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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the second leading cause of cancer mortality in the U.S. with an estimated incidence of 148,000 cases and 56,000 deaths in 2002. CRC screening (CRCS) by fecal occult blood testing has been shown to reduce mortality. Although randomized studies using colonoscopy have not been performed, indications are that colonoscopy is the most effective method for CRCS. In spite of the proven efficacy of CRCS, no more than 35% of the population is screened in contrast to screening for breast and cervical cancer, which are utilized by 85% of women nationwide. This under-utilization is more pronounced in minority communities, such as Harlem, N.Y., where the 5-year survival rate of CRC patients is 20% compared to the national average of 47-62%. The decline in CRC mortality seen in white males and females has not been seen in African Americans. There is a need to increase screening for CRC, particularly in poor minorities communities. This study proposes to examine the feasibility of a model program for CRCS by offering screening to women at the time of mammography. Because close to 85% of women undergo mammography, there is a unique opportunity to enhance CRCS by offering it at the time of mammography. The aims of the study are to test the feasibility of a model for a CRCS program among minority women by offering a screening colonoscopy at time of mammography to document knowledge, attitudes and barriers to CRCS, and to determine the feasibility of using women who participate in CRCS to motivate their spouses to undergo CRCS. The prevalence, stage and pathology of lesions found during screening will be determined. CRCS by colonoscopy will be offered to 3000 women, age 50 or above, during their mammography visit. Those consenting will undergo a pre-procedure medical assessment and be scheduled for a colonoscopy. The findings on colonoscopy will be analyzed. In the process, knowledge and attitudes to CRCS, barriers to compliance, and the ability to motivate spouses and other members of the household will be determined. Demonstration of the feasibility of this model can form the basis for a nationwide project using mammography centers to enhance CRCS.