Need: Incidence and mortality rates from colorectal cancer (CRC) are higher in East Texas compared to Texas as a whole. CRC screening rates in Texas are far lower for individuals without compared to those with health insurance (6.8% vs. 9.1% for stool blood testing, 28.1% vs. 57.8% for endoscopy). CRC death rates per 100,000 persons are higher in rural than in urban counties. Our team will increase access to and delivery of CRC services, focusing on the un- and under-insured.

We will provide a coordinated program to increase access to and delivery of CRC services to individuals in a seven county area of East Texas. The program leverages a complementary, nonoverlappi...

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Incidence and mortality rates from colorectal cancer (CRC) are higher in East Texas compared to Texas as a whole. CRC screening rates in Texas are far lower for individuals without compared to those with health insurance (6.8% vs. 9.1% for stool blood testing, 28.1% vs. 57.8% for endoscopy). CRC death rates per 100,000 persons are higher in rural than in urban counties. Our team will increase access to and delivery of CRC services, focusing on the un- and under-insured.

We will provide a coordinated program to increase access to and delivery of CRC services to individuals in a seven county area of East Texas. The program leverages a complementary, nonoverlapping partnership with a federal program, focusing on the un- and under-insured. Unlike many CRC screening projects, it focuses on a mostly rural population, which poses unique challenges related to access, delivery of education and CRC services.

To achieve our objectives in this population, we have established multiple partnerships with existing programs in the community which are visible, effective, and which people in this region trust. We will also engage our clinical colleagues in primary care who deliver medical services to many thousands of individuals in this region to assist with recruitment to the program and with providing CRC screening decision tools, which assist the individual in deciding which form of screening is best for them.

Goals include: 1) increase CRC screening education and access in a seven county, mostly rural area of East Texas; and 2) increase the rate of CRC screening services by at least 10%. We estimate that the number of people educated through this project, in collaboration with the federal project, will be 10,000 or greater, and the number screened 2,200 or greater. Since a limitation of the federal CRC screening project is that it does not provide CRC screening services, nor transportation to receive the services, this CPRIT project will provide these services for individuals recruited and educated both through the federal and the CPRIT CRC screening projects. Moreover, the CPRIT project will provide access to CRC treatment, if appropriate.

Most publications regarding CRC screening projects have focused on urban and suburban populations, and on either health care (clinical) systems or public outreach services. Our catchment area is primarily rural, but contains an academic medical center with a large pool of patients who receive primary care clinical services. In this context, we take advantage of the resources available, combining both public outreach and clinical avenues, as well as partnering with an ongoing CRC screening project which educates but does not actually deliver CRC screening or treatment, to optimize participant recruitment, education, and delivery of CRC screening services, as well as offer treatment if indicated.

Rural settings present unique challenges, including those of relatively low population density and distance. It is therefore not surprising that CRC screening rates in East Texas and nationally are lower in rural than in urban areas. Moreover, East Texas has one of the highest rates of CRC incidence and mortality. Our program is designed to educate and deliver CRC screening services to individuals who are most in need, both by region and because they are un- or under-insured.

CRC screening is among the highest ranked preventive services based on the burden of disease prevented and cost effectiveness. Screening can prevent CRC by polypectomy and identify early stage cancers for treatment with less morbidity. Screening can reduce the frequency of advanced CRC and identify individuals at increased risk. In this collaborative partnership, each entity contributes in a unique way to the overall success of the project, which will provide a comprehensive array of services related to CRC screening, including participant education which explains screening options and comparative risks/benefits, delivery of screening, biopsy of suspicious lesions when identified, follow-up navigation, including treatment, if indicated, and provide sustainability using proven approaches to optimize the chance that individuals will undergo repeat CRC screenings.

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