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J Natl Cancer Inst. 2014 Apr;106(4):dju032. doi: 10.1093/jnci/dju032. Epub 2014 Mar 28.

Challenges and possible solutions to colorectal cancer screening for the underserved.

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Affiliations of authors: Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA (SG); University of California San Diego Moores Cancer Center, San Diego, CA (SG, MEM); Division of Gastroenterology, Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL (DAS, ARD); Department of Family Medicine and Community Health at the Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics, Leonard Davis Institute for Health Economics, and the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA (CAD); Southern California Kaiser Permanente Group, San Diego, CA (DAS); San Francisco General Hospital; University of California San Francisco, San Francisco, CA (LD, MS, JA); Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI (BJE); Division of Gastroenterology, Department of Medicine, Howard University, Washington, DC (AOL); MD Incorporated, Encinitas, CA (JM); Kaiser Northern California Division of Research, Oakland, CA (JA); Alameda County Medical Center, Oakland, CA (TB); University of Texas Southwestern Medical School, Dallas, TX (ZG); Group Health Research Institute, Seattle, WA (BBG); Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (SHI); Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA (MEM).


Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. CRC incidence and mortality can be reduced through screening. However, in the United States, screening participation remains suboptimal, particularly among underserved populations such as the uninsured, recent immigrants, and racial/ethnic minority groups. Increasing screening rates among underserved populations will reduce the US burden of CRC. In this commentary focusing on underserved populations, we highlight the public health impact of CRC screening, list key challenges to screening the underserved, and review promising approaches to boost screening rates. We identify four key policy and research priorities to increase screening among underserved populations: 1) actively promote the message, "the best test is the one that gets done"; 2) develop and implement methods to identify unscreened individuals within underserved population groups for screening interventions; 3) develop and implement approaches for organized screening delivery; and 4) fund and enhance programs and policies that provide access to screening, diagnostic follow-up, and CRC treatment for underserved populations. This commentary represents the consensus of a diverse group of experts in cancer control and prevention, epidemiology, gastroenterology, and primary care from across the country who formed the Coalition to Boost Screening among the Underserved in the United States. The group was organized and held its first annual working group meeting in conjunction with the World Endoscopy Organization's annual Colorectal Cancer Screening Committee meeting during Digestive Disease Week 2012 in San Diego, California.

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