Thanks in part to the leadership of Memorial Sloan Kettering gastroenterologist Sidney Winawer, an ambitious program to increase screening for colorectal cancer in New York City has had dramatic results. The massive effort, known as the C5 initiative, has boosted the city’s routine colonoscopy rate to record-high levels and has eliminated screening disparities among racial and ethnic groups.
The C5 initiative — short for Citywide Colon Cancer Control Coalition — launched in 2003 with Dr. Winawer as co-chair of its advisory and steering committees. Thomas Frieden, then commissioner of the New York Department of Health and Mental Hygiene (DOHMH), spearheaded the program after naming colonoscopy a top health priority for New York City.
In the dozen years since, the colonoscopy rate in the city has skyrocketed from 42 percent in 2003 to nearly 70 percent today, thanks to a citywide network of physicians, hospitals, professional organizations, health departments, advocacy groups, and others who worked doggedly to promote colonoscopy among people age 50 and older. Additionally, blacks, Hispanics, and Asians in New York City are now screened as often as whites — significantly higher than national rates.
“It seemed to be a monumental task, but I’m basically an optimist, and many people I work with are also optimists,” says Dr. Winawer, who has enjoyed a half-century career distinguished by wide-ranging efforts to increase colorectal cancer screening. “We’re used to rolling up our sleeves and fulfilling our objectives, and that’s what happened. With the optimism and energy so many people have brought to this, I don’t think we ever questioned our success.”
Dr. Winawer and his C5 colleagues report on the public health effort in the November 23 issue of the journal Cancer.
Multiple Tactics, Single-Minded Commitment
Colonoscopy is considered the gold standard screening exam for colorectal cancer. A 2012 study led by MSK biostatistician Ann G. Zauber and Dr. Winawer, which was published in the New England Journal of Medicine, showed that removing polyps by colonoscopy not only stops colorectal cancer from developing but also prevents deaths from the disease.
Learn more about who should get screened for colorectal cancer depending on age and family medical history.
With 2002 estimates indicating that more than 1,500 New York City residents die of colorectal cancer each year and that 60 percent of at-risk New Yorkers were unscreened, hundreds of C5 volunteers joined forces with DOHMH employees to turn the tide through a combination of advocacy, policy, and resource-development programs.
Key tactics included:
- free colonoscopies for about 20,000 uninsured patients
- public education campaigns in English and Spanish
- educational outreach and site visits to healthcare providers
- patient navigator programs to usher people through the colonoscopy process
- a direct referral program eliminating unnecessary pre-colonoscopy consultations for eligible patients
- colonoscopy quality-control monitoring
Annual daylong summits involving all C5 participants kept the coalition’s accomplishments on track and supplemented daily communication, helping solve problems and avoiding wasted efforts, Dr. Winawer explains.
“There’s a lot of synergistic communication always going on between committees and members, with constant emails and phone calls,” he says. “In the world we live in, it’s so encouraging and gratifying to find the people we’ve had at C5. They step up to the plate and give their time, energy, and wisdom because they feel it’s the right thing to do.”Back to top
Model Urban Program Inspires Others
Given his career-long contributions to the field, Dr. Winawer’s pivotal role in C5 was a natural fit. He has headed the World Health Organization’s Collaborating Center for the Prevention of Colorectal Cancer to establish prevention guidelines for the disease. He’s also currently co-chair of the International Digestive Cancer Alliance, which initiated a worldwide campaign to increase awareness and prevention of digestive cancers.
The American Cancer Society recently awarded Dr. Winawer its Medal of Honor in recognition of his lifetime contributions to colorectal cancer screening and prevention.
“I’m absolutely delighted to see my interests operationalized and incorporated into the New York City program — and for them to be so successful,” he notes. “I’m also delighted that we’ve become a model of an urban program that people around the world can use to develop similar types of programs.”
While Dr. Winawer no longer co-chairs the C5 steering committee, he remains active in its ongoing efforts. Future goals include reaching an 80 percent screening colonoscopy rate among people 50 and older by 2018, a benchmark shared by more than 250 public, private, and nonprofit organizations around the country.
Dr. Winawer, who has been on MSK’s staff since 1968, feels that MSK’s support and encouragement of his work with C5 was pivotal.
“I think the C5 effort tells the world that Memorial Sloan Kettering is very much interested in the prevention of cancer as well as treatment,” he says. “It also demonstrates that MSK faculty are in leadership roles in these efforts, not only in New York City but also nationally and internationally.Back to top