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Fighting a Killer Cancer


Cancer: It’s the second-most common killer in the U.S., and colorectal cancer is the second-most deadly form. Only about a third of Travis County residents with limited access to care receive routine screening. Some (in particular those who have been historically underserved) may have to wait more than six months for colonoscopies.

Working alongside clinical partners — CommUnity Care Health Centers, the Community Care Collaborative, Dell Seton Medical Center at The University of Texas and the Livestrong Cancer Institutes of the Dell Medical School — Dell Med has developed a community-wide project to boost colorectal cancer screening rates.

The Brief

Dell Med’s Michael Pignone, M.D., a national expert in colorectal cancer screening, leads a diverse team that seeks to improve access to screening, diagnostic colonoscopy and subsequent treatment.

It recently began a project to offer free mail-in stool tests, eventually serving about 15,000 Travis County residents. Those with positive test results receive follow-up colonoscopies and comprehensive preventive care.

Graph showing declining results.

Access to Care Matters

In the U.S., the lowest colorectal cancer screening use happens among people without a usual source of health care and those who are uninsured.

Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report

How It Works

Understanding the need to help those with limited access, Pignone and team set out to make colorectal screening as easy and efficient as possible. They studied best practices across the country and examined outcomes from the entire spectrum of screening approaches.

After considerable research, the team determined that mailing fecal immunochemical tests to historically underserved Travis County residents would be more effective than relying solely on traditional practices. The tests screen for small amounts of blood in the stool — an early sign of colon cancer.

With funding secured from a three-year, $2.3 million grant from the Cancer Prevention Research Institute of Texas, Dell Med teamed up with CommUnityCare and the Community Care Collaborative (CCC) to identify unscreened patients and mail the tests to 15,000-plus residents lacking colorectal cancer screening.

CommUnityCare is Central Texas’ largest Federally Qualified Health Center (FQHC). FQHC’s provide much of the care to low income or uninsured residents facing the greatest challenges to health and care access. The CCC comprises Ascension Seton and Central Health, Travis County’s health district. The health care delivery system provides high-quality, cost-effective, person-centered care to improve health outcomes for vulnerable residents.

Recipients who participate in the screening can mail the test back to be analyzed, free of charge. Patients with positive tests connect with bilingual patient navigators who follow up to schedule colonoscopies, which can detect colon polyps that can be removed before developing into cancer.

Colorectal Cancer Screening Rates by Race

The Screening Rate Gap

The colorectal cancer screening rate among U.S. adults is 64 percent for the white (non-Latinx) population. It decreases by eight percent — to a 59 percent rate overall — for black communities.

The gap, nearly 27 percent, is even wider for those in the Latinx community, only 47 percent of whom receive screening.

Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report


Dell Med’s areas of expertise were crucial to the success of establishing a colorectal screening program for underserved residents in several ways:

  • Carefully culling and reviewing existing research to help determine the most efficient, cost-effective approach;
  • Designing and implementing an effective intervention;
  • Securing funding from government resources to support the program;
  • Leveraging the strength of Dell Med’s community partnerships to establish the best process for administering the screening tests to those who need it the most; and
  • Engaging a range of learners to meet our educational mission.

Future plans include using lessons learned from the first round of patients to help shape the screening program’s extension into other area clinics.