NCI selects UT Southwestern, Parkland to improve colorectal cancer screening

Oct 10 2011

The National Cancer Institute (NCI) has selected UT Southwestern Medical Center and Parkland Health & Hospital System as a national site to improve screening for colorectal cancer, the nation's No. 3 cancer killer.

The five-year, $6.3 million NCI grant establishes the Parkland-UT Southwestern PROSPR Center as part of a three-site network for colorectal cancer screening. The UT Southwestern-Parkland partnership, which hopes to reach more than 32,000 Dallas County residents age 50 and older, is unique because its screening effort will focus on people who lack insurance or are underinsured.

The NCI's PROSPR designation stands for Population-based Research Optimizing Screening through Personal Regimens. Other colorectal cancer PROSPR sites are in California and Washington. In all, the NCI is establishing nine to 12 PROSPR sites around the country to examine and improve screening processes for colorectal, breast and cervical cancers.

Leading the Dallas core are two UT Southwestern investigators: Dr. Celette Sugg Skinner, associate director of the Harold C. Simmons Cancer Center, and Dr. Ethan Halm, chief of general internal medicine and professor of internal medicine and clinical sciences. Their goal is twofold: to optimize colon cancer screening among Dallas residents and to develop a model for screening that can be used by public hospitals nationwide.

"The earlier we can detect cancers, the better we are able to treat them," said Dr. Skinner, a professor of clinical sciences at UT Southwestern. "Late-stage cancer is harder to treat, and there is no reason why people with less insurance should bear a disproportionate burden of cancer."

There are more than 140,000 new cases of colorectal cancer in the U.S. each year and nearly 50,000 deaths. But the disease, like breast and cervical cancer, can often be cured if caught early.

"Screening for colon cancer has the potential to virtually eliminate colon cancer mortality," said Dr. James K.V. Willson, director of the Simmons Cancer Center.

The project represents a partnership among Parkland, UT Southwestern, the Texas Cancer Registry, the UT School of Public Health in Dallas and the Simmons Cancer Center, which is the only NCI-designated cancer center in North Texas. The joint venture also illustrates the decades-long commitment of UT Southwestern and Parkland to bring together world-renowned research expertise with outstanding clinical care to uninsured and underinsured patients.

Colorectal cancer has higher rates of occurrence and mortality among low-income patients, often because they lack access to proper screening, Dr. Skinner said. The safety net setting of UT Southwestern and Parkland is unique compared to other PROSPR sites, which serve populations that tend to have better insurance coverage.

"There is a known disparity in morbidity related to colorectal cancer that is evident along racial, ethnic and socioeconomic groups," said Dr. John Jay Shannon, Parkland's executive vice president for medical affairs and chief medical officer. "The methodologies we will be exploring in the PROSPR grant are an attempt to apply innovative thinking and behavioral sciences to bridging that disparity."

One of the key factors in securing the NCI grant is Parkland's comprehensive electronic medical records system and its Center for Clinical Innovation, which will serve as the information technology backbone of the collaboration with UT Southwestern, Dr. Halm said.

"With the help of Parkland, we are one of the few places in the country that can conduct this sort of comprehensive cancer screening program for a safety net population," he said.

The grant will help expand and refine three interlocking research projects already under way at UT Southwestern. The first involves a touch-screen computer program used in clinics to ask patients questions in English or Spanish about their personal risk factors and family history, using the responses to generate a personalized screening regimen for colon cancer for each patient.

"People will get personalized recommendations to make sure they get the right care for them," Dr. Halm said. "We especially want to make sure that patients at high risk for colorectal cancer get the enhanced screening they need."

The second project will compare the cost and effectiveness of various outreach strategies aimed at people who are in need of cancer screening. In the third project, investigators will attempt to determine best practices in both the primary care clinics and across the entire Parkland network that most effectively promote screening.

"We have an incredible safety net system that is among the best in the country, and leaders at Parkland who are deeply committed to providing screening and follow-up for people in the community," Dr. Skinner said. "We think the Parkland-UT Southwestern PROSPR Center will make an important dent in colorectal cancer in Dallas County."

Source: UT Southwestern Medical Center