Initiating Colorectal Cancer Screening in Unscreened Individuals 45 to 54

PROJECT SUMMARY Colorectal cancer (CRC) is the third leading cause of cancer death in Black men and women, with mortality rates that are 44% and 31% higher in Black men and women compared to White men and women respectively. Approximately 40% of the difference in incidence and 20% of the difference in mortality are due to disparities in screening. Community health centers (CHCs) in

urban areas serve a large share of racial and ethnic minorities and have lower screening rates (41.9%) compared to the general population (69.7%). Low screening rates, and rising incidence and mortality from CRC in adults at younger ages also suggests that focusing on increasing screening uptake from 45 to 54 is a critical target. This career development award leverages an

existing partnership with Codman Square Health Center, a predominantly Black CHC in inner- city Boston, to develop implementation strategies with a focus on equity to initiate CRC screening in previously unscreened individuals age 45 to 54 at CSHC. Dr. Adjoa Anyane- Yeboa’s long-term career goal is to use equity-driven implementation science methods to

reduce CRC inequities among historically marginalized populations. The proposed project blends rigorous methodologic training with an innovative research agenda to facilitate Dr. Anyane-Yeboa’s development into an independent investigator through three training goals: (1) enhance quantitative and qualitative research skills, (2) design and conduct mixed methods

research to inform implementation of evidence-based interventions, and (3) learn equity-driven implementation science methods. This proposal has three scientific aims: (1) identify system- level determinants of CRC screening in individuals 45 to 54 using mixed methods; (2) identify equity-driven implementation strategies to initiate CRC screening matched to systems-level

determinants; and (3) determine the acceptability and feasibility of implementation strategies for CRC screening by conducting a pilot trial and using mixed methods. In addition to advanced training through formal coursework, this award is supported by an extraordinary mentorship team, including internationally-recognized experts in CRC prevention, implementation science,

health equity, community-engaged research, and mixed methods. Upon completion of the proposed research and training, Dr. Anyane-Yeboa will expand her findings in an R01 to rigorously test her findings in a trial across CHCs in Massachusetts. The combination of formal training and mentored research outlined in this application is designed to ensure that Dr.

Anyane-Yeboa will emerge from this award as a nationally recognized independent investigator with the skills and experience to reduce CRC inequities in marginalized patient populations.