Increasing colorectal cancer screening rates among communities with the greatest need is the goal of a five-year, $4.2 million grant from the Centers for Disease Control and Prevention (CDC) to Penn State College of Medicine. The award marks the first time an institution in the commonwealth has received funding from the CDC to support colorectal cancer screening in rural and underserved communities, underscoring the urgency of the challenge.
"Increasing access to colorectal cancer screening will save lives. This award allows us to support providers across Pennsylvania in learning from one another, scaling what works and offering patients in both rural and urban communities a full range of effective screening options," said Fornessa T. Randal, principal investigator of the grant, director of the Center for Advancing Health Equity in Rural and Underserved Communities, associate professor of medicine and public health sciences, and associate director of Research Excellence and Health Systems Engagement at the Penn State Cancer Institute.
A statewide need
Despite being highly preventable through early screening and detection, colorectal cancer remains one of the leading causes of cancer-related deaths in the United States, according to the American Cancer Society. In Pennsylvania, data from the CDC show that many counties, particularly those with rural populations, fall well below national screening thresholds.
Many of these communities are "screening deserts," where barriers such as cost, transportation and access to providers contribute to persistently low participation in recommended colorectal cancer screenings. Even if a person accesses a screening in one of these areas, it can be challenging to connect to follow-up care after a positive screening test, explained Karen Kim, dean of the Penn State College of Medicine and member of project leadership team, especially in rural communities where there may be limited access to specialty care.
"This award recognizes both the disparities in colorectal cancer screening across Pennsylvania and our commitment as a land-grant institution to serve all communities of the commonwealth," Kim said. "It affirms that our state not only needs this support, but also that the College of Medicine is uniquely positioned to translate this program into action, improving health for generations."
Implementation science and system-level change
The new grant will establish the Pennsylvania Colorectal Cancer Alliance to Reduce Mortality and Enhance Screening (PA-CARES), a partnership between public health and health systems. PA-CARES partners include Penn State College of Medicine, Penn State Cancer Institute, Penn State Health, Broad Top Area Medical Center, Keystone Rural Health Center and Rural Health Corporation of Northeastern Pennsylvania.
The framework for PA-CARES is built on a network approach, connecting and leveraging the strength and resources of collaborating organizations. The program is designed not only to increase individual screenings but to change how health systems, both urban and rural, embed evidence-based screening practices into everyday operations.
Beginning this fall, PA-CARES will work with Federally Qualified Health Centers, community-based primary care clinics and community-based organizations in 28 Pennsylvania counties with the lowest screening rates to implement evidence-based screening practices. These organizations are trusted organizations that are grounded in the community and who have established relationships with residents, which Randal said may encourage more people to get screened.
PA-CARES will also establish a referral network with each health system to facilitate timely linkage to care, including follow-up diagnostic colonoscopy and cancer treatment. Community-based organizations also provide a wide range of social services that can address the main barriers to screening and follow-up care, such as insurance, transportation and childcare.
This work described in this story is supported by CDC grant 1 NU58DP007983-01-00.
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