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Published on: August 1, 2019
Implementation and Evaluation of a Large Community-Based Colorectal Cancer Screening Program
Navkiran K Shokar1, Jessica Calderón-Mora, Rebekah Salaiz
1Author Affiliations: Departments of Population Health (Drs N. K. Shokar and Calderón-Mora) and Medical Education (Dr G. S. Shokar), Dell Medical School, University of Texas at Austin, Austin, Texas; Department of Family and Community Medicine (Ms Salaiz), Division of Gastroenterology (Dr Zuckerman), Department of Internal Medicine (Ms Casner), and Department of Molecular and Translational Medicine (Dr Dwivedi), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas; and School of Health Professions, University of Texas at Tyler, Tyler, Texas (Dr Byrd).
A community-based colorectal cancer (CRC) screening program successfully increased screening rates among uninsured Hispanic populations. The program achieved high participation in fecal immunochemical testing and diagnostic colonoscopies, leading to early cancer detection.
Area of Science:
- Public Health
- Cancer Prevention
- Health Disparities
Background:
- Colorectal cancer (CRC) screening significantly reduces incidence and mortality, but screening rates remain suboptimal, particularly among uninsured and those without a usual care source.
- Addressing screening disparities is crucial for improving population health outcomes in cancer prevention.
Purpose of the Study:
- To describe the implementation and evaluation of a community-based CRC screening program (2012-2015).
- To increase CRC screening in a predominantly Hispanic population along the US-Mexico border.
Main Methods:
- A multicomponent, evidence-based program involving bilingual, culturally tailored health education by community health workers.
- Provided no-cost stool-based testing, diagnostic colonoscopies, and navigation services.
- Recruited uninsured individuals through clinics and community sites, followed by extensive process and outcome evaluations.
Main Results:
- 8361 eligible individuals were approached, with 74.8% completing screening and 74.6% completing diagnostic testing.
- 14 colorectal cancers were diagnosed; participants were predominantly Hispanic, female, and of low socioeconomic status (mean age 56.8).
- Process evaluation indicated effective implementation, staff training, process compliance, and high patient satisfaction.
Conclusions:
- The population-based program successfully achieved high fecal immunochemical test kit return and colonoscopy completion rates among uninsured individuals.
- Key success factors included tailored interventions, strong community partnerships, CRC screening expertise, and an active community advisory board.
- This program model can enhance CRC screening rates for underserved populations, especially along the US-Mexico border.
