Final Task Force Report

Task Force Report, December 23, 2006 Jay Cooper ACS Colorectal Cancer Screening CD Revision Project The following is a list of revisions that have been made to each of the American Cancer Society Colorectal Cancer CDs. Lay Version of the Presentation Old Slide Number 2

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“In 2006, it is estimated that 2040 Iowans will develop colorectal cancer. This represents 13% of all the cases of cancer, which will develop in Iowa each year. This slide introduces the concept of average versus high risk without explaining difference, wrote in Notes that this will be explained later in the presentation Text for average risk was highlighted in yellow. Text for high risk was highlighted in red. “It was estimated that 660 Iowans will die from colorectal cancer in 2006. This represents about 10% of all cancer-related deaths.” Slide was deleted, as it duplicated Slide 2. In the notes, added, “How do you determine whether your risk is average or high?” On slide, replaced “more than average” with “higher” In notes, added, “Even if you do not fit into the high risk category, you should be screened. People can develop colorectal cancer even without any symptoms.” On slide, replaced “more than average” with “higher” All capital letters sometimes makes things hard to read. Changed the slide text to a more normal capital and lower-case scheme. Did away with the legend and put the Before 50/After 50 labels with the percentages on the graph 93% after age 50, not 94% 7% before age 50, not 6% Changed white section of graph to blue. Changed “Listen Up” to “Attention” Fixed “years” text, so that it all is on one line in the slide. Relative survival rate is 91%, adjusted for normal life expectancy – changed from the 95% in the slide. Explained in the notes what the technical abbreviations stand for.

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Changed “Center” to “Centers” for Disease Control and Prevention Stage 0: 100% Stage 1: 96% Stage 2: 84% Stage 3: 65% Stage 4: 8% Early diagnosis percent is 60% Late diagnosis percent is 40% Dukes information was removed, to reduce clutter Information from SEER*Stat Version 6.2.4 Added to cost segment that some people wait until 65 to be screened because Medicare will cover screening. BRFSS data suggests people do not seek screening due to low education level, very low income, and because around 5% believe that colorectal cancer is a high problem. Added this to notes. Rephrased comments on slide so they appear more like patient comments, so that this can be a more interactive slide. Inserted into the first line of the second bullet in the Notes: “given cards like these pictured in the slide” Inserted into the second sentence in the second bullet: “The cards with the three small stool samples are mailed” Inserted into the second sentence in the second bullet: “from blood and some foods which may be in the stool sample.” Inserted into the last line of the second bullet in the Notes: “as far as the tube used for a colonoscopy which is another screening test for colorectal cancer.” Added to notes, “When used in combination, flexible sigmoidoscopy and fecal occult blood tests can catch nearly 3 out of 4 of all polyps and cancerous cells.” Changed “The” to “This” at the beginning of the second sentence in the Notes. Deleted “one” in parenthetical phrase in the fifth line of the Notes. Inserted “which is” before the work linked in the sixth line of the Notes. Deleted “their” and “self” in the last line of the first bullet in the Notes. Changed picture of the “examines entire colon” from picture of colonoscopy equipment to picture of the colon. Added “as grey areas” after the phrase “on the film” in

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the third line of the first bullet in the Notes. Changed “your” to “the patient’s” personal physician in the fourth line of the first bullet on the Notes. Explained “barium stools” in the second to the last sentence of the first bullet of the Notes. Changed the last sentence of the first bullet of the Notes by changing “Following the exam” to “During this time”. Added bullets to indicate different points in the Notes section of the slide. Added information about availability and cost to the Notes section. Defined CT and CAT in the Notes. Deleted “virtual colonoscopy” from the second line of the second bullet Inserted “the” between while and patient in the fourth line of the second bullet of the Notes. Defined 3D image in the Notes. Changed “This” to “The” in the third bullet of the Notes. In the notes section, added: “Note that the cost of these tests ranges from $10 to $1500, depending on the test and type and amount of insurance coverage. Consult your insurance plan or provider to determine which tests are covered.” Made new slide stating that, “Insurance covers most, if not all kinds of screening. Consults your insurance plan or provider to determine which tests are covered. Screening should begin at age 50, not at age 65 when Medicare begins.” Highlighted Average Risk text in yellow. Highlighted High Risk text in red. In notes, added: “If you don’t see your physician regularly, call and make an appointment today to discuss your screening options.” Changed graphic from tissue to tumor. Added Dr. Wolfe and Dr. Thompson to the list of acknowledgments.

