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October 25 , 2004
Emory, UNC hope to increase colorectal screening

BY holly korschun

More than half of all adults over 50 do not adhere to health guidelines that recommend periodic colon cancer screening, despite the fact that early detection and intervention can significantly reduce illness and death from the disease.

Using a $2.5 million CDC grant, a team of researchers at the Rollins School of Public Health and the University of North Carolina’s Lineberger Cancer Center, along with Aetna, one of the nation’s largest health insurers, hope to change those habits and increase screening for colorectal cancer.

Colorectal cancer (CRC) is the second most common cause of cancer mortality in the United States, with the estimated number of deaths exceeding 57,000 each year. The U.S. Preventive Services Task Force recommends all asymptomatic adults age 50 and older be screened periodically through FOBT (fecal occult blood test), flexible sigmoidoscopy, colonoscopy or double contrast barium enema.

Two key predictors of whether individuals get screened for colorectal cancer are receiving a physician recommendation for screening and having health insurance. Previous studies have indicated that community- and clinic-based behavioral interventions can increase colorectal cancer screening. The Emory and UNC research team will conduct a randomized trial of members enrolled in an Aetna health plan who receive primary care through physician group practices in Georgia and North Carolina, to determine whether these same behavioral interventions can be effective in increasing CRC screening in health plan members.

The study will test a program that combines videotape-based decision aid and “academic detailing,” which involves working closely with physician practices to prepare them for increased patient demand for CRC screening. Some of the practices and their members (ages 52–75) will receive this program, and others will receive the routine reminders that Aetna sends to members who are overdue for screening. The study will continue for up to two years in still-unscreened participants. The main outcome will be whether the participants receive one of the recommended methods of CRC screening.

“This study has the potential to save lives and increase longevity in health plan participants,” said Karen Glanz, professor of behavioral sciences and health education, a Georgia Cancer Coalition Distinguished Research Scholar, and principal investigator of the project.

“Not only will it help us establish systems to increase screening that will fulfill recommended requirements,” Glanz continued, “but it also will help us forge collaborative relationships between public health and health care researchers and the affected communities of health plans and health care providers.

“The project also will improve our understanding of how screening promotion interventions work in both white and black populations,” Glanz continued.

Other investigators on the team include Tracy Scott from the Rollins school and Michael Pignone and Barbara Rimer from the UNC Line-berger Cancer Center. The research is being conducted as a collaborative partnership with Aetna’s Southeast region through the Emory Center on Health Outcomes and Quality, a multidisciplinary health care research group formed to measure and evaluate the quality of health care.

“Aetna is pleased to work with two leading research institutions in this effort to increase the number of members who receive this critical preventive screening service,” said Charles Cutler, head of national quality management for Aetna. “Our Southeast region quality and medical economics teams look forward to beginning this important work.”

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