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Daniel Reuland, MD, MPH, and colleagues published in JAMA Internal Medicine a review of data from 73 randomized clinical trials that tested different ways of increasing screening for colorectal cancer.
 UNC Lineberger’s Daniel S. Reuland, MD, MPH.

University of North Carolina Lineberger Comprehensive Cancer Center researchers were awarded $5.5 million to increase colorectal cancer screening, follow-up and care referrals in community health centers in North Carolina.

Community health centers play a critical role in providing colorectal cancer screening for vulnerable populations. Yet, colorectal cancer screening rates in North Carolina’s community health centers average just 39 percent, which is well below the national target of 80 percent. Funded by the five-year, $5.5 million grant from the National Cancer Institute Beau Biden Cancer Moonshot Initiative, the UNC Lineberger team will refine and evaluate the initiative that includes mailing screening tests and bolstering regional colonoscopy access networks.

“Multi-level interventions can improve screening, including mailing stool tests, commonly referred to as FIT kits, directly to patients, promoting screening for patients during clinic visits, and improving access to colonoscopy,” said UNC Lineberger’s Daniel S. Reuland, MD, MPH, director of UNC Lineberger’s Carolina Cancer Screening Initiative. “However, there are barriers to implementing these interventions. One such barrier is the lack of a single, integrated electronic health record across community health systems. Some of the systems we build will be centralized and independent of specific EHR systems. We’ll be testing interventions iteratively and in pragmatic randomized trials, all the while looking at cost-effectiveness to see which approaches are sustainable and scalable.”

The project will be tested in community health center networks that serve two representative regions across North Carolina, including an 11-county region in northeastern North Carolina with higher than average colorectal cancer mortality, sometimes referred to as a colorectal cancer “hotspot.” The larger goal is to create a long-term state-level strategy to reduce CRC burden and disparities through improved screening in community health center populations.

“We have formed a large, multi-disciplinary team that is committed to advancing our ability to improve CRC screening in vulnerable populations,” said Reuland, who is also a professor of medicine in the Division of General Medicine and Clinical Epidemiology, and  the principal investigator for the project known as SCORE, which stands for Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement. “We are delighted to be one of three groups in the nation that were awarded funding to test CRC screening implementation strategies as part of the NCI Cancer Moonshot Initiative.”

During the first year, the team will develop the infrastructure for the project, pilot-test the intervention, and engage partners and stakeholders from academia, industry, government, community, and foundations in North Carolina.

“To refine the components of the SCORE project, we will rely on several focused working groups, formed with support from the North Carolina CRC Roundtable,” said Reuland. “State and local stakeholders will be critical in helping refine and implement the SCORE project.”

Major support for the development of this project has come from the UNC Lineberger Comprehensive Cancer Center through the University Cancer Research Fund and the UNC Department of Medicine. Other partners and stakeholders include: North Carolina CRC RoundtableNorth Carolina Community Health Center AssociationNorth Carolina Health Information Exchange Authority, North Carolina Society of GastroenterologyPolymedcoLabCorpVidant HealthRoanoke Chowan Community Health CenterBlue Ridge Community Health Services, Western North Carolina Colorectal Cancer Screening Initiative/Digestive Health PartnersEast Carolina University, and North Carolina State University.

The UNC team includes Alison Brenner, PhD, Stephanie Wheeler, PhD, Catherine L. Rohweder, DrPH, Teri L. Malo, PhD, Renée Ferrari, PhD, Seth Crockett, MD, MPH, Xianming Tan, PhD, Leah Frerichs, PhD, Jennifer Leeman, DrPH, Kristen Hassmiller Lich, PhD, Shana Ratner, MD, Jennifer Elston Lafata, PhD, and Karyn Stitzenberg, MD, MPH.