Uptake of colorectal cancer screening in an uninsured population

Montgomery County established a colorectal cancer education, screening, and treatment program as part of the Maryland state cancer program. The program removed barriers to screening by providing free endoscopy (predominantly colonoscopy) to uninsured county residents.

The education component was available to the general public and included distribution of free fecal occult blood cards (FOBTs). The clinical component was available only to the low-income uninsured. Clinical program participants met with a registered nurse who provided education, made endoscopy (colonoscopy) referrals, and provided case management. County residents entered the program in three ways: by direct referral from a physician, after contact with a health educator, or via telephone.

Over 2 years, 1672 uninsured individuals registered with the program, of whom 13% had prior screening. In this group, 52% completed screening with at least one modality, the majority by colonoscopy.

This program is one of the first in the nation to offer uninsured individuals free access to colonoscopy mediated by nurse referral and case management. It provides an experience that can inform interventions of experimental design in which the uptake of the options for colorectal cancer screening are compared; or it can serve as a "benchmark" against which other efforts to screen uninsured minority populations may be compared.