Colorectal Cancer Education, Screening and Prevention Program (CCESP): Empowering Communities for Life

Each year in the United States, approximately 50,000 people die from colorectal cancer (CRC), the second-leading cause of cancer-related deaths in this country. CRC disproportionately affects racial minorities, with African Americans being more likely than other groups to develop CRC and die from the disease. Additionally, those who live in rural communities are more likely to die from cancer than those living in an urban setting.

CRC screening can detect colorectal cancer at an early stage to maximize the potential for treatment to be effective. Further, the detection and removal of polyps can prevent colorectal cancer from developing. The U.S. Preventive Services Task Force recommends regular screening beginning at age 50 and continuing until age 75 using high-sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy. Despite these recommendations, only 67% of adults are up to date with CRC screening. African Americans and other people of color are less likely than Whites to get screened, and a lower level of education, lower income, and lack of access to insurance and a regular source of health care have a negative impact on screening rates. Precision public health interventions designed to promote colorectal cancer screening to medically underserved individuals are needed, particularly among racial/ethnic minorities, rural residents, and socioeconomically disadvantaged groups in poor-resourced communities.

The Colorectal Cancer Education, Screening and Prevention Program (CCESP): Empowering Communities for Life is a community-based intervention designed to increase colorectal cancer screening among underserved adults aged 50-75 who are due for CRC screening. Grounded in health behavior theory, the intervention was developed using principles of community-based participatory research and involved the initiation of dialogue and collaborative partnerships between the community and academia to address CRC screening disparities.

Participants, recruited primarily through community organizations, attend a meeting to receive a 45-minute educational presentation. Delivered by an academic health professional (AHP), the presentation aims to provide informed professional advice to empower participants to be healthy and teach them about cancer, cancer prevention, and colorectal cancer screening. The content of the presentation includes national statistics on CRC incidence, mortality, and screening; general information on the risk factors for CRC, symptoms of CRC, and screening guidelines; detailed instructions on how to use the FOBT screening card correctly; and tests that can be used after screening, such as colonoscopy, flexible sigmoidoscopy, and double contrast barium enema imaging.

During the presentation, participants have the opportunity to ask questions and discuss their concerns. At the end of the presentation, each participant is given an FOBT kit to be completed at home, an instruction card, and a brochure that summarizes the presentation. Two weeks after the presentation, cards are mailed to participants with stamped, return address envelopes.

-- 8 hours to train AHPs
-- 45 minutes to deliver the presentation to participants

The intervention is intended for adults aged 50-75 who are due for CRC screening.

The intervention is designed to be implemented in community, religious, and clinical settings in rural environments.

Required resources to implement the program include the following:
-- Colon Cancer Awareness Poster
-- Information on Colonoscopy
-- Colon Cancer: Catching It Early Flyer
-- Advertisement
-- Colorectal Cancer Fact Sheet
-- Initial Contact Form
-- Instructions for Fecal Immunochemical Test (English)
-- Instructions for Fecal Immunochemical Test (Spanish)
-- Pledge Magnet for Colorectal Cancer Screening
-- Professional Colorectal Cancer Health Meeting Slide Presentation
-- Release of Information
-- FOBT

For costs associated with this program, click on Contact Program Developer on the Program Materials page.

A randomized controlled trial conducted in the Mississippi Delta of Arkansas assessed the impact of three conditions: the intervention, a comparison, and an attention control on CRC screening. Participants were recruited from two medically underserved counties, Mississippi and St. Francis. Those who were aged 50-75, were uninsured, resided locally, and were due for CRC screening were eligible to participate.

All three groups received a 45-minute presentation. The intervention group (n=110) received CCESP: Empowering Communities for Life. The comparison group (n=103) received a presentation on CRC by a community lay health worker, an FOBT kit, a brochure conveying the presentation content, and a card mailed 2 weeks after the intervention with a stamped, return address envelope. The presentation provided incidence, mortality, and screening data relevant to the local area; screening guidelines; individualized CRC risk feedback; and personal stories. The control group (n=117) received a presentation by an AHP on cardiovascular disease, including national data on cardiovascular disease incidence and mortality, risk factors, screening, and monitoring risk. These participants also received FOBT test kits but with no instruction.

Among study participants, 70% were African American, 14% were White, 1% were "other," and 15% did not disclose their race/ethnicity.

The primary outcome was return of the FOBT screening kit, which was measured at two time points: 60 days or less and greater than 60 days. At both points, pairwise comparisons were completed for each intervention arm.

• Up to 60 days after the intervention, participants in the intervention group had higher screening rates than those in the comparison group (p=.0422) and control group (p=.0099). After 60 days, intervention group participants had higher screening rates than control group participants (p=.0029).