Colorectal cancer is the second leading cause of cancer deaths in the United States. The U.S. Preventive Services Task Force recommends that all adults ages 50 to 75 get screened for the disease. But in 2015, only about 62% of adults in the United States were screened according to the guidelines.
In Illinois, the problem is even more pronounced. The state is in the highest quartile for incidence rates of colorectal cancer in the Nation, and the lowest quartile for screening rates. Within the state, Cook County falls in the lowest quartile for screening rates by county, and screening rates are particularly low among racial and ethnic minorities.
The Cook County CARES program—which stands for Colorectal Cancer Alliance to Reinforce and Enhance Screening—at the University of Chicago Medicine set out to increase colorectal cancer screening rates among low-income Asian Americans, Hispanics, and African Americans ages 50 to 75 in Cook County. With support from a CDC grant, the program aims for an 80% screening rate in its partner health systems by 2018.
“It’s not just about early detection of cancer,” says Dr. Karen E. Kim, Professor of Medicine and Principal Investigator at Cook County CARES. She explains that, because colorectal cancer begins as polyps (precancerous lesions) in the colon or rectum, finding and removing the polyps during a colonoscopy actually stops the cancer from forming in the first place. “Unlike most other cancers, colorectal cancer is preventable.”
Bridging a Gap in Care
The overall aim of the program is to establish a multi-level, multifaceted framework to increase organized approaches to colorectal cancer screening, prevention, and control in partnership with a diverse group of health care system sector partners. Cook County CARES works primarily with Federally Qualified Health Centers (FQHCs), which provide health care to many underserved populations, including people who are uninsured.
FQHCs offer colorectal cancer screening through a fecal immunochemical test, or FIT test—also called a stool test. If the result of a FIT test is positive, the patient needs further screening by colonoscopy. “Unfortunately,” says Kim, “about half the people diagnosed with a positive FIT test nationwide don’t get a colonoscopy, and a big reason for that is because they don’t have access to care.”
Why the disconnect? Getting a colonoscopy means going to a hospital. And with only 1 safety net hospital serving the entire Chicago area, the wait for a colonoscopy appointment could be over a year. “We know that a 1-year delay results in a 2-fold increase in colon cancer risk,” says Kim. “But it doesn’t make any sense to start the process if we can’t finish it.”
Cook County CARES decided to focus on this gap in access because frustration over wait times was leading doctors to give up on colorectal cancer screening entirely. “A lot of providers said that they didn’t even want to order the stool test because they had no place to send patients for follow-up care,” Kim explains. “So why look?”
Connecting Providers Through a Portal
“We heard about these challenges from multiple FQHC partners,” says Matt Johnson, Program Director at Cook County CARES. “So, we said, okay, let’s see what we can do about it.” The team sought out hospital health systems with the capacity for colonoscopy care that were willing to take uninsured patients. “We asked potential partners, ‘Are you willing to work with us to develop a system to enhance connection of care?’ And that’s what our website is all about.”
The website is Illinois Colon CARES, a web portal created by the Cook County CARES team that helps providers navigate the colorectal cancer screening process from start to finish. The portal connects FQHCs to partner hospitals, ensuring that patients get needed follow-up screening and that the results get back to their primary care doctors. Through this portal, individuals from underserved populations who seek care at local FQHCs are connected to life-saving preventive services.
Building a Coalition for Care
Johnson attributes the program’s success to its broad coalition of partners. “When the CDC funding opportunity came about 2 years ago,” he says, “we actively partnered with the Chicago and Illinois Departments of Public Health to address this problem.” Other partners include the American Cancer Society, the Illinois Primary Health Care Association, and community-based organizations that help Cook County CARES tailor its approach to diverse cultural and ethnic groups.
Fornessa T. Randal, Executive Director of Illinois Colon CARES, stresses that the program works because it targets the specific needs of the people it serves. “There’s no better feeling than to meet a need for a community organization—because they really are the heartbeat of the community.”
Organizations across Illinois are working to replicate the success of Cook County CARES in other counties, even for different types of cancer. “We’re seeing additional partnerships taking on our evidence-based strategies and advancing the cause,” says Johnson. “And we’re also seeing programs applying these approaches to breast cancer and cervical cancer screening.”
Dr. Kim sees plenty of room for expansion. “The reason our program has such appeal is that, with the right training and access to this type of web portal, anybody can do it. We can replicate this model and solve problems across the country.”
About Stories from the Field
Each month, this series highlights how communities across the Nation are addressing the Healthy People 2020 Leading Health Indicators (LHIs). LHIs are a subset of 26 Healthy People 2020 objectives that communicate high-priority health issues. Tackling the LHIs appropriately will dramatically reduce the leading causes of death and preventable illnesses.
This month’s story features a program that is addressing the Clinical Preventive Services LHI topic.