Telephone outreach can dramatically increase the incidence of screening for colorectal cancer (CRC) in an urban minority population, according to a new study published in the December 2006 issue of American Journal of Public Health.
The study suggests a promising strategy for increasing CRC screening, which may help reduce CRC incidence and death in black men and women, who are at significantly higher risk for both than their white counterparts. Past studies have shown that blacks are less likely to receive CRC screening, which when conducted regularly via three day stool blood test, reduces mortality by as much as 15-33 percent. With early detection, five-year CRC survival rates exceed 90 percent.
"There's a clear connection between African Americans' high rates for developing and dying from colon cancer and their low rates of screening at the age when colon cancer becomes a significant risk," said Charles E. Basch, Richard March Hoe Professor of Psychology and Education at Teachers College, Columbia University. "This study is the first to demonstrate that telephone outreach can dramatically increase the rate of CRC screening in an urban minority population. By providing such screening, health insurers and employers could find a significant reduction in the human and financial toll taken by colon cancer."
From 1992-2001, CRC incidence for black men was 13.2 percent higher than for white men and 21.7 percent greater for black women than for white women. Annual mortality was 34 percent greater for black men than for white men and 38 percent greater for black women than for white women.
While prior research has demonstrated the effectiveness of telephone outreach to motivate cancer screening, the Teachers College study is the first to show that the technique can increase CRC screening in a predominantly black population.
The study focused on a mainly minority population in the New York City metropolitan area. The 456 participants all were employed and had health insurance, were all at least 52 years old, and had not received or scheduled CRC screening of any kind in recent years. Half received phone education during the study – an average of five conversations totaling 23.5 minutes within six months-- while half received only printed material (via direct mail) recommending CRC screening.
The impact of phone intervention far exceeded the researchers' expectations. Those who received telephone education were more than four times as likely to follow through with CRC screening as those who received printed material.
More specifically, 61 people in the phone intervention group (27 percent) underwent CRC screening within six months of receiving phone contact, whereas only 14 people in the control group (6 percent) underwent screening. Of those who underwent screening after receiving phone education, 18 received medically significant diagnoses, compared to three in the control group.
Of the 456 study participants, 288 were black, 74 white and 90 "other." About 75 percent (324) had incomes under $50,000, and fewer than half (213) had more than a high school education. There were 324 women and 132 men.
"It is encouraging to find that telephone outreach can have a strong positive impact on the health-related behavior of this high risk urban minority group," said Basch. "Indeed, the impact of the phone intervention surprised us because it exceeded that of earlier studies that did not focus on minorities. The inference is that phone intervention may be particularly effective among groups who are less likely than the general population to have participated in screening."
In addition to Basch, the study was conducted and co-authored by Randi L. Wolf (Teachers College, Columbia University), Corey H. Brouse (SUNY Oswego), Celia Shmukler (Disease Management and Wellness Program), Alfred Neugat (Mailman School of Public Health, Columbia University), and Steve Shea (College of Physicians and Surgeons, Columbia University).
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Journal
American Journal of Public Health