NYC Coalition's Significant Progress Against Colorectal Cancer

By Gil Ross — Nov 23, 2015
A New York City-based coalition of healthcare workers, physicians and community outreach specialists managed to increase the city's screening colonoscopy rate from an abysmal 42 percent in 2003, when the C5 coalition began, to an amazing 70 percent last year. A incredible boon for public health.

Colon and GI tractA new study published in the journal Cancer documented the accomplishments of a community-based outreach program led by a multi-center team of physicians and community outreach specialists. Their coalition ("C5") helped to increase screening colonoscopy rates in the city from 42 percent in 2003 to 70 percent last year.

Given the tremendous toll of colorectal cancer (CRC), and the susceptibility of this dangerous disease to curative interventions at the early stage via screening colonoscopy, these results are near-miraculous. Physicians and other providers are working nationwide to raise the profile of a cancer that one in every twenty Americans will develop in their lifetime unless they go for screening. CRC develops in the large intestine, which includes the colon and rectum, and it is the second leading cause of cancer death in both men and women. Unlike many other cancers, CRC can be prevented and cured with the simple screening test, colonoscopy; during this test, lesions that are pre-malignant or malignant can be spotted and removed. About 140,000 Americans are diagnosed with colorectal cancer every year, and over 50,000 succumb to it, the second leading cause of cancer death among men and women (first is lung cancer).

Ninety percent of all colorectal cancers occur in patients aged 50 or older. Cigarette smoking, obesity and having a sedentary lifestyle also raise your risk, as do some other chronic conditions, like ulcerative colitis and Crohn s disease.

The current study is entitled "New York Citywide Cancer Control Coalition: A public health effort to increase colon cancer screening and address healthcare disparities," was led by Dr. Steven Itzkowitz and Ms. Lina Jandorf of the Icahn School of Medicine at Mt. Sinai Hospital, New York. Ms. Jandorf is the Director of Cancer Community Outreach in the Department of Oncological Sciences as well as the Director of Minority, Outreach, Recruitment and Education (MORE) for the Tisch Cancer Institute. Dr. Itzkowitz is Professor of Medicine there and head of the GI fellowship program.

Colonoscopy as a screening modality was first introduced into clinical guidelines in 1997, and it became a covered benefit for Medicare beneficiaries at average risk in 2001. Shortly thereafter (2003), the NYC Department of Health and Mental Hygiene (DOHMH), made CRC screening colonoscopy a top priority for NYC. Scientific studies had demonstrated that CRC deaths could be prevented by screening. An advisory committee was formed; its main charge was to assess the potential contribution of colonoscopy to NYC s CRC prevention efforts. From this, the Citywide Colon Cancer Control Coalition (C5).

"The increased screening rates from 2003 to 2012 translates to an additional 833,000 New Yorkers who have undergone screening colonoscopy and represents an important public health intervention," Dr. Itzkowitz was reported as saying by Science Codex. "By making screening accessible and providing high quality screenings, we can reduce the incidence and mortality of colorectal cancer in men and women."

"We know that routine colorectal screenings save lives, and we continue to educate the public of the importance of this," said Ms. Jandorf. "Thanks to our efforts, screening rates have dramatically increased and lives have been saved."

"This Coalition has demonstrated how public agencies and community stakeholders can partner to successfully increase colonoscopy screening and eliminate ethnic disparities in a large urban diverse population," said Sidney Winawer, MD, C5 Coalition advisory committee member and chairman of gastroenterology at Memorial Sloan Kettering Cancer Center.

The authors write, "The implementation and evolution of C5 may offer some generalizable principles and approaches that could help guide the development of similar coalitions in other communities. Similarly to the proposed cascade model in which screening guidelines are driven by available resources as well as medical evidence,32 communities seeking to develop a C5-like organization must build it with their own unique resources." Reviewing the lengthy course and multi-faceted approach the authors traveled down to achieve these striking results evokes admiration for their organizational rigor and devotion to attaining truly salutary public health outcomes, evidenced by the remarkable screening rates and, undoubtedly as outcomes are tracked, many lives saved.

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