The last frontier: innovative efforts to reduce colorectal cancer disparities among the remote Alaska Native population

Background: The Alaska Native (AN) population experiences twice the incidence and mortality of colorectal cancer (CRC) as does the U.S. white population. CRC screening allows early detection and prevention of cancer. Objective: We describe pilot projects conducted from 2005 to 2010 to increase CRC screening rates among AN populations living in rural and remote Alaska. Design: Projects included training rural mid-level providers in flexible sigmoidoscopy, provision of itinerant endoscopy services at rural tribal health facilities, the creation and use of a CRC first-degree relative database to identify and screen individuals at increased risk, and support and implementation of screening navigator services. Setting: Alaska Tribal Health System. Patients: AN population. Interventions: Itinerant endoscopy, patient navigation. Main Outcome Measurements: AN patients screened for CRC, colonoscopy quality measures. Results: As a result of these ongoing efforts, statewide AN CRC screening rates increased from 29% in 2000 to 41% in 2005 before the initiation of these projects and increased to 55% in 2010. The provision of itinerant CRC screening clinics increased rural screening rates, as did outreach to average-risk and increased-risk (family history) ANs by patient navigators. However, health care system barriers were identified as major obstacles to screening completion, even in the presence of dedicated patient navigators. Limitations: Continuing challenges include geography, limited health system capacity, high staff turnover, and difficulty getting patients to screening appointments. Conclusions: The projects described here aimed to increase CRC screening rates in an innovative and sustainable fashion. The issues and solutions described may provide insight for others working to increase screening rates among geographically dispersed and diverse populations. (Gastrointest Endosc 2012;75:474-80.)