Testing to prevent colon cancer: results from a rural community intervention

Abstract

Purpose: Colon cancer is the second leading cause of cancer death in the United States. Despite tests that can detect and enable removal of precancerous polyps, effectively preventing this disease, screening for colon cancer lags behind other cancer screening. The purpose of this study was to develop and test a community-based participatory approach to increase colon cancer screening.

Methods: Using a community-based participatory research approach, the High Plains Research Network and their Community Advisory Council developed a multicomponent intervention-Testing to Prevent Colon Cancer-to increase colon cancer screening. A controlled trial compared 9 intervention counties in northeast Colorado with 7 control counties in southeast Colorado. We performed a baseline and postintervention random digit-dial telephone survey and conducted both intent-to-treat and on-treatment analyses.

Results: In all, 1,050 community members completed a preintervention questionnaire and 1,048 completed a postintervention questionnaire. During the study period, there was a 5% absolute increase in the proportion of respondents who reported ever having had any test in the intervention region (from 76% to 81%) compared with no increase in the control region (77% at both time points) (P = .22). No significant differences between these groups were found in terms of being up to date generally or on specific tests. The extent of exposure to intervention materials was associated with a significant and cumulative increase in screening.

Conclusions: This community-based multicomponent intervention engaged hundreds of community members in wide dissemination aimed at increasing colorectal cancer screening. Although we did not find any statistically significant differences, the findings are consistent with an intervention-related increase in screening and provide preliminary evidence on the effectiveness of such interventions to improve colon cancer screening.

Keywords: Colon cancer prevention; community-based participatory research; practice-based research; rural; underserved.

Figure 1

Change in colorectal cancer screening (ever had test) in intervention vs control regions.

Figure 2

Impact of exposure on colorectal cancer screening (n = 1,048). Note: endoscopy refers to colonoscopy and/or sigmoidoscopy. ^aP <.05

Figure 2

Impact of exposure on colorectal cancer screening (n = 1,048). Note: endoscopy refers to colonoscopy and/or sigmoidoscopy. ^aP <.05

Figure 2

Impact of exposure on colorectal cancer screening (n = 1,048). Note: endoscopy refers to colonoscopy and/or sigmoidoscopy. ^aP <.05

Figure 3

Temporal changes in hospital endoscopy for intervention and control regions. Note: Annual number of sigmoidoscopies and colonoscopies performed as reported by hospitals in the intervention region vs control region. Vertical line denotes beginning of intervention in 2004–2005.