A grant to the University of Arizona Cancer Center aims to increase colorectal cancer screening in Arizona’s American Indian communities, where screening rates lag sharply behind those for others across the nation.
The University of Arizona Cancer Center has received a $3 million, three-year award from the National Cancer Institute’s (NCI) Cancer Moonshot Initiative to increase colorectal cancer screening in Arizona’s American Indian communities.
Colorectal cancer is the second leading overall cause of cancer death, representing about 9% of all new cancer cases in the United States. Nevertheless, overwhelming evidence exists that screening of healthy individuals to diagnose and then treat early-stage disease can substantially reduce colorectal cancer mortality. Accordingly, regular screening for colorectal cancer is strongly recommended for all U.S. individuals between ages 50 and 75.
Unfortunately, compared with the general population, American Indians have experienced no improvements in colorectal cancer incidence and mortality, have disproportionate diagnoses of late-stage disease, and have lower survival rates. These disparities are attributable to very low screening rates among American Indians and poor access to colorectal cancer treatments.
“The University of Arizona has a strong commitment to working with the Native nations of our state and region, and partnering to improve health outcomes for Native communities is an area where we can have a significant positive impact,” said University of Arizona President Robert C. Robbins, MD. “As we increase rates of colorectal cancer screening in these communities, we can begin to reduce the mortality that comes with this disease, and we are excited this initiative will allow us to identify new ways to continue our long-standing tradition of partnering with Arizona’s Native nations to reduce health disparities well beyond the realm of colorectal cancer.”
One of the Cancer Moonshot goals is to reduce disparities by expanding use of proven cancer prevention and early-detection strategies. The American Indian Colorectal Cancer Screening Consortium of the NCI-designated cancer centers at UArizona, New Mexico and Oklahoma first was funded through the Moonshot initiative in July 2018 for “Dissemination of a Colorectal Cancer Screening Program Across American Indian Communities in the Southern Plains and Southwestern United States.”
Led initially by Peter Lance, MD, UArizona professor emeritus and a member of the Cancer Prevention and Control Program, the project saw a leadership change in July 2019, when Jennifer Hatcher, PhD, MPH, MSN, professor of public health and UArizona Cancer Center associate director for community outreach and engagement, assumed leadership of the program. The team was charged from the outset with beginning research of system-level changes to improve screening rates and data sharing to close the gap in colorectal cancer outcomes between the American Indian and overall U.S. population.
Drs. Lance and Hatcher estimate only 9% to 35% of Arizona’s American Indians with regular access to health care are current with colorectal cancer screening guidelines. In contrast, about two-thirds of both the general Arizona and U.S. populations receive regular colorectal cancer screenings. Screening rates for the substantial number of American Indians without regular access to health care almost certainly are worse than reported rates for those with regular access, they added.
The UArizona Cancer Center received an initial $300,000 NCI grant in 2018 and $400,000 in 2019 to establish pilot sites and begin colorectal cancer screening in the American Indian communities, taking recommended public health and clinical practice approaches to implement screening into health care procedures at select sites serving those communities.
To accomplish the initial goals, the center identified pilot sites throughout the state, conducted environmental scans and provided resources for participating clinic sites to hire “navigators” for the project. Together, it offers a community-based participatory research approach in which navigators are health care professionals based in the clinic or community who help direct individuals through the health care system – in this case, colorectal cancer screening activities.
“It is very important to receive input from the communities we are serving,” Dr. Hatcher said. “We seek input from the navigators, community leaders, community advisory boards and other key stakeholders to ensure we always are culturally appropriate in our tailored approaches.”
Dr. Lance added, “When we do these environmental scans, we want to find out what they understand about colorectal cancer and screening. But we also want to find out what they think would help them the most. The only thing we insist on is that the screening they propose be in accordance with accepted national guidelines.”
Colorectal cancer screening tests approved by the U.S. Preventive Services Task Force include colonoscopy and fecal blood tests, of which fecal immunochemical tests (FIT) are the most effective available in underserved communities. Since colonoscopy capacity is severely limited in these communities, FIT is the predominant colorectal cancer screening test at sites participating in this project.
Data collection is another critical project component. Study navigators use tablet and laptop computers for REDCap (Research Electronic Data Capture) data entry. To ensure integrity of that data and the project, however, investigators can access only aggregate anonymized data – no patient identifiers are available to the research team. The electronic health record systems at participating facilities will be adapted to incorporate “what works” to enhance sustainability of improvements in colorectal cancer screening rates and outcomes. Study investigators already are involved in this aspect of the project.
“This is an effort to increase screening rates for the population served by those clinics,” Dr. Hatcher said. “It’s called `academic detailing.’” We want to make sure the eligibility criteria are met and the providers know when to refer people to colorectal cancer screenings.”
With three more years of funding now approved, she and other investigators will expand the project’s implementation to seven clinics across Arizona. Their goal is to meet or exceed a 25% increase in colorectal cancer screenings and lay the foundation for future American Indian cancer care and research.
The Cancer Moonshot, NCI initiatives supported by the National Institutes of Health, aim to accelerate cancer research by making more therapies available to more patients, while improving the ability to prevent cancer and detect it at an early stage. It was included in the 21st Century Cures Act, which was signed into law in December 2016, and authorized $1.8 billion to fund the Cancer Moonshot over a 7-year period.
Research reported in this publication was supported by the National Cancer Institute, a unit of the National Institutes of Health, under Award Number P30CA023074. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.