$3.3 Million Grant to IU Researchers Aims to Increase Colorectal Cancer Screening in Rural Indiana

Victoria Champion, PhD

Researchers at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center are addressing the low colorectal cancer screening rates in rural Indiana communities with a five-year, $3.3 million grant from the National Cancer Institute.

“This grant is geared toward helping rural clinics establish the procedures to get all eligible people screened for colon cancer,” said Victoria Champion, PhD, Edward W. and Sarah Stam Cullipher Professor at IU School of Nursing and associate director of Community Outreach and Engagement at the IU Simon Comprehensive Cancer Center.

In addition to Champion, other lead investigators on the grant are cancer center member Thomas Imperiale, PhD, and Teresa Damush, PhD, of IU School of Medicine.

When looking at rates of colorectal cancer screening at rural clinics, Champion and her research team found clinics with screening rates below 10 percent, compared to about 65 percent of eligible individuals screened statewide. The National Colorectal Cancer Roundtable has set a goal of 80 percent.

Through a partnership with the Indiana Rural Health Association, the IU researchers are identifying nine rural health clinics to test implementation of an evidence-based colorectal cancer screening program.

"Our purpose is to help these clinics implement a known intervention so that we can dramatically increase the screening rates in rural Indiana,” Champion said. “The most effective studies have found that merely sending out stool-based tests in the mail to eligible people with follow-up navigation is the most effective intervention to increase screenings.”

Researchers will work with the clinics to identify patients who are age 45 and older, at average risk for colorectal cancer and have not had a screening. Those patients will be mailed a fecal immunological test (FIT) along with a patient navigator’s phone number and screening directions. If preferred, they can also choose to have a screening colonoscopy.

If the FIT screening is positive, the clinics will follow up to schedule a diagnostic colonoscopy. Current data shows that only 50 percent to 55 percent of individuals in the United States with a positive FIT result follow through with a diagnostic colonoscopy.

Colorectal cancer is the third leading cause of cancer mortality in the United States; screening can detect polyps or cancer early when it may be easier to treat.

Colorectal cancer screenings are recommended starting at age 45. According to the National Comprehensive Cancer Network screening guidelines, most individuals at risk of colorectal cancer have an average risk—meaning no family history of that cancer type and no other major risk factors—and can choose a stool-based test for their screening.

Although stool screening tests are one of the colorectal cancer screening options supported by the United States Preventive Services Task Force, many people believe colonoscopy is the only recommended test.

“The best screening test is the one that people will do,” Champion said.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.