Colorectal Cancer Can Be Prevented: Dedicated Community Outreach on CRC Screening Makes a Difference

Dartmouth outreach program helps to increase New Hampshire colorectal cancer screening rate for those over 50 to one of highest nationwide.

Focus article photo

Dr. Stuart R. Gordon and Dr. Lynn Butterly with “polyp man” at a CRC screening event.

Even though colorectal cancer (CRC) is one of the few cancers that can be prevented, it is still the second most common cause of cancer deaths in men and women combined in the United States. Norris Cotton Cancer Center is working to change this.

"By removing any polyps that are found with screening, we can reduce the chances that those polyps can later develop into colorectal cancer," said Lynn Butterly, MD, director of Colorectal Cancer Screening for Dartmouth-Hitchcock Medical Center and medical director for the New Hampshire Colorectal Cancer Screening Program (NHCRCSP), a Centers for Disease Control and Prevention grant program. "That's why screening is so important for this type of cancer."

Compelling outreach, creative messaging on colorectal cancer prevention

Butterly is a driving force behind Norris Cotton Cancer Center's colorectal cancer prevention outreach. For years she's been a passionate advocate, working to bring this message to people across the state. She has partnered with many organizations including, NH Department of Health and Human Services (NHDHHS), American Cancer Society (ACS), and the New Hampshire Comprehensive Cancer Collaboration to increase screening. Not afraid to get playful with the message, she has hosted annual events that feature a colorful giant colon exhibit and a costumed polyp figure.

Her goal is to get more people to have colorectal screening, but Butterly also wants people to understand the screening process.  For example, people should understand how important following pre-screening prep instructions is to getting a good view of the colon and accurate results. She's even produced a how-to video for the colonoscopy prep on You Tube, offering tips and suggestions that help de-mystify the process, offer encouragement, and to help make the pre-colonoscopy diet go smoothly.

In 2009, as a bona fide agent for NHDHHS, Dartmouth received a five-year grant, for approximately 5 million dollars from the Centers for Disease Control and Prevention (CDC) to increase colorectal screening statewide. Led by Butterly as the grant PI, the New Hampshire Colorectal Cancer Screening Program's goal is to work with partners across the state to increase colorectal cancer screening rates for those over 50 years of age to 80 percent by 2014. The latest New Hampshire Behavioral Risk Factor Surveillance Survey (BRFSS) indicates that there's been significant improvement: screening rates have increased from 66.9 percent in 2006 to 74 percent in 2011, one of the highest in the country.

Working with endoscopy sites across New Hampshire, the NHCRSP also provides free colorectal cancer screenings to uninsured low income residents. This free colonoscopy program, which includes patient navigation, has performed more than 1,000 screening tests with zero no shows and 98 percent adequate prep rates. The CDC is assisting the NHCRCSP in evaluating the role patient navigation plays in achieving such remarkable success.

Outreach targeting older adults increases colorectal screenings statewide

Recent outreach efforts build on the observations of Dr. Stefan Holubar, a member of NCCC's Gastrointestinal Oncology Program, who is himself a colon cancer survivor. Concerned about the number of older patients he was seeing with advanced colorectal cancer, he asked the NHCRCSP Medical Advisory Board to take a look at the data. "If colorectal cancer is caught early enough it can be treated and cured, even in older patients," he said. "Catching it early is what matters."

The New Hampshire Cancer Registry data showed that 62 percent of colorectal cancers diagnosed in 2007 were in the 65 and older age group. The NHCRCSP, with funding from NH Comprehensive Cancer Collaboration, developed a small media campaign that is aimed at older adults. In a unique collaboration, NHCRCSP is teaming up with the AARP to hand out flyers, which feature senior citizens, to everyone who comes for help at their 2013 tax clinics.  Collaborating with all of these committed partners should enable us to prevent colorectal cancer or catch it early and save many lives.

More information on New Hampshire Colorectal Cancer Screening Program

March 04, 2013