From 2005-2009, CDC funded five sites to implement the Colorectal Cancer Screening Demonstration Program to screen low-income, under or uninsured men and women ages 50-64 living in the US at or below 250-350% of the federal poverty level. This multiple component evaluation provided a descriptive summary of program models and implementation processes, screening results, and a cost analysis. Program design was influenced by two critical factors: pre- existing infrastructure and the need to adapt programs to fit local service delivery structures. Partnerships were integral to the demonstration program at all stages of its development.
The implementation experience pointed to the importance of utilizing a comprehensive and systematic screening approach. Well-defined patient pathways and clinical protocols, clear mechanisms for patient referrals, and the development of quality assurance and tracking systems were imperative to ensure high quality screening and patient adherence. A wide variability was found between fecal occult blood tests ( FOBT) and colonoscopies. Polyp, adenoma and cancer detection rates were five to ten times lower for those tested with a single FOBT compared to screening colonoscopy in average risk persons, with even higher colonoscopy polyp, adenoma, and cancer detection rates among those at increased risk for colorectal cancer. Screening using FOBT was found to be much less costly than colonoscopy, both per person and per program. The cost analysis found that start-up costs are significant and that in-kind contributions play a critical role in overall program funding.
Report Title: Development of a Framework for a Demonstration Colorectal Cancer Screening Program with an Evaluation Component
Agency Sponsor: CDC, Centers for Disease Control and Prevention
Federal Contact: Amy DeGroff, 770-488-2415
Performer: CDC, Information Management Services, Research Triangle Institute
Record ID: 8710 (Report issued May 31, 2010)