Howard University Hospital’s Experience in Community Outreach and Prostate Cancer Screening

  Responsible Prostate Cancer Early Detection Screening Program

September 22, 2017

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Dr.  Pamela  Coleman,  Program  Director  “Men  Take  Ten”  Men’s  Health  Educa>on  &  Early  Detec>on  Program  

Howard  University  Cancer  Center  

Disclosure Statement

• No Disclosures

Men Take Ten Program

• Founded  in  the  late  1990’s  by  a  Howard  University  Cancer  Center  (HUCC)  researcher  aKer  her  father  was  diagnosed  with  prostate  cancer.  

• Focus  was  bringing  awareness  to  prostate  cancer  in  addi>on  to  being  a  resource  for  men  seeking  informa>on.  

• The  program  offered  free  prostate  specific  an>gen  (PSA)  tes>ng  and  digital  rectal  examina>ons  (DRE)  each  month.  

• Men  40  years  and  older  were  encouraged  to  get  screened  annually.  

•  In  2005:  program  offered  community  outreach  and  educa>on  to  help  men  make  an  informed  decision  about  screening.  

•  In  2007:  Center  for  Disease  Control  (CDC)  and  the  DC  Department  of  Health  (DOH)  awarded  HUCC  a  grant  which  included  the  purchase  of  a  40  K.  mobile  health  screening  unit.  

•  The  grant  was  also  used  to  increase  awareness  in  the  Washington,  DC  area.  

•  In  2012:  unit  was  renovated  and  now  includes  a  recep>on  area,  phlebotomy  sta>on,  bathroom,  2  exam  rooms,  and  most  of  the  appliances  were  also  upgraded.  

Men Take Ten Program History

Men Take Ten Mobile Unit

Men Take Ten Mobile Unit “front entrance”

Men Take Ten Mobile Unit “exam room”

Program Today

•  Focus  is  to  provide  health  informa>on  to  everyone  and  encourage  men  to  make  an  informed  decision  about  ge\ng  screened  for  prostate  as  well  as  other  cancers  (i.e.,  lung  &  colon).  

•  Screening  is  offered  on  the  3rd  Wednesday  of  every  other  month  at  HUCC  and  at  select  community  events  (i.e.,  Congressional  Black  Caucus  &  the  NBC4  Health  &  Fitness  Expo).  

•  Screening  is  free  for  uninsured  par>cipants.  

•  Par>cipants  will  receive  a  copy  of  their  screening  results  and  may  also  receive  pa>ent  naviga>on  services  for  follow-­‐up  care.      

Program Today

• Many  of  our  par>cipants  have  been  screened  over  the  years  and  past  results  are  considered  with  current  findings.  

• Our  team  is  currently  entering  data  into  our  electronic  database.  

• Data  collec>on  tools  have  changed  over  the  years.  

• Data  from  recent  years  are  available  and  will  be  presented  at  American  Associa>on  for  Cancer  Research  (AACR)  in  Atlanta,  GA  next  week.  

MTT Data Highlights (2009-2015)

• Database  includes  more  than  2300  cases.  

•  Includes  par>cipant’s  iden>fying  informa>on,  medical  history,  BPH  Impact  Index,  Quality  of  Life  scale,  DRE  results  and  PSA  value  at  the  >me  of  screening.  

• One  of  our  first  abstracts  reviews  the  impact  of  the  US  Preven>ve  Services  Task  Force  recommenda>on  against  screening  on  u>liza>on  of  the  program.  

MTT Data Highlights (2009-2015) •  There  was  a  significant  change  in  program  u>liza>on  aKer  the  USPSTF  recommenda>ons  compared  to  u>liza>on  before  the  recommenda>ons.  

•  57.4%  of  par>cipants  were  screened  at  a  community-­‐based  event.      

• Mean  age  of  par>cipants  was  56.6  years.  

•  84.1%  were  of  African  descent.      

