Decade-Long Screening Efforts Bear Fruit for CRC Screening in New York City

A state-led program, initiated in 2003, has nearly doubled screening colonoscopy rates in New York City (NYC)—from 42% in 2003, screening colonoscopies were at 70% in 2014—and eliminated racial and ethnic disparities in the process. An article published in the journal Cancer delineates the conception, implementation, and impact of the program in NYC.

The program, called the Citywide Colon Cancer Control Coalition (C5), was launched via a collaboration between the Department of Health and Mental Hygiene (DOHMH) and the NYC Health and Hospitals Corporation (HHC). Then city commissioner, Thomas Frieden, MD, MPH, who now heads the CDC, made colorectal cancer (CRC) screening a top priority for NYC based on what he deemed a high rate of CRC-related deaths. He was supported in his efforts by then HHC head Benjamin Chu, MD, MPH, who’s now at Kaiser Permanente.

Following its launch in March 2003, the C5 coalition partnered with NYC DOHMH to increase awareness and screening for CRC and adenomatous polyps among men and women in NYC to reduce incidence and subsequent death from tis preventable disease. The primary goals of the program were:

• Increase colonoscopy screening rates for all New Yorkers 50 years of age or older and define targeted screening goals.
• Eliminate racial and ethnic screening disparities.

Several subcommittees were formed under the C5 umbrella, including a Steering Committee, Screening Guidelines Committee, Summit Planning Committee, and so on. Engaging and raising awareness was the primary objective of the program, and required participation by diverse stakeholders for the successful implementation of the program. These included physicians, hospitals and other healthcare organizations, insurers with extensive NYC membership, professional organizations, advocacy groups, health departments, survivor organizations, and patient navigators. Surveys, an annual C5 summit, public education campaigns, professional education, and patient navigator programs were just a few of the tools used by C5 to achieve its objectives.

To eliminate racial and ethnic disparities, an extensive outreach campaign was launched at NYC’s HHC, which caters to about 1.3 million patients annually; the primary demographic is Asian, black, and Hispanic. This included an aggressive media campaign by focus groups, ethnic radio and newspaper campaigns, and provider education. Additionally, freestanding endoscopy centers provided free colonoscopy screening to uninsured patients referred by community health centers.

The authors conclude that the substantial increase in NYC screening colonoscopy rates among average-risk men and women—from 42% in 2003 to 62% in 2012 to 69% in 2013—was a result of the collaboration between NYC HHC and DOHMH, the clear mission goals that were laid out, the citywide coalition and diverse stakeholder engagement, development of associated programs, and real-time monitoring of progress.

Despite the success, there are several challenges that remain, the authors write, including:

• Sustained primary care provider engagement is lacking.
• Lack of adequate resources to screen the uninsured.
• Lack of data on care continuum for those diagnosed with CRC or advanced adenomas.
• Continuous need to secure new resources.