Comprehensive cancer control programs and coalitions: partnering to launch successful colorectal cancer screening initiatives.

Colorectal cancer control has long been a focus area for Comprehensive Cancer Control programs and their coalitions, given the high burden of disease and the availability of effective screening interventions. Colorectal cancer control has been a growing priority at the national, state, territorial, tribal, and local level. This paper summarizes several national initiatives and features several Comprehensive Cancer Control Program colorectal cancer control successes.

Development of a federally funded demonstration colorectal cancer screening program.

Colorectal cancer is the second leading cause of cancer-related mortality among U.S. adults. In 2004, treatment costs for colorectal cancer were $8.4 billion. There is substantial evidence that colorectal cancer incidence and mortality are reduced with regular screening. The natural history of this disease is also well described: most colorectal cancers develop slowly from preexisting polyps. This slow development provides an opportunity to intervene with screening tests, which can either prevent colorectal cancer through the removal of polyps or detect it at an early stage. However, much less is known about how best to implement an effective colorectal cancer screening program. Screening rates are low, and uninsured persons, low-income persons, and persons who have not visited a physician within a year are least likely to be screened. Although the Centers for Disease Control and Prevention (CDC) has 15 years of experience supporting the National Breast and Cervical Cancer Early Detection Program for the underserved population, a similar national program for colorectal cancer is not in place. To explore the feasibility of implementing a national program for the underserved U.S. population and to learn which settings and which program models are most viable and cost-effective, CDC began a 3-year colorectal cancer screening demonstration program in 2005. This article describes briefly this demonstration program and the process CDC used to design it and to select program sites. The multiple-methods evaluation now under way to assess the program's feasibility and describe key outcomes is also detailed. Evaluation results will be used to inform future activities related to organized screening for colorectal cancer.

The role of a state health agency in promoting cancer prevention at the community level: examples from New York State.

Cancer is a major cause of morbidity and mortality in the U.S. and more work is needed to decrease the number of new cancer cases and the number of cancer cases diagnosed at a late stage. In New York State, about 106,000 people are diagnosed with cancer each year, 37% of which are diagnosed in adults aged 45-64 years and 55% in those aged ≥65 years. State health agencies are in a unique role to support implementation of cancer prevention strategies at the local level that may have a large impact on the burden of cancer by changing the context in which an individual makes health decisions. The New York State Department of Health, with support through the CDC, is implementing an 18-month cancer prevention demonstration project in two counties aimed at increasing access to nutritious foods, promoting exclusive breastfeeding and decreasing barriers to obtainment of cancer screening. The specific activities being used by the two counties are highlighted, and promising results after the first 6 months of the project are described. Lessons learned from these projects will be reported at regular intervals and used to inform development of larger, statewide initiatives aimed at reducing cancer incidence and death in New York State.