Colorado Cancer Screening Program

Mission

The mission of the Colorado Cancer Screening Program is to:

• Partner with local, state, and national clinical and community organizations to implement evidence-based interventions and population-based research in cancer prevention and control in order to promote health equity.
• Facilitate training and technical assistance for healthcare teams to implement cancer prevention and control initiatives aimed at reducing barriers and increasing access to care.
• Convene partners at the local, regional, and national level with a shared interest in cancer prevention and control to align efforts for increased reach and effectiveness.

Work to Date

With a foundation in colonoscopy navigation for colorectal cancer (CRC) screening, participating clinic systems have successfully navigated eligible patients into 39,348 endoscopic CRC screening exams such as colonoscopy since the Program’s inception in 2006. Cancer has been detected in 286 individuals, that if not caught would have gone on later to more advanced disease, poorer prognoses, and diminished quality of life.

During the recently culminated July 2018-June 2023 CCPD grant cycle, clinic systems participating in the Program successfully navigated 12,121 individuals for CRC screening using colonoscopy and cancer was detected in 88 individuals. Additionally, there were 520 advanced polyps, the type of polyps that are most likely to develop into cancer, detected and removed.

In a previous estimation at the start of the past grant cycle, CCSP estimated that it had saved the health care system conservatively $12-$15 million based on the detection of at least 550 advanced adenomas and the conservative amount it would cost to treat (first course of therapy) if these had developed into cancer minus the program costs. With 520 additional advanced adenomas detected in the last grant cycle, the lifetime cost savings of the Program is estimated to have substantially increased.

A key accomplishment for CCSP and participating clinics in the last grant cycle was the ability to rebound and return to screening after the onset of COVID-19. Between 2021-2023, the screening rates of participating clinics were similar to screening rates prior to COVID-19, and are continuing to increase, despite ongoing challenges in capacity, staffing, and access.

There are persistent disparities in cancer screening, incidence, and late-stage mortality in Colorado and across the United States for many cancers among Black/African American, Hispanic/Latino populations, those that live in rural/frontier regions, and populations who are uninsured or with Medicaid. The program collected aggregate level data reported by participating clinic systems on intervention reach, outcomes, and patient demographics. Highlights of the program accomplishments in the past grant cycle (July 2018-June 2023) for CRC screening colonoscopy navigation, and capacity building projects for CRC screening stool-based testing, hereditary cancer risk assessment, and lung cancer screening include:

• Colonoscopy navigation and stool-based testing
  • Although 12% of Coloradan’s live in rural communities, 18% of individuals navigated into CRC screening colonoscopy on behalf of the Program lived in rural areas (13% in the past grant cycle). 41% of those navigated into colonoscopy self-reported as Hispanic, 7% were Black/African American, 47% report as Non-Hispanic White, and other races comprised 5% of those screened with colonoscopy.
  • There was a 93% adequate bowel prep rate and 97% complete exams for those screened with colonoscopy and other visual exams.
  • Seven clinic systems focused on building capacity for implementation of stool-based testing methods. Through those efforts, more than 3,852 stool based tests were returned by patients at these 7 clinic systems, with 460 reported positive tests requiring navigation into follow-up colonoscopy.
  • Based on the results of a dedicated sustainability assessment tool and planning process for colorectal cancer screening patient navigation, the majority of clinic systems feel that they have increased capacity to sustain the navigator role a moderate to great extent over the course of the grant cycle.
• Hereditary cancer risk assessment and lung cancer screening:
  • Four clinic systems participated in hereditary cancer risk assessment, with full implementation integration achieved at two clinic systems. Through these efforts, a total of 1,330 patients from the four participating clinic systems completed a hereditary cancer risk assessment through participation in these capacity building efforts.
  • Six clinic systems participated in lung cancer screening capacity building, with full implementation integration achieved at one clinic system. A total of 397 patients from four clinic systems were screened for lung cancer with LDCT through participation in these capacity building efforts.

See Dwyer et al. (2022) for more information about the program structure, outcomes, and sustainability planning strategies in the July 2018-June 2023 grant cycle.

CCSP began a new CCPD funding cycle in July 2023 focused on implementation of a select set of evidence-based interventions for further improvement of colorectal cancer screening rates incorporating a team-based care approach, and will also continue to provide technical assistance and linkages to support for patient navigation, hereditary cancer risk assessment, and lung cancer screening.

Resources

Visit Our Website for additional information about our work and cancer screening implementation resources for healthcare teams and public health professionals.

Contact Us:

• Program Director – Andrea (Andi) Dwyer: andrea.dwyer@cuanschutz.edu
• Senior Program Manager – Elsa Staples: elsa.staples@cuanschutz.edu