Professional Version of the Presentation – Long Version Slide Number 1

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Planned Revisions Changed graphic to picture of a tumor Inserted “screening” between “cancer” and “task in the last line of the Notes.

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Changed graphic to picture of a tumor Deleted “through” in the first line of the third sentence in the Notes. Changed NSAID’s to NSAIDs Add to Notes that diet modification, vitamin E, and folic acid have not been shown in analysis to prevent the formation of colorectal cancer – in fact, folic acid might help in the development of colorectal cancer! Changed “prevention” to “preventive” in the last line of the Notes. 148,610 (in 2006) new cases will be diagnosed in the U.S. Occurs in 6% of population (1 in 18) Second leading cause 55,170 deaths/year, 5-year mortality 33% Changed tense in the Notes. Changed 94% to 91% Changed wording to “relative survival rate (adjusted for normal life expectancy)” Changed last sentence in the Notes: “examinations which lead to the removal of polyps” Inserted acronyms after all technical terms in the Notes. Updated slide with most recent BRFSS data Updated slide with most recent BRFSS data Stage 0: 100% Stage 1: 96% Stage 2: 84% Stage 3: 65% Stage 4: 8% Early diagnosis percent is 60% Late diagnosis percent is 40% Title changed to “5-Year Relative Survival Rate* for Iowa Patients Diagnosed with CRC Between 1995-2001” with “*Adjusted for normal life expectancy” added to bottom Original statement in box (“Screening saves lives through early diagnosis and treatment”) at bottom deleted Inserted “Stage 0” before “Stage I” in the Notes. Changed “that stage” to “these stages” in the Notes. Changed 50% to 65% in the Notes. Citation from “SEER*Stat Version 6.2.4” added to the slide. Included point that people are not screened until 65, because they wait to be covered by Medicare before getting screened. Cited reference for information on the slide (BRFSS, 2004). Added that “about half of the respondents said their health care professional ever talked with them about colorectal cancer screening” and “of those who receive a recommendation for colorectal cancer screening from their physician, 75% say they

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get the test”. Deleted “and the procedure” after “cleansing” in the Notes. Inserted “which” after “cleansing” in the Notes. Deleted “the” and inserted “a” before the word “test” in the first line of the Notes. Updated graph with information from Iowa Cancer Registry from: http://www.publichealth.uiowa.edu/shri/images/charts/Age Color.gif Changed “colon cancer” to “colorectal cancer” in the Notes. Changed “diagnoses” to “diagnosed” in the Notes. Changed caption to the slide: “It shows that 94% of cases are diagnosed after age 50 and 74% after age 65.” Deleted the second occurrence of “recommended” in the first line of the Notes. Inserted: “Although Medicare covers colorectal cancer screening, a person should not wait until age 65 (when Medicare coverage begins) to seek screening. Most insurance providers cover some, if not all costs of screening. Patients should consult their insurance plan or provider for more information. Changed HMO’s to HMOs. Inserted “cancer” after colorectal in the first line of the Notes. Deleted reference to barium enema in the last line of the Notes. Inserted “showing that FOBT is an appropriate and” after “mortality” in the Notes. “Pro’s” changed to Pros “Con’s” changed to Cons Defined the term “contrast” Changed the photo referencing the entire colon from the picture of the colonoscopy equipment to a picture of the colon. Changed the photo referencing the entire colon from the picture of the colonoscopy equipment to a picture of the colon. Inserted data from SECAP study Removed as many abbreviations as possible Updated graph from National Endoscopy Database Used “The” instead of “These” at the beginning of the second sentence in the Notes. Changed “should be continues” to “should be continued” in the Notes. 300 pts. fixed to match other text on the slide Inserted “of” after “accumulation” in the Notes. Removed question mark after polyps Changed “colon” to “colorectal” cancer in the Notes. Added information about the perfect test: high sensitivity, high specificity, low cost, and non-invasive. Added to Notes: “Costs are different for each insurance provider, Medicare, and screening provider. Patients should consult their

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insurance plan or provider to obtain full details on cost and coverage of colorectal cancer screening tests.” Changed graphic to picture of a tumor Changed “preventative” to “preventive” in the Notes. Changed “Center” to “Centers” for Disease Control and Prevention.

Professional Version of the Presentation – Short Version Removed slides 9, 15, 16, 21, 24, 31, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 50, 51 Material from slide 15 was moved to the Notes section of slide 14. Slides 20 and 21 were combined. Material from slide 24 was moved to the Notes section of slide 23. Material from slide 31 was moved to the Notes section of slide 30. Slide 34 was summarized briefly in the Notes section.