•  2/3  pa>ents  had  medical  insurance,  41.8%  had  a  primary  care  physician,  and  21.9%  had  a  family  history  of  prostate  cancer.      

•  44%  resided  in  DC  wards  5,  7  &  8  (the  greatest  prostate  cancer  incidence  rates).  

The impact of the US Preventive Services Task Force recommendation against prostate screening on

utilization of the Howard University Cancer Center’s “Men Take Ten” prostate cancer screening program

Background  • Black  men  in  DC  face  significant  prostate  cancer  dispari>es.    Incidence  for  blacks  is  230.7  compared  to  99.7  for  whites.    Mortality  is  2.6  >mes  higher  for  black  men.    To  address  this  disparity,  since  2005,  the  Men  Take  Ten  (MTT)  program  has  offered  outreach,  educa>on  and  screening.    In  2012,  the  US  Preven>ve  Task  Force  (USPSTF)  recommended  against  prostate  cancer  screening.    This  recommenda>on  presents  a  decisional  dilemma  for  black  men.  Currently,  MTT  con>nues  to  offer  screening  with  emphasis  on  informed  decision-­‐making.  

 Aim  •  This  study  examines  the  impact  of  the  USPSTF  recommenda>on  on  prostate  cancer  screening  in  the  MTT  program.  

The impact of the US Preventive Services Task Force recommendation against prostate screening on utilization of the

Howard University Cancer Center’s “Men Take Ten” prostate cancer screening program

Methods  • We  analyzed  MTT  u>liza>on  from  July  2009  through  December  2015.    Social  and  demographic  characteris>cs  of  1,045  par>cipa>ng  men  are  described.    

Results  •  From  2009  –  2012,  on  average,  123.3  men  par>cipated  in  MTT  screening  annually.    From  2013-­‐2015,  the  u>liza>on  increased  to  an  average  of  183.7  men  per  year.    Over  half  (57.4%)  were  screened  via  a  community-­‐based  event.    The  remainder  were  screened  in  the  MTT  clinic.    The  mean  age  of  par>cipants  was  56.6  years  and  84.1%  were  of  African  descent.    Over  half  (55.9%)  reported  some  educa>on  beyond  high  school  and  43.3%  reported  a  household  income  of  <  $36K.    Two-­‐thirds  had  medical  insurance,  41.8%  had  a  primary  care  physician,  and  21.9%  had  a  family  history  of  prostate  cancer.    Forty-­‐four  percent  resided  in  DC  wards  5,  7  &  8  which  have  the  greatest  prostate  cancer  incidence  rates.  

Conclusion  •  Despite  the  controversies  surrounding  prostate  cancer  screening,  our  data  does  not  reflect  a  decrease  in  program  u>liza>on.  

The impact of the US Preventive Services Task Force recommendation against prostate cancer screening on utilization of the Howard University Cancer Center’s “Men Take Ten” prostate program.

Clinton  Burnside,  BS,1,2  Carla  Williams,  PhD,1,2  Radhika  Kakarla,  MBBS,1  Stephanie  Purnell,  BA,2  Theresa  Vaughn,  MS,1,2  Cherie  Spencer,  MS,1,2     Tamaro  Hudson,  PhD,  MPH,1,2,3  TeleDa  Taylor,  PhD,1,2  Ali  Ramadan,  MD,4  Adeyinka  Laiyemo,  MD,  MPH,1,2  Pamela  Coleman,  MD,  FACS1,2,5  

   

AffiliaDons:  Howard  University  Cancer  Center1,  Howard  University  College  of  Medicine2;  Department  of  Pharmacology3,   Howard  University  Hospital;  Department  of  Pathology4,  Department  of  Surgery5  

Washington,  DC  20060  

CONCLUSIONS •  Based   on   our   data,   overall   u>liza>on   increased   in   the   three   years   aKer   the   USPSTF  

guideline.    Thus,  our  data  implies  the  USPSTF  guidelines  did  not  significantly   impact  the      men  u>lizing  the  MTT  PCa  screening  program.

