL CANCER Intermediate Case Management Advanced assessment and core plan Clinical oversight using approved protocol Patient education Provide assistance to reduce barriers Schedule or ensure clients have referrals Advanced Case Management Advanced assessment and core plan Ensure referral for treatment Patient education Provide assistance to reduce barriers Tracking Treatment Complete No Longer on HFS Support Refer to IDHFS for Treatment Terminate Client from IBCCP Tracking Figure reproduced from IBCCP Policy and Procedure Manual, Revised April 2011, Section 6, p16.

28 IBCCP Case Enrollment & Case Management Staff Time For a new client without symptoms to be enrolled and case managed takes approximately 3:40 hours staff time Annual case management of an established client without symptoms takes approximately 2:20 hours staff time Clients that require more staff time, include Symptomatic clients Clients under 35 years old Clients with a positive cancer diagnosis Referral to Treatment Act (RTTA) clients

29 Medical Provider Visit Reimbursement Rates for Common Scenarios New Client Both Breast & Cervical Screenings Established Client Both Breast & Cervical Screenings Service Fee Service Fee Office visit $ Pap test (Thin Prep) $28.51 Mammography (Digital, Bilateral) $ TOTAL $ Office visit $74.37 Pap test (Thin Prep) $28.51 Mammography (Digital, Bilateral) $ TOTAL $252.70

30 Program Highlights for FY2011 Program saw 1,063 clients (38.8% were new) 13 clients in the program were diagnosed with cancer 9 with invasive breast cancer 2 with in situ breast cancer 2 with cervical cancer

31 Caseload Attainment for Lead Agencies Through December 31, 2009 Source: IDPH Office of Women s Health, Illinois Breast and Cervical Cancer Program, January 2010

32 IBCCP Screening Services Summary for FY2011 Screening Services Number % Abnormal Clinical Breast Exam 1, % Mammography % Pap Test % TOTAL 2, %

BRENDA LOWERY GRAVITT OPINION BY v. Record No JUSTICE LAWRENCE L. KOONTZ, JR. September 17, 1999 PHILLIP D. WARD, M.D., ET AL.

Present: All the Justices BRENDA LOWERY GRAVITT OPINION BY v. Record No. 982269 JUSTICE LAWRENCE L. KOONTZ, JR. September 17, 1999 PHILLIP D. WARD, M.D., ET AL. FROM THE CIRCUIT COURT OF HALIFAX COUNTY