Both colorectal (CRC) and cervical cancers are major causes of death in the US; colorectal cancer is the third leading cause of cancer deaths among men and women in Michigan; while deaths from cervical cancer in Michigan have been declining, in 2019, the ACS estimated 360 new cases, despite an effective vaccine against HPV, the primary cause of cervical cancer. Both cancers have effective screening approaches (colonoscopy, the gold standard for colorectal cancer), and clinician-directed speculum exam (the gold standard for cervical cancer). Follow-up after a positive screening test is key to survival from both cancers; there is consistent evidence that time to follow-up diagnostic testing after a positive screen is suboptimal, and unequally distributed. Thus, both cancers are still likely to be diagnosed after symptoms develop. The initial diagnosis is most likely to take place in the primary care setting. With both types of cancer, residents in rural areas experience a higher incidence of these cancers than urban residents. Multi-level screening approaches—with individuals, clinical teams, and health care institutions—have been found effective in increasing screening for both cancers, but are rarely implemented conjointly for CRC and cervical cancer screening in the primary care setting.
The goal of the project is to advance understanding of the multi-level healthcare policy, institution, provider team, and patient factors that contribute to colorectal and cervical cancer-related health disparities in incidence and mortality among rural populations, and the implications of these inequities. One of our specific aims is to recruit 40 primary care sites from networks serving rural patients, yielding letters of support or MOU’s for the long-term conduct of long-term research within these settings. The project, a planned center grant application (P01), will contain four novel R01’s, one focused on practice-level shared decision-making and patient navigation interventions, another, implementing an SMS-based program at the healthcare and patient levels, a third, on self-screening for cervical cancer at the provider workflow and patient levels, and a fourth, on disseminating multilevel HPV vaccination approaches to rural primary care practices.