•  The  majority  of  the  increase  was  due  to  screenings  offered  in  targeted  community-­‐based  se\ngs  in  DC  Wards  5,  7  &  8,  coupled  with  appropriate  educa>on.    

•  Further   analysis   is   needed   to   fully   assess   the   impact   the   2012   USPSTF   guidelines  may  have  on  AA  men  in  Washington,  DC.

•  Targe>ng   community-­‐based  events  while  providing  appropriate  educa>on,  may  help   to  increase  cancer  awareness  and  the  u>liza>on  of  healthcare  services.  

 

RESULTS •  A   total   of   1,045   men   were   included   in   the   final   analysis.   Demographic   data   are  

presented  in  Table  1.

•  The   mean   age   of   par>cipants   was   56.6   years.   Most   (84.1%)   par>cipants   self-­‐iden>fied  as  AA  men,  48.6%  were  between  the  ages  of  55-­‐69,  87.6%  had  at   least  a  high   school   educa>on,   67%   had  medical   insurance,   and   56.5%   had   a   primary   care  physician.    

•  On   average,   123.3   men   u>lized   the   program   annually   from   2009-­‐   2012,   while   an  average   of   183.7   men   u>lized   the   program   annually   from   2013-­‐2015.     Annual  u>liza>on  is  depicted  in  Figure  1.

•  Across  all  years,  57.4%  were  screened  via  community-­‐based  events  (Figure  1).

•  Data   demonstrated   that   44%   of   par>cipa>ng   men   resided   in   DC  Wards   5,   7   &   8,  which  have  the  highest  PCa  incidence  rates2  (Figure  2).  

BACKGROUND •  African   American   (AA)   men   in   the   US   suffer   higher   burdens   from   prostate   cancer  

(PCa)  than  any  other  ethnic  groups.1  

•  PCa   incidence   in   AA  men   residing   in  Washington,   DC   is  more   than   2   >mes   greater  than  rates  for  white  men  in  Washington,  DC.2  

•  Since  2005,  Howard  University  Cancer  Center’s  “Men  Take  Ten”   (MTT)  program  has  offered   outreach   and   educa>on   to   help   men   make   an   informed   decision   about  ge\ng  screened.    

•  For  men  who  make  the  informed  decision  to  get  screened  for  PCa,  screening  services  include   a   physical   exam   (digital   rectal)   and   a   serum  prostate   specific   an>gen   (PSA)  test.  

•  In  2012,   the  US  Preven>ve  Services  Task  Force   (USPSTF)   recommended  against  PCa  screening.3

•  A  2015  study  found  screening  rates  declined  among  men  age  50  and  older  aKer  the  USPSTF  report.4  

•  The  USPSTF  recommenda>on  presents  a  decisional  dilemma  for  AA  men.  

METHODOLOGY •  Howard   University’s   Ins>tu>onal   Review   Board   (HU-­‐IRB)   approval   was   obtained   to  

review   the   de-­‐iden>fied,   prospec>vely   maintained   ins>tu>onal   database   for   PCa  screening  from  July  2009  to  December  2015.

•  Descrip>ve   sta>s>cs   were   used   to   summarize   the   social   and   demographic  characteris>cs  of  1,045  par>cipa>ng  men  residing  in  Washington,  DC.

•  Annual   program  u>liza>on   data  was   compared   to   examine   changes   before   and   aKer  the  USPSTF  recommenda>on.

•  U>liza>on   rates   were   compared   based   on   the   loca>on   of   the   screening   ac>vity  (community-­‐based   or   hospital-­‐based)   and   the   local   residence   (by   DC   Ward)   of  par>cipants.  

