NYC Program Diminishes Disparities, Sees Uptick in CRC Screening

A program implemented in New York City successfully increased colorectal cancer screening rates and diminished racial and ethnic disparities in screening.

A program implemented in New York City to increase colorectal cancer screening rates among all citizens was shown to be successful, according to a study published in Cancer. Colonoscopy screening rates increased from 42% in 2003 to 62% in 2007, to almost 70% in 2014. Importantly, the boost in rates drove down racial and ethnic disparities in screening.

Among Hispanics, screening increased from 38% in 2003 to 70% in 2012, higher than the national average of 48% in 2012.

Lina Jandorf, MA, and Steven H. Itzkowitz, MD, both of the department of oncological sciences at the Icahn School of Medicine at Mount Sinai in New York City, and colleagues describe the screening program in New York as a model for how other cities and regions can increase awareness and cancer screening rates among citizens.

“The increased screening rate from 2003 to 2012 translates to 833,000 New Yorkers who have undergone screening colonoscopy and represents an important public health intervention,” said Itzkowitz in a statement.

The New York City program known as the Citywide Colon Cancer Control Coalition (C5) was led by the New York City Department of Health and Mental Hygiene, and aimed to both increase colorectal cancer screening rates and to ensure equal access for all New Yorkers age 50 years and older.

The campaign included major stakeholders-hospitals, physicians, ambulatory surgery centers, healthcare plans, unions, medical societies, and advocacy and survivor groups. The program especially targeted communities with the lowest screening rates, which included culturally and linguistically tailored campaigns, public education, and outreach to healthcare providers.

Colonoscopy screening has been demonstrated to reduce both the incidence of colorectal cancer and the mortality of patients with colorectal cancer. In 2001, Medicare began to cover colonoscopy screening. Yet, in New York City, about 60% of citizens at risk for colorectal cancer were not being screened. While about 52% of people were being screened nationwide in 2003, the rate was only 42% in New York City.

To engage stakeholders, the C5 Steering Committee holds an annual summit to discuss initiatives and obtain feedback. Public education campaigns included celebrity spokespeople for radio and poster campaigns in the subway, on bus shelters, and in hospitals, as well as card distributions in check cashing offices. The campaigns were initially in Spanish and English but have since expanded to Mandarin, Russian, and Cantonese.

“We have learned that this needs to be a dynamic process that is flexible as new concepts of colorectal cancer prevention evolve,” wrote the authors in their discussion.

The New York City Department of Health and Mental Hygiene, New York State, and the Centers for Disease Control and Prevention, as well as private support from foundations, provided the funding for this program. The impact of the increase in screening on incidence and mortality of colorectal cancer in New York City will be discussed in a future report.