The city that never sleeps has woken up in a big way to one cancer prevention measure, colonoscopy, boosting uptake of the potentially lifesaving test for New Yorkers aged 50 or over from only 42 percent in 2003 to 66 percent five years later.
How did they do it? A concerted effort involving innovative outreach and education, expanded endoscopy suites at city hospitals, more primary care referrals, and clinic workers called 'navigators' who help patients understand the value of colonoscopy and remind them as their appointment draws near.
Not only did the city boost screening rates between 2003-2008, but "we have also closed the gap [in colonoscopy screening] among whites, blacks and Hispanics," said Marian Krauskopf, director of the Cancer Prevention and Control Program at the New York City Department of Health and Mental Hygiene. Assuring high rates of screening for all groups is important, Krauskopf noted, and messages tailored to specific communities and an aggressive focus on the part of the City’s public hospitals helped end those disparities when it came to colonoscopy.
Could the Big Apple's success be replicated elsewhere? "I think every jurisdiction could do what we did," Krauskopf said. "They could take a scan of where are the institutions, the people, who are most invested in this issue" and tailor similar initiatives to their city or region.
According to department of health figures, 1,600 New Yorkers died from colon cancer in 2003, but that year only about 4 in every 10 city residents aged 50 or over - the age group for whom colonoscopy is recommended – said they had had the test within the past 10 years.
Krauskopf and her colleagues knew something had to be done, so the Citywide Colon Cancer Control Coalition (C5)-a consortium of gastroenterologists, primary care doctors, advocacy organizations, city health officials, hospitals, health plans, and others-was formed to help turn the situation around. Their success has relied on a few key ingredients, Krauskopf said:
- Clarity of Message. Although the American Cancer Society and others recommend a number of screening modalities given at various intervals, C5's message focuses on colonoscopy for most New Yorkers aged 50 or over, given once every 10 years. This message was targeted to ethnicities or neighborhoods with low screening rates via subway and radio ads. C5 even employed the innovative "Get Checked" campaign, which handed out free colonoscopy reminder cards to people patronizing city check-cashing outlets.
- Ample Resources. To ensure that the city could provide colonoscopy to all who might ask for it, the Health and Hospital Corporation, the City’s public hospital system invested capital and staff to expand endoscopy suites citywide.
- Patient Navigators. These specialized clinic workers - first employed to help breast cancer patients navigate the health care system - were the brainchild of Harlem Hospitals' Dr. Harold Freeman. Now, participating C5 hospitals have patient navigators in their endoscopy suites whose job it is to guide patients through the colon cancer screening process. According to Krauskopf, this could involve "removing barriers to screening" (such as a lack of transportation to/from the clinic), reminding people of an upcoming appointment, or explaining the bowel prep needed for the procedure.
- Involving Primary Care. The C5 team put together innovative outreach to primary care physicians, "to embed the idea of direct referral [for colonoscopy] into their routine practice," Krauskopf said. This includes a colonoscopy referral deskpad that doctors can use much as they would a prescription pad.
The success of the program continues to build, and with the number of participating hospitals ballooning from three in 2006 to 18 today, C5 is on track to reach its 2012 goal of an 80 percent colonoscopy rate for all New Yorkers aged 50 or above.
For her part, Krauskopf hopes NYC's success catches on in districts nationwide. Any city or region "can build it own C5- type organization," she said, "and then begin to tailor an effort that triggers whatever those resources are in that community."
