Colorectal cancer is the second-leading cause of cancer death in central Pennsylvania, which is partially attributable to low screening rates among certain segments of the population. Penn State Cancer Institute researchers are developing and testing strategies to improve screening rates in order to diagnose and treat colorectal cancer in earlier stages, when treatment efficacy is generally optimized.
Penn State Cancer Institute’s Cancer Health Equity team are pictured with Jennifer Moss, MD, and Siddhartha Roy, MD, who work within Penn State College of Medicine Family and Community Division and conduct research within the community.
Back row, left to right: Joanne Senft, research associate, Office for Cancer Health Equity, Penn State Cancer Institute; Roberta Granny, administrative support coordinator, Penn State Cancer Institute; Lorna O. LeMelle, MA, community outreach and engagement manager, Office for Cancer Health Equity, Penn State Cancer Institute; Sol Rodriguez-Colon, MS, community research project manager, Office for Cancer Health Equity, Penn State Cancer Institute
Front row, left to right: Eugene Lengerich, VMD, MS, professor of Public Health Sciences and associate director of Health Disparities and Engagement, Penn State Cancer Institute; Jennifer Moss, PhD, assistant professor in the Department of Family and Community Medicine and the Department of Public Health Sciences, Penn State Cancer Institute; Siddhartha Roy, MPH, DrPH, assistant professor in the Department of Family and Community Medicine, Penn State Cancer Institute
Although overall colorectal screening rates in central Pennsylvania are similar to those elsewhere in the United States, rates are lower among minority and rural segments of the population.
“We know that at least 40% of all cancers diagnosed in central Pennsylvania are associated with modifiable factors, such as not being screened for colorectal cancer through proven methods,” says Eugene Lengerich, VMD, MS, professor of Public Health Sciences and associate director of Health Disparities and Engagement at Penn State Cancer Institute, who leads the coordination and development of this funded research, working with other Penn State investigators, clinicians and educators. “Our challenge is to develop, test and disseminate individualized approaches — in collaboration with clinical providers — to increase colorectal cancer screening and ultimately reduce the number of preventable cancers in central Pennsylvania.”
“What excites me most about this body of research is seeing local physicians and residents using effective, personalized strategies developed in central Pennsylvania to have an impact upon population health.”
— Eugene Lengerich, VMD, MS, professor of Public Health Sciences and associate director of Health Disparities and Engagement at Penn State Cancer Institute
Research Leads the Way
Dr. Lengerich and his colleagues are undertaking that challenge through multiple research studies funded by organizations that include the National Institutes of Health’s National Cancer Institute and the American Cancer Society. The ongoing effort, expected to continue between 5 and 10 years, is fostered by four investigators, six research staffers, 10 clinical providers and 10 community-based organizations.
Jennifer Moss, PhD, assistant professor in the Department of Family and Community Medicine and the Department of Public Health Sciences at Penn State Cancer Institute, who specializes in identifying and improving geographic disparities in cancer prevention, is piloting an important facet of this research. Dr. Moss is developing and testing a strategy that combines screening for multiple cancers into a single solution for women who reside in some of the most rural communities in central Pennsylvania, specifically, by providing a self-sampling option for colorectal and cervical cancer screenings.
While a clinician recommendation is one of the most influential factors in determining whether or not a person is tested for colorectal cancer, the Penn State Cancer Institute’s research is examining how other factors could play a role.
“We hypothesize that opportunities to reduce the cancer burden in central Pennsylvania can be better achieved through community engagement,” Dr. Lengerich says. “Consequently, we work closely with community organizations that represent central Pennsylvania residents [in order to test the theory].”
In one illustration of that, Siddhartha Roy, MPH, DrPH, assistant professor in the Department of Family and Community Medicine and Department of Public Health Sciences at Penn State Cancer Institute — whose general research interests include cancer prevention and community-engaged research — is testing a community-based strategy tailored to the African-American population. This research examines the feasibility and acceptability of training barbers and hair stylists in a health advisor capacity, wherein they would encourage their salon patrons to connect with patient navigators to become educated about and be screened with fecal immunochemical tests and colonoscopy exams.
Meanwhile, Dr. Lengerich, an epidemiologist with more than 25 years of experience in clinic- and community-based research, has recently been involved in a study that found that colorectal cancer screening rates among Hispanics and Latinos in central Pennsylvania might be doubled by incorporating strategies that use social support and pledge to link the community with the clinical realm.
One of the biggest obstacles to colorectal cancer screening compliance is the incorporation of a personalized approach for patients. This translates into a need to communicate colorectal screening options to patients, particularly for those who face accessibility or affordability barriers.
Primary care providers and other clinicians recommending colorectal screenings to their patients per U.S. Preventive Services Task Force guidelines better serve their patients when they take a proactive stance: Any test is preferable to no test. If a patient declines a colonoscopy or sigmoidoscopy, then a fecal occult test could become a lifesaving measure.
“Just as each test has its own clinical test characteristics, patients have their own preferences for a test,” Dr. Lengerich says. “This is what makes it incredibly important, and challenging, that we develop individualized strategies for each patient.”
Spreading the Word
Clinicians throughout central Pennsylvania are invited to be part of the research studies being conducted at Penn State Cancer Institute.
“Our research typically involves minimal effort on the part of participating physicians, and those physicians will receive best practices,” Dr. Lengerich says. “Offering a personalized approach for colorectal cancer screening to their patients is the right thing to do, and it is in the practice’s interest to have high screening rates.”
Working together, researchers, providers and community organizers have the potential to shift the balance in favor of more screenings, resulting in more cancers being found and treated successfully.