Innovative colorectal cancer screening program meets quality standards

New research from the Texas A&M Health Science Center indicates that colonoscopy in a family medicine residency met or exceeded recommended quality standards set forth by the American Society for Gastrointestinal Endoscopy and was therefore, comparable to those of specialists.

In the U.S., relatively few primary care physicians perform colonoscopies, and only a fraction of family medicine residencies train residents to conduct colonoscopies, though trust in a primary care physician is associated with patients adhering to Colorectal Cancer (CRC) screening compliance. CRC usually results from malignant transformation of polyps, unwanted growths that over time, develop into cancerous cells. Approximately 28 million Americans are not up to date on colorectal screenings though CRC remains the second most common cause of cancer mortality for both men and women combined.

Through an innovative partnership between the Texas A&M College of Medicine’s family medicine residency program and the Texas A&M School of Public Health, with funding from the Cancer Prevention and Research Institute of Texas (CPRIT), increased access to affordable colonoscopies for underinsured or uninsured residents was made available while providing colonoscopy training to family medicine resident physicians. Targeting seven counties in central Texas, six of which are rural, a total of 1155 colonoscopies were performed over a 3-year period supervised by four board-certified family physicians. Polyps were discovered in 275 people and 11 cases of cancer were found, nine of which were rural residents.

CPRIT funding enabled the Texas A&M Family Medicine residency program to purchase equipment needed for training. The Texas A&M School of Public Health was responsible for grant administrative requirements and outreach to inform community members and health care providers about the available services. The partnership resulted in about 50 clinical partners who keep an eye out for patients who might need colorectal screenings. Over 200 community partners such as churches and social service agencies helped get the word out about the availability of the free colorectal screenings and bilingual community health workers were employed to provide culturally relevant community outreach and patient navigation services.

“Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program,” published this month in the Journal of the American Board of Family Medicine, reports quality indicators from colonoscopy procedures performed by family medicine physicians met or exceed the American Society for Gastrointestinal Endoscopy standards.

“It is our hope that this program will serve as a national model for reducing the incidence of colon cancer, as well as incorporating cancer prevention, screening and education into family medicine residency training programs,” said David McClellan, M.D., an assistant professor of family and community medicine in the Texas A&M College of Medicine and co-PI on the project.

The Centers for Disease Control and Prevention estimate that CRC-related mortality can be reduced by 60 percent if age-eligible adults adhere to screening recommendations.

“Since primary care physicians are more likely to practice in rural and less affluent areas than their specialist counterparts, training and equipping primary care physicians to perform colonoscopies should be explored as means of increasing colonoscopy capacity, especially among underserved populations,” said Jane Bolin, Ph.D., J.D., B.S., professor at the Texas A&M School of Public Health and co-PI on the project.

Other members of the Texas A&M research team include Chinedum Ojinnaka, M.B.B.S., M.P.H., Robert Pope, M.D., Katie Pekarek, D.O., Andrew Richardson, M.D., Janet Helduser, M.A., and Marcia Ory, Ph.D., M.P.H.