Offering colorectal cancer screening to poor minority women during mammography visits can effectively expand screening in this otherwise underserved population, although lack of medical insurance remains a significant barrier. That is the conclusion of a new study published early online in Cancer, a peer-reviewed journal of the American Cancer Society. The results highlight the need to find alternative funding sources for colorectal cancer screening from the government or private institutions.

Colorectal cancer screening is inadequate in minority communities in the United States, particularly among those who lack health insurance. Many minority women receive mammograms, though, so it may be possible to expand colorectal cancer screening by offering it during mammography visits.

Moshe Shike, MD, of the Memorial Sloan-Kettering Cancer Center in New York City led a team that offered colonoscopies to women attending the Breast Examination Center of Harlem, a community outreach program of Memorial Sloan-Kettering serving the primarily black and Hispanic Harlem Community.

Screening was offered from July 2003 through October 2005, and 2,616 women were eligible (at least 50 years of age without a history of colorectal cancer or screening within the last 10 years). Of these women, 2,005 (77 percent) refused to participate in the study, and 611 women (23 percent) were enrolled. The investigators found that the overwhelming majority of women who declined to participate in the study were interested in colorectal cancer screening. Therefore, offering colorectal cancer screening at the time of mammography is an effective way of generating interest and initiating the process. Of the 611 women who enrolled in the study, 337 (55 percent) went on to have a screening colonoscopy. The most important barrier to screening was lack of medical insurance. Forty-nine women (15 percent) who underwent screening had cancerous polyps.

These results verify that colorectal cancer screening can indeed be expanded by offering it during mammography visits. “Minority women can be referred, medically screened, and prepared for colonoscopy without seeing a doctor initially; this can be done by nurses and can greatly facilitate colon cancer screening, particularly in medically underserved communities,” said Dr. Shike. “The new Health Insurance Bill passed by Congress will likely increase demand for screening, and it is important to find ways to facilitate the process,” he added.

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Wiley-Blackwell