Colorectal cancer (CRC) is one of the most common, deadly, and preventable forms of cancer. In South Carolina (SC), CRC incidence and mortality are higher than the national average and elevated among African Americans (AAs). AA men have an 8% higher incidence rate and AA women have a 16% higher rate than their European-American (EA) counterparts. 2 Mortality rates exhibit an even more striking trend with AA men having a 46% higher mortality rate than EA men. Surviving CRC depends critically on the stage at which it is diagnosed. When CRC is detected at an early, localized stage, the 5-year survival is 90%; however, only 39% of CRC cases are diagnosed at this stage, mostly due to low rates of screening, essentially resulting in upstaging of disease, and a majority of South Carolinians (56.7%) are diagnosed at advanced stages of CRC. Focused, coordinated efforts to promote prevention and down-staging of disease through CRC screening (particularly colonoscopy), such as through patient and community navigation, do not currently exist and are needed to address this public health problem and racial health disparity in SC. Community navigators can increase awareness and knowledge of CRC and facilitate access to and provide support for CRC screening by working with community assets, including community organizations, businesses, and churches, to reach individuals. A community navigation program is particularly relevant to reducing the burden of CRC among South Carolinians because CRC screening can result in decreased disease incidence and CRC screening has unique characteristics and requirements as compared to other cancer screening tests.

CRC Work Group Update - Chaired By Dr. Frank Berger
In 2006, the South Carolina Cancer Alliance established a Colorectal Cancer Workgroup. This workgroup actively participated during the plannin of a Dialogue for Action leadership summit, which took place in August of 2007. Having completed the Dialogue, the Colorectal Cancer workgroup is focusing its efforts to develop novel, creative, and high-impact action plans to address the key points discussed at the conference. (Summary Report: SC Dialogue for Action 2007) This collaborative group has grown to over 40 members statewide; charged with implementation, using the finding from the DFA's Summary Report to help guide and direct both statewide initiatives and local strategies. The workgroup has two subcomittees: 1. The messaging subcommitte 2. Tthe screening subcommittee.

CRC Screening Subcommittee, Chaired By Dr. Jim Burch
The South Carolina Cancer Alliance Colorectal Cancer Work Group Screening Subcommittee is in the process of developing a plan for a statewide colorectal cancer screening program entitled SCOPE SC. Members of the Screening Subcommittee have consulted with the five Colorectal Cancer Screening Demonstration Programs that are currently funded by the Centers for Disease Control in addition to other states in the US who have initiated statewide screening programs. The Screening Subcommittee is working closely with our partners with the South Carolina Department of Health and Environmental Control (SCDHEC) as SCDHEC prepares for potential state funding to support a colorectal cancer screening program for our citizens who are uninsured.

Through the collaborative efforts we have been able to achieve the following accomplishments in South Carolina:

• August 2006 – SC Medicaid Program’s 45,000 enrollees who are 50 years and older and now eligible for screening colonoscopy
• January 2007 – SC State Employee Health Plan’s 95,000 members who are 50 years or older are now eligible for colonoscopy screening
• February 2008 – BCBSSC 75,000 fully insured enrollees who are 50 years and older are now covered for colonoscopy screening
• May of 2008, the Center for Colon Cancer Research and the South Carolina Gastroenterology Assocation was awarded $100,000 by BCBS to implement a CRC screening program. This two year program will screen uninsured residents in Abbeville, Anderson, Laurens and Greenwood counties. The program will reach individuals who are aged 50 and older for whom CRC screening is recommended and provide assistance with obtaining CRC screening.

CRC Messaging Subcommittee, Chaired by Anjelica Q. Davis, MPPA
The American Cancer Society, The Center for Colon Cancer Research at the University of South Carolina, the Outdoor Advertising Association of South Carolina, the South Carolina Cancer Alliance (Messaing Subcommittee), the South Carolina Department of Health and Environmental Control and the South Carolina Gastroenterology Association collaborated on a colorectal cancer awareness campaign during March 2007 & 2008. The team developed a campaign throughout South Carolina to promote awareness about colorectal cancer. The billboards (featuring local survivors and advocates) were placed in Anderson, Charleston, Columbia, Florence, Georgetown, Greenville, Greenwood, Hilton Head, Myrtle Beach, Rock Hill, Spartanburg, Sumter in addition to billboards in Barnwell, Cherokee, Clarendon, Dillon and Dorchester counties. In 2007, 32 billboards were placed throughout South Carolina. During the 2008 awareness campaign over 114 billboards were viewed throughout South Carolina.

In addition to outdoor advertising, the Messaging subcommittee is working closely with FB Enterprises, South Carolina Department of Health and Environmental Control, the American Cancer Society, and the South Carolina Gastroenterology Association to develop and implement the CRC prevention campaign. Entitled The Shop Talk Movement, the campaign is focused educating and training African American stylists and barbers on colon cancer prevention. Through this innovative awareness campaign, clients will receive information from their barbers or stylists about the prevention and early detection of colorectal cancer and resources to link them to screening opportunities. (Recent article featured in Hair, etc March 2008)

CRC EVENTS:
The 8 th Annual Colorectal Cancer Awareness Walk was once again coordinated by the Palmetto Health Alliance on March 8, 2008. In cold and windy conditions, over 300 came out to walk; bringing attention and awareness to this preventable disease.

The 2 nd Unmasking Colon Cancer Ball was held on March 1, 2008 in Columbia, SC. Over 300 people attended this spectacular event and over $65,000 was raised to help support colorectal cancer: research, awareness and screening programs in South Carolina.

James E. Clyburn Health Disparities Lecture Series on Friday, April 25, 2008
The following are abstracts accepted for poster presentation at the poster session, "Forging Solutions through Research and Practice" at USC - Public Health Research Center:

Xirasagar, Sudha et al. Expanding African Americans' Access to Screening Colonoscopies: How effective and safe are Primary Care Physician (PCP)-Performed Procedures.

Xirasagar, Sudha et al. Screening Colonoscopy Performance Among Patients of African American Primary Care Physicians Trained in Colonoscopy Performance in South Carolina.

Wright, Marcie S. et al. Assessing Psychosocial, Cultural, and System-Level Barriers to Colorectal Cancer Screening Among African-Americans.

Berger, Frank et al. Shop Talk Movement: An evidence-based approach to increase colorectal cancer awareness and screening in beauty salons and barbershops in South Carolina.

Adams, Swann Arp et al. A Pilot Investigation of Ethnic Disparities in Patient-Initiated Premature Treatment Discontinuation Among Colon Cancer Patient. Presented 25