Innovative State Program Reduces Colorectal Cancer Disparities, Mortality Rates Among African American Patients

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Eliminating disparities in cancer screening, diagnosis, treatment, and mortality is an essential step toward improved health outcomes for all Americans with cancer.

—Stephen S. Grubbs, MD

A study analyzing the impact of the Delaware Cancer Consortium, the state’s cancer control program, reports a 41% reduction in colorectal mortality rates for African Americans.1 The recently published study provided analysis on a novel design and approach used to eliminate colorectal cancer disparities for the first time by a state cancer control program.

The findings show the percentage of colorectal cancer cases diagnosed at advanced and regional stages among African Americans declined from 79% to 40%. Overall incidence rates per 100,000 also declined from 67% to 58% for African Americans and whites, respectively, in 2002 to 45% for both in 2009.

“We can achieve tremendous progress when governments, insurers, and providers work together to reduce disparities,” said Stephen S. Grubbs, MD, lead coauthor of the study and oncologist at Christiana Care’s Helen F. Graham Cancer Center. “Eliminating disparities in cancer screening, diagnosis, treatment, and mortality is an essential step toward improved health outcomes for all Americans with cancer,” he said.

Statewide Colorectal Cancer Screening Program

The Delaware Cancer Consortium, designed to create a comprehensive statewide colorectal cancer screening program, included insurance coverage for screening, the use of nurse navigators to conduct screening outreach and recruitment, and ultimately treatment for those with a colorectal cancer diagnosis. With funding from the state legislature, Delaware Governor Ruth Ann Minner developed the program in 2003. Delaware law tasked the Consortium with coordinating cancer prevention and control activities in the state.

Members of the Consortium include representatives from the Delaware House of Representatives and State Senate, the Governor’s Office, the Secretary of the Department of Health and Social Services and physicians from cancer centers.

State’s Program Could Serve as Model for Nation

“The results we achieved in Delaware can be replicated across the country,” said Congressman John Carney, a member of the Cancer Consortium’s Advisory Committee and former Chair of its Disparities Committee. “Forming strong partnerships, ensuring access to care for all, and focusing on prevention is what really makes the difference,” he said.

Using colonoscopy as the preferred screening method, the Delaware Cancer Consortium provided reimbursement for screening starting in 2002 for any uninsured Delaware resident with an income of up to 650% of the federal poverty level. Other residents were eligible for coverage through Medicaid, Medicare and private insurers. From its inception through 2011, the program has provided over 5,000 colorectal cancer screenings.

A companion program, the Delaware Cancer Treatment program, was developed to cover the costs of cancer care for 2 years for the uninsured who are newly diagnosed. Combined, the Delaware Cancer Consortium and the Delaware Cancer Treatment program provided Delaware residents with universal colorectal cancer screening and treatment.

Equal Care and Access Mitigate Disparities

“The Consortium demonstrated that racial disparities can be mitigated by providing equal care and equal access,” said Blase N. Polite, MD, MPP, lead coauthor and oncologist at University of Chicago Medical Center. “They were able to identify cancers at an earlier stage and likely found and removed precancerous lesions before they could become cancer.”

The authors also note the long-term financial savings produced through the state program. In the United States, annual costs of colorectal cancer detection and treatment are estimated to total $14 billion. While the Delaware Cancer Consortium screening costs approximately $1 million annually, the increase in screening in Delaware through its expanded program saved approximately $8.5 million annually from reduced incidence of cancers that would have required aggressive therapy.

These annual savings more than offset the $6 million annual cost of the Cancer Treatment Program, which provided universal treatment for all cancers. ■

Disclosure: For disclosure information of all of the contributing authors, see the original report at


1. Grubbs SS, Polite BN, Carney Jr J, et al: Eliminating racial disparities in colorectal cancer in the real world: It took a village. J Clin Oncol. April 15, 2013 (early release online).