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Article from the Edmonds Journal
Health and Fitness
Early Detection
By Jeffrey Ward, DO, July 4, 2006
One of the weaknesses of our nation's health care system is its apparent inability to provide widely applied screenings for the prevention of disease. The reasons for the inability are varied, and many of them, such as obesity, diet and smoking, are lifestyle issues and most effectively addressed by societal and public policy solutions.
Our failure to adequately screen for cancer before symptoms appear and is most curable, or even preventable, however, is a failure that must be laid squarely at the feet of a short-sighted medical establishment that rewards politicians, insurers, industry and providers more for treating disease than for preventing it.
Several years ago, our Cancer Committee at Stevens Hospital grappled with a staggering statistic—one not unique to our community. In a controlled HMO population of senior citizens in our community—and even in clinics with mammography on-site, where it was convenient and to the clinic's advantage financially—only 40 percent of eligible patients were receiving appropriate mammograms. From brainstorming for innovative solutions came the idea for a screening registry.
One of the duties of the Cancer Committee is to maintain the Tumor Registry, a repository of detailed information about each cancer patient that we see and treat. The information is fed into a state and national registry that provides vital statistics in our war on cancer. When we have questions about the cancer care we provide, we can mine this powerful, computerized database to answer them. Why not, we thought, develop a screening registry—a computerized repository of information provided by individuals—that can be used to identify patients appropriate for cancer screening evaluations?
As the idea took form, we envisioned that patients deemed appropriate for screening interventions would be sent mailings, directing them to their primary care provider to access the evaluation. But, we didn't wish that either patients or physicians view this as a replacement for their regular doctor or nurse practitioner appointments. So we determined that providers would be notified each time we communicated with their patients, allowing them to contact their patients proactively in concert with the registry if they desired.
Yet we also wanted to reach as many people as we could. If someone had no primary care provider, we would help them find one, and if their doctor was not in the Stevens community, that was okay too.
Using screening guidelines from the American Cancer Society, the National Cancer Institute and specialty societies, colon, breast, prostate and cervical cancers were identified as malignancies in which screening studies were scientifically validated and widely accepted.
In addition we chose to include information in the screening registry that would identify people who wereat significant risk of being carriers of genes that cause breast cancer and colon cancer. These people would then be eligible for counseling and testing to identify if they really were at risk.
With a gift from the Stevens Hospital Foundation, a software package was purchased to manage data entry and patient/physician communications. Once we developed a screening questionnaire and formatted our notification letters, we were ready to start. The years 2004 and 2005 were pilot years in which we worked first with just two physicians within Stevens Internal Medicine and then with the entire clinic. This allowed the committee to work with a small number of patients to refine the tools and allow for some measurement of success.
However, from the beginning we realized that enrolling patients who regularly see their physicians may be preaching to the choir. It is the patients who are not frequently seen by their doctors, or perhaps have no primary care physician at all, who could benefit from this system the most. We are now ready to take the screening registry to "prime time".
Enrolling in the registry is simple. The questionnaire is not long, consisting of just over two pages of straightforward questions. Click here to fill out the Cancer Screening Registry questionnaire.
Last month at the national meetings of the American Society of Clinical Oncology, more than 25,000 oncologists descended on Atlanta to learn of the latest, and extremely expensive, treatments for cancer. Our ability to treat advanced cancer—changing natural history by extending lives while improving the quality of the life that is left—is impressive.
But no cancer treatment, regardless of its impressiveness, can compare with not getting cancer in the first place. And catching cancer early through screening and successfully curing it is by far preferable to waging a late-stage cancer battle. Therein lies the power and the efficacy of a screening registry.
Dr. Ward is a medical oncologist at Puget Sound Cancer Centers. He can be reached at 425.775.1677.
