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CENTERPIECE
 






In the Community, a Boost for Colon Cancer Screening
Johns Hopkins is at the forefront of community-based prevention


Jean Ford on Eager Street, near his office's headquarters at East Baltimore Medical Center. "We wanted to be right in the midst of the community."

Since 2001, funds have been available to screen low-income residents of Baltimore City for breast, oral, prostate and cervical cancers. Repeated cuts in the state budget earlier in this decade, however, precluded funding for colorectal cancer screening, even though deaths from colon cancer can be prevented through testing, and the colon-cancer death rate is significantly higher in Baltimore than it is nationally.

So several years ago, local organizations, hospitals and cancer support groups, all led by a representative from the American Cancer Society, came together to find ways to promote colon cancer screening among city residents. This group came to be known as the Baltimore City Colorectal Cancer Collaborative.

Along with the Maryland Department of Health and Mental Hygiene, it applied for and received last September a three-year grant from the federal Centers for Disease Control. The award will make colonoscopy available each year to 300 underserved Baltimoreans. “Our main concern has been the city’s uninsured and underinsured, for they are the ones who do not have access to colon cancer screening,” says Jean Ford, director of Community Programs and Research at the Kimmel Cancer Center.

Ford, a physician with faculty appointments in the Bloomberg School of Public Health and School of Medicine, joined forces with Tony Kalloo, director of gastroenterology, and Michael Choti, director of the Colon Cancer Center, to help plan the Collaborative and lead its Hopkins component.

Hopkins Hospital will be a screening site, along with Harbor, Sinai, St. Agnes and Union Memorial hospitals. “Colon-oscopy will be the primary screening modality,” says Kalloo. “We believe this is the most efficient way to diagnose colon cancer.”

But, says Ford, costs are likely to exceed what has already been provided by the CDC. In the first place, colonoscopy itself is relatively expensive. Secondly, says Ford, “Out of the 300 colonoscopies a year, two to five cases of cancer will be detected that will require treatment, such as surgery and chemotherapy. Those cases wind up being very costly.”

The group plans to apply for more funding to pay for follow-up case management, diagnosis and treatment, and, Ford says, each hospital will be expected to make some in-kind contribution to supplement the CDC grant.

“The available resources are limited, but the program’s impact will be extensive,” says Choti. “It will raise awareness about colorectal cancer screening, not only among the underserved, but also across Baltimore.”

Johns Hopkins is expected to be a key participant in the collaborative, thanks in part to its experience in the Baltimore City Cancer Plan. The BCCP, directed by Ford, has engaged numerous local organizations in carrying out cancer-related public health initiatives. It is supported through the Maryland Cigarette Restitution Fund, which was created from the multibillion-dollar national settlement won in 1998 from the major cigarette manufacturers.

BCCP programs are led by Johns Hopkins and the University of Maryland. The Hopkins component initially focused on prostate cancer screening and then, with a gift from the Avon Foundation, expanded its programs to include breast cancer. Working with community partners, Johns Hopkins has provided no-cost screening to 2,300 men for prostate cancer since 2001 and to more than 200 women for breast cancer since 2003.

Coordinating this work is Jin Lee, community programs manager in the Kimmel Cancer Center. Her team works in and among local churches, community organizations and health fairs.

For the colon cancer project, Lee will be able to tap into this same local network. Many already screened for prostate and breast cancer fit the eligibility criteria for colon cancer testing in that they are 50 or older and have no access to screening because they are uninsured or underinsured. “We already have a waiting list,” says Lee.

The University of Maryland is not participating in the new colon cancer screening program. That leaves Hopkins as the only major academic medical center in the consortium. “We’ve been at the table from the beginning,” says Ford, “and we believe that our experience in running a large-scale cancer-screening program and following medically underserved populations in the Baltimore City Cancer Plan is highly relevant to the Collaborative.”

The Baltimore City Colorectal Cancer Collaborative rolls out this spring.

Anne Bennett Swingle

 

 

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