The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #56553

G. Ethan Feldman, MD, MPH, MBA, MHA, Director of Cancer Prevention & Control, New York City Department of Health & Mental Hygiene, 2 Lafayette Street, 20th Floor, CN 46, New York, NY 10007, 212.676.2157, gfeldman@health.nyc.gov

Objectives. Screening adults 50 and older for colon cancer is a proven, cost-effective public health intervention that could prevent thousands of premature deaths. Citywide data show that half of eligible NYC residents have had a flexible sigmoidoscopy or colonoscopy, while only 25% of state residents reported a recent fecal occult blood test. These tests screen for colon cancer. Recent data show that NYC physicians fail to refer eligible patients for screening due to confusion over screening guidelines that offer multiple testing options for colon cancer. We thus sought to simplify, or tailor, current guidelines. Methods. We convened a panel of five NYC expert physicians to tailor current colon screening guidelines. The panel reaffirmed the validity of current guidelines. Tailoring was intended to adapt current guidelines into a “best practice” model for NYC. Results. The panel recommended the following colon screening guidelines, based on both direct and indirect evidence: For higher resource settings, colonoscopy every 10 years. For lower resource settings, fecal occult blood testing every year. Colonoscopy was preferred because it assesses the entire colon, can screen, diagnose, and treat, and because it is generally available in higher resource areas. Conclusions. Public health simplification, or tailoring, of valid guidelines, may enable more patients to undergo the desired intervention. This hypothesis will be tested within the framework of an upcoming colon cancer awareness campaign. Clinicians should feel free to use other screening options, though the NYC DOHMH campaign will promote its own colonoscopy-based, tailored guidelines.

Learning Objectives:

• List three reasons for tailoring cancer screening guidelines.
• Describe the process a health department would implement to develop tailored guidelines.
• Articulate and discuss NYC DOHMH's newly tailored colon cancer screening guidelines.

Keywords: Cancer Screening, Practice Guidelines

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.