Colorectal cancer (CRC) is a leading cause of cancer death in the United States and Texas. Screening can prevent CRC death, but screening rates for the uninsured are just 37%. This striking public health challenge demands urgent implementation of evidence-based strategies to reduce avoidable CRC death.

John Peter Smith Health System (JPS) in Tarrant County, TX, in collaboration with UT Southwestern Medical Center and Moncrief Cancer Resources, has attempted to boost screening for uninsured 50 year olds with a pilot program. The program used a direct-to-consumer strategy with: 1) mailed invitation to screening, including a free fecal occult blood test (FOBT) kit, 2) telephone reminders, and...

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Colorectal cancer (CRC) is a leading cause of cancer death in the United States and Texas. Screening can prevent CRC death, but screening rates for the uninsured are just 37%. This striking public health challenge demands urgent implementation of evidence-based strategies to reduce avoidable CRC death.

John Peter Smith Health System (JPS) in Tarrant County, TX, in collaboration with UT Southwestern Medical Center and Moncrief Cancer Resources, has attempted to boost screening for uninsured 50 year olds with a pilot program. The program used a direct-to-consumer strategy with: 1) mailed invitation to screening, including a free fecal occult blood test (FOBT) kit, 2) telephone reminders, and 3) systematic clinical follow up, rather than the traditional, visit-based screening approach, in which a patient visits clinic and the physician offers screening. An 18% increase in screening was observed.

However, many issues remain, including whether it will work for an expanded group of patients, whether substitution of FOBT (an inexpensive, non-invasive test with a potentially higher participation rate) with colonoscopy (a highly sensitive, but complex, invasive, and expensive test that may have a lower participation rate) should be considered, and whether the program costs in context of outcomes merit widespread implementation.

Our specific goals are to: Goal 1. Deliver evidence-based services (mailed invitation to screening, telephone reminders, and systematic clinical follow up) to several thousand uninsured, unscreened patients served by JPS. Patients will be invited to either: a) Complete a home-based, non-invasive immunochemical FOBT, with a kit included in the mailing, or b) Complete a colonoscopy. Goal 2. Rigorously evaluate program outcomes, including screening rates, cancers detected, and program costs.

Overall, CPRIT investment will both result in delivery of substantial screening services with immediate impact, and allow public health advocates and policymakers to determine whether the program should be sustainably supported and expanded.

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