Colonoscopy on the rise in New York City, closing ethnicity gap

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NYC leads the pack in colonoscopies. Source: Sanofi-Aventis  

The number of New York City residents age 50 and older who have undergone a colonoscopy almost doubled in five years, according to Thomas R. Frieden, MD, the city’s health commissioner.

The results, which were based on a survey conducted by the city from 2003 through 2007, showed that 1.25 million people were screened in 2007, up from 826,000 in 2003, with the biggest rates of increase in minority communities, reported the New York Times (NY Times).

The increased screening rate is credited to the work of a group of physicians, insurers, union workers, hospital administrators and city health officials called the New York Citywide Colon Cancer Control Coalition (C5), which emphasizes a single, simple recommendation: That a colonoscopy should be performed once every 10 years for anyone 50 or older without a family history or other heightened risk factor for colon cancer, and more often for those who have those risk factors.

According to the NY Times, C5 has introduced a number of innovations aimed at ensuring that that recommendation is followed more often, ranging from high-tech to high-touch. Much of the buzz is about the use of “patient navigators,” people who sometimes call people aged 50 and older to encourage them to make an appointment. They also hold patients’ hands as they move through the steps of a proper exam and follow-up.

Freiden said the navigator program, which has now expanded to 10 city-run hospitals and six other hospitals, is credited with facilitating 30,758 colonoscopies from 2003 through 2007, resulting in “hundreds of lives saved.”

“In my career, three things have surprised me: how quickly tuberculosis cases came down in New York City, how quickly tobacco use came down in New York City, and how quickly colon cancer screening went up in New York City,” Frieden said. “Even more surprising is the closing of the race and ethnicity gap.”

According to demographic figures provided by the city, only about 35 percent of black New Yorkers 50 or older had undergone a colonoscopy as of 2003, compared with 38 percent of Hispanics and 48 percent of whites. In contrast, by 2007, the screening rates for blacks had climbed to 64 percent, slightly higher than the 63.3 percent rate for Hispanics and 62.2 percent for whites. The one ethnic group still significantly trailing was Asians, despite having more than doubled their rate, from 25 percent in 2003 to 53.6 percent in 2007, reported the NY Times.

As great as the progress in raising screening rates has been, coalition members are shooting higher: to have 80 percent of New Yorkers age 50 or older having undergone a colonoscopy by 2011.

According to the NY Times, the results so far appear to be exceeding those of other states. According to the Centers for Disease Control and Prevention, rates of screening with either colonoscopy or sigmoidoscopy, a less extensive examination of the colon, ranged in 2006 from a low of 40.5 percent of people over 50 in Oklahoma to a high of 60.9 percent in Delaware.