UK Receives $3.75 Million For Community-Based Rural Cancer Prevention

Researchers at the University of Kentucky (UK) Rural Cancer Prevention Center (RCPC) have just received a $3.75 million, five-year grant renewal from the Centers for Disease Control and Prevention (CDC) to promote screening and prevent death from colorectal cancer in Central Appalachia and other rural areas.

At 44, Sherry Payne was uncommonly young to be diagnosed with colon cancer. She was also too young to have started regular colon cancer screenings, so by the time she developed symptoms and went to the doctor, the disease had already progressed to Stage 3. It was 1998, and she was given two years to live.

 "As you can see, I did not take that seriously and I am still here," Payne says today.

More than 15 years after her diagnosis, Payne is cancer-free and dedicates her life to cancer prevention in Eastern Kentucky. A Knox County resident, she works as a community health advisor for the American Cancer Society, improving communities' health by encouraging men and women to practice early detection of colon, breast, and cervical cancer while it is in the most treatable stages.

Her passion has also led her to work with researchers at the University of Kentucky (UK) Rural Cancer Prevention Center (RCPC).

The UK RCPC, housed at the UK College of Public Health, is a planned collaboration of community members, public health professionals, and researchers that conduct applied prevention research to reduce health disparities associated with cervical cancer, breast cancer, and colorectal cancer among residents of the Kentucky River Area Development District (KRADD). The UK RCPC is one of just 26 CDC-funded Prevention Research Centers (PRC) in the country, and the only one focused on developing and disseminating strategies for rural cancer prevention.

The central mission of the PRC program is to support community-based, participatory prevention research to drive major community changes that can prevent and control chronic diseases. In line with this mission, the work of the UK RCPC is guided by a Community Advisory Board (CAB) that sets research and service priorities. Payne serves as one of 13 members on the RCPC board, along with other health care professionals, administrators, and educators; business, media, and government representatives; and family members of cancer survivors.

In fact, it was the CAB that directed the RCPC to dedicate its current five years of funding to colorectal cancer screening and prevention. In the previous five years of funding, the RCPC focused on human papillomavirus (HPV) vaccination and cervical cancer screening at the direction of the CAB.

 "This is where we need to be focusing our attention — in the response to needs indicated by representatives of the community," says Dr. Richard Crosby, director of the RCPC and professor and chair of the department of health behavior in the UK College of Public Health.

The data supports the decision of the CAB to focus on colorectal cancer: Not only does Kentucky have the nation's highest rates of cancer incidence and death, more people from Appalachian Kentucky die from colorectal cancer than those diagnosed with colorectal cancer in other regions of the state.

While colorectal cancer is usually a slow growing cancer that has a much higher survival rate if detected and treated early, delayed or no screening can lead to late-stage diagnosis when the chance of survival is significantly lower.  For people living in rural areas like Appalachia, where they may be geographically and socially isolated from health care providers, a major problem is a lack of access to recommended screenings for colorectal cancer. This is especially true in the KRADD counties, all eight of which are classified as Healthcare Professional Shortage Areas by the U.S. Health Services and Resources Administration.

The counties in which the RCPC works also experience severe economic distress. Collectively, the communities that compose the KRADD represent one of the lowest income regions in the country, and the three poorest counties in the U.S.--Breathitt, Lee, and Owsley--are all located in the KRADD.

 "This is about serving Kentuckians, and we are targeting an area of the rural Appalachia that has extremely high rates of colorectal cancer morbidity," says Crosby. "We're focusing on a project that engages people at a point when we can still do something to prevent their death."

Over the next five years, Crosby and the RCPC team will develop, implement, and disseminate an intervention to promote a simple, at-home screening test called FIT (fecal immunochemical test) that could drastically increase rates of annual colorectal cancer screening in rural areas. FIT tests use a new technology for detecting antibodies to polyps (potentially cancerous clumps of cells) in the stool. With FIT, you simply brush the surface of the stool with a brush included in the kit and then dab the end of the brush onto the test card, which is mailed off for testing. The test is quick, painless, low-cost, and doesn't require a trip to the doctor -- still somewhat unpleasant, but likely preferable to an unnecessary colonoscopy or, of course, cancer. In the case of a positive FIT test result, RCPC staff will help individuals navigate the healthcare system to get further testing and treatment as needed.

Their upcoming work will build upon the successes of their previous round of funding, which focused on cervical cancer prevention and screening. The cervical cancer prevention program developed by the RCPC is now being used in 18 local Kentucky health departments and has also been adapted for use in 30 local health departments in North Carolina.  Over the next five years, Crosby and the RCPC team will leverage the key partnerships that have supported their previous success, not only working with the CAB but also with local health departments, the Kentucky Department of Public Health, and further academic and medical resources on campus like the Markey Cancer Center, the Center for Clinical and Translational Science, the College of Communication and Information, the National Coordinating Center for Public Health Practice-Based Research Networks, and the Kentucky Cancer Registry.

Crosby says the work of the RCPC goes beyond the "bench to bedside" goal of moving laboratory discoveries into new applications, such as treatments or devices, for humans.

"This is 'bench to community' work — we want to keep people from needing bedside care at all," he says.

 Payne is similarly hopeful that efforts of the RCPC to prevent colorectal cancer in Appalachia will spare others the experience she endured, and prevent deaths from treatable cancers.

"I am so grateful to be part of the RCPC project," she says.   "While under treatment, I saw too many colon cancer patients passing away when they could have avoided late stage cancer if they had participated in cancer screenings."