The Carolina Cancer Screening Initiative (CCSI) leverages UNC Lineberger members’ expertise in research-backed interventions – along with a network of community, academic, and government partners – to improve the quality and accessibility of cancer screening programs throughout North Carolina.
One of the most effective ways to improve outcomes for several of the most common types of cancer is through preventive screening for early detection – yet geographic and demographic inequities often mean that underserved populations have insufficient access to potentially lifesaving tests.
To address these inequities, the UNC Lineberger Comprehensive Cancer Center launched the Carolina Cancer Screening Initiative (CCSI) in 2016. Initially supported by the University Cancer Research Fund and since bolstered by foundation and federal grant funds, the CCSI leverages UNC Lineberger members’ expertise in research-backed interventions – along with a network of community, academic, and government partners – to improve the quality and accessibility of cancer screening programs throughout North Carolina.
One key research partnership has been UNC Lineberger’s work with the Roanoke Chowan Community Health Center (RCCHC), which has helped boost cancer screening rates in northeastern North Carolina while providing new insights into how to effectively improve cancer prevention in rural areas.
“What we know about colon cancer screening is that if you do it, it reduces cancer mortality,” said CCSI Co-Director Dan Reuland, MD, MPH and professor, Division of General Medicine and Clinical Epidemiology at the UNC School of Medicine. “We are taking evidence-based practices that are known to improve screening rates, and we are learning how to adapt those practices in this resource context to improve screening in rural areas.”
In 2015, an American Cancer Society study identified northeastern North Carolina as one of three hotspots in the country for colon cancer, with higher-than-expected death rates for disease even after accounting for known risk factors. As a federally qualified health center that provides clinical services throughout five northeastern counties, RCCHC had already been working to improve screening rates by adjusting their operations and improving patient outreach – doubling their screening rates within a year of the ACS hotspot study.
“Our aggressive efforts to improve screening rates is what caught Lineberger’s attention, especially with the dynamic of those national headlines,” said Kim Schwartz, RCCHC’s CEO. “They reached out with some conceptual ideas, and we had many meetings and conversations. Their focus has always been, ‘What can we do as a research process that would fit in with what you’re doing – how can we add more value?’ From day one, it has felt like we are all in this together. It’s been a great team.”
Prior studies had already found mail-in fecal immunochemical tests (FITs) can be an effective preliminary colon cancer screening approach when added to usual (visit-based) screening. Partnering with RCCHC to tailor that approach and to build on the center’s existing work and vision, UNC researchers provided technical support to help determine who was due for a screening, mailed screening tests to eligible residents in RCCHC’s service area, gathered results for those tests, and embedded a patient navigator in the northeast to help guide patients whose mail-in kits yielded positive results.
“It’s so easy to do – you do it in private, in your own home,” said RCCHC Lab Manager Regina Jacobs, who championed and implemented the center’s operational and outreach initiatives that successfully doubled its screening rates. “You send it in, we get it processed, and we get the results. If it’s positive, we get you on the right path to get help – and we potentially save a life.”
UNC also partners with Blue Ridge Health in the western part of the state as a second site for the study, which is now in its fifth and final year. While the last bits of data are still being collected and analyzed, initial results indicate that the FIT tests were an effective screening approach: Of the nearly 2,000 eligible residents who received a FIT kit in the mail, about 25% completed and returned the tests – and more than 80% of patients whose FIT results were positive also followed up with a colonoscopy.
CCSI Deputy Director Alison Brenner, PhD, MPH, assistant professor, Division of General Medicine and Clinical Epidemiology at UNC School of Medicine, said the next step is to determine how to sustain the screening initiative to improve long-term outcomes. “Keeping these screening rates as high as possible will make a measurable difference in long-term outcomes, so the hope is that we can find some way to transition this from a resource-intensive, randomized control trial to a more sustainable program,” she said. “But you need resources to do that. Part of the reason we took this on is because the clinics don’t have the resources to do it all.”
In addition to colorectal cancer, the CCSI focuses on breast, cervical, colon, liver, and lung cancer screening research. UNC Lineberger was recently named as one of three southeastern U.S. cancer centers on Stand Up 2 Cancer’s Lung Cancer Health Equity Research Team, which – thanks to a $3 million, four-year grant – are working with federal health centers in Virginia and North Carolina to establish a sustainable infrastructure to improve screening, diagnosis and treatment of lung cancer in the Black community. Black Americans are disproportionately impacted by lung cancer and by social determinants of health, which can increase their risk for smoking and limit their access to lung cancer screening and care.
As the colorectal screening study wraps up, Geniene Jones, MD, RCCHC’s chief medical officer, hopes to continue the center’s partnership with Lineberger and improve screening for other cancers, like lung cancer. “Cancer is our No. 1 killer, so we are always looking for ways to address it, especially in terms of equity and special populations,” she said.