OBJECTIVE   •  The   aim   of   this   study   was   to   examine   the   demographic   characteris>cs   of   men   who  

par>cipated   in   MTT   PCa   screening.     The   study   also   examined   changes   in   screening  par>cipa>on  before  and  aKer  the  2012  USPSTF  screening  recommenda>on.  

REFERENCES 1.  Di  Pietro,  G  et.al.   (2016).  Racial  Differences   in   the  Diagnosis  and  Treatment  of  Prostate  

Cancer.  Interna>onal  Neurourol  J  2016;20  Seppl2;S112-­‐119.

3.  District  of  Columbia,  Cancer  Registry,  Bureau  of  Cancer  and  Chronic  Disease,  2014.

5.  Moyer  VA,  (2012)  US  Preven>ve  Services  Task  Force:  Screening  for  prostate  cancer:  U.S.  Preven>ve  Services  Task  Force  recommenda>on  statement.  

           Ann  Intern  Med  157:120-­‐134,  2012. 4.  Drazer  MW,  Huo  D,  Eggener  SE  (2015).  Na>onal  Prostate  Cancer  Screening  Rates  AKer                  the  2012  US  Preven>ve  Services  Task  Force  Recommenda>on  Discouraging  Prostate-­‐              Specific  An>gen-­‐Based  Screening.    J  Clin  Oncol.  Aug  1;33(22):2416-­‐23.    

ACKNOWLEDGEMENTS •  Howard  University  Hospital    Department  of  Community  and  Family  Medicine.  

n   %  AGE  (YEARS)  40-­‐54     434   42.0  55-­‐69     508   48.6  70+     99   9.5  Missing   4   0.4  

ETHNICITY  African  American     883   84.5  White   52   5.0  Hispanic   46   4.4  Other   43   4.1  Missing   21   2.0  

EDUCATION  Less  than  HS   84   8.0  HS  Diploma/GED   329   31.5  Less  than  4  yrs.  of  college   243   23.3  4  yrs.  of  college  or  more   343   32.8  Missing   46   4.4  

MEDICAL  INSURANCE  Yes   700   67.0  No   313   30.0  Missing   32   3.1  

PRIMARY  CARE  PHYSICIAN  Yes   590   56.5  No   415   39.7  Missing   40   3.8  

MARITAL  STATUS  Non-­‐Married   373   35.7  Married   207   19.8  Separated   37   3.5  Divorced   86   8.2  Widowed   23   2.2  Missing   319   30.5  

116  

140  

33  

197  189  

62  

106  

169  

33  

Ward  1   Ward  2   Ward  3   Ward  4   Ward  5   Ward  6   Ward  7   Ward  8   *Other  

Figure  1.  UUlizaUon  by  LocaUon  and  Year  

0  

75  

150  

225  

2009   2010   2011   2012   2013   2014   2015  

Hospital-­‐based   Community-­‐based   Total  

Table  1.  Demographics  

Figure  2.  UUlizaUon  by  Ward  

Take Away

• Our  data  suggest  that  targe>ng  community-­‐based  events  while  providing  appropriate  educa>on,  may  help  to  increase  cancer  awareness  and  the  u>liza>on  of  healthcare  services.  

Cancer Education & Awareness Programs

•  “Men  Take  Ten”  (Prostate  Cancer)  •  3rd  Wednesday,  every  other  month  &  select  community  events  •  Mr.  Clinton  Burnside  •  202.865.4653  •  Clinton.burnside@howard.edu    

•  “Colorectal  &  Lung  Screening”  (Colon  &  Lung  Cancer)  •  Appointment  only  •  Mrs.  Debra  Parish-­‐Gause  •  202.865.7256  •  Dparish-­‐gause@howard.edu  

•  “Mammoday”  (Breast  Cancer)  •  1st  or  2nd  Saturday,  every  other  month  •  Mrs.  Kimberly  Higginbotham  •  202.865.4655  •  khiggin@huhosp.org    

THANK  YOU!