AUSTIN, Texas — A novel colorectal cancer screening initiative run by Dell Medical School at The University of Texas has helped double the percentage of CommUnityCare Health Center patients being screened for this form of cancer to 37 percent from 18.4 percent in just a year.
Cancer is the leading cause of death in Travis County, and nationally colorectal cancer is the second leading cause of cancer deaths. Fewer than about one in three historically underserved Travis County residents receive routine screening for colorectal cancer and generally face a six-month wait to receive a colonoscopy.
In 2018, as part of a three-year $2.3 million grant from the Cancer Prevention and Research Institute of Texas (CPRIT), Dell Med led a coalition to address low screening rates by starting a mailed test kit program and by boosting clinic-based screenings. More than 15,700 fecal immunochemical tests (FIT) were mailed to CommUnityCare patients age 50 to 75 with average risk of colorectal cancer. More than 2,860 patients completed the tests, resulting in 77 subsequent colonoscopies.
“Our goal is to fill a significant gap in cancer prevention across Central Texas, especially among people facing financial and access barriers to these critical preventive services,” said Michael Pignone, M.D., MPH, chair of Dell Med’s Department of Internal Medicine and director of Cancer Prevention and Control for the LIVESTRONG Cancer Institutes. “A big part of this effort also involves raising community awareness so that eventually, everyone who needs screening receives it,” Pignone said, whose team spearheaded the project.
The FIT kit allows participants to submit a stool sample by mail. The samples are analyzed for traces of blood — a signal of increased risk for precancerous polyps or early-stage cancer. Patients with positive test results are connected with bilingual patient navigators who follow up to schedule colonoscopies, which can detect colon polyps that are then removed to avoid developing into cancer. Colonoscopies can also identify cancer at an early stage, when it is curable.
“It was easy. I just read the instructions, filled it out and sent it in,” said 61-year-old Austin native and CommUnityCare patient Arthur Castillo, who had his first colorectal cancer screening after receiving the free kit in the mail last year. His test showed signs of blood in his stool and resulted in a colonoscopy provided at no cost to him.
“I’d recommend to anyone receiving the kit in the mail that if you have the opportunity to take the test, do it, and tell others to do it too,” Castillo said.
Leaders at Dell Med point to the success of this program as another example of how the school is improving health outside the clinic setting to benefit the people of Travis County.
“So much of what influences health happens outside of the doctor’s office — in places where we live, learn, work and play,” said Clay Johnston, M.D., Dell Med’s dean. “When we meet people where they are, we can deliver much better health and even lower costs. Everyone wins.”
The screening program involved expertise from across Dell Med, including designers from the Design Institute for Health who redesigned the mailed kits to make them easier to understand and use. Data experts from the school’s Department of Population Health also integrated inpatient and outpatient electronic health records into one cohesive framework to make them easier for clinicians to access. Dell Med faculty gastroenterologists perform the colonoscopies at Dell Seton Medical Center at The University of Texas.
“As a result of the dynamic partnership between Dell and CommUnityCare, we were able to gain resources, utilize expertise and most importantly advance colorectal preventive screening,” said Alan Schalscha, chief medical officer of Central Health-funded CommUnityCare. “The unique screening methodology that was used avoided some of the barriers that are so often in the way of good care advocacy,” he said.
“The Colorectal Cancer Screening Program is a key part of the Community Care Collaborative’s overall strategy to improve the rates of early diagnosis for people with low income throughout the county,” said Mark Hernandez, M.D., chief medical officer for the Community Care Collaborative — a partnership between Ascension Seton and Central Health. “It has allowed us to screen more patients in a more cost-effective way. I appreciate Dell Medical School and CommUnityCare’s work to make this happen.”
The FIT screening method requires an annual test. The colorectal cancer screening initiative will continue to send test kits to last year’s recipients as well as new patients in 2019. If the project model continues its success, future plans may include extending the model to lung cancer screenings and similar health tests, and incorporating such programs into routine care, Pignone said.