• colorectal cancer screening;
  • colonoscopy;
  • underserved population;
  • uninsured



Colorectal cancer screening (CRCS) in the United States is inadequate in minority communities and particularly among those who lack insurance. Finding ways to increase screenings in these minorities presents a healthcare challenge. The authors sought to determine whether offering CRCS at the time of mammography is an effective way to increase CRCS among minority women.


This study was offered to women attending the Breast Examination Center of Harlem (BECH), a community outreach program of Memorial Sloan-Kettering serving the primarily black and Hispanic Harlem Community. Screening was explained, medical fitness was determined, and colonoscopies were performed. Barriers to screening and ways to overcome them were ascertained. Participants had to be at least 50 years of age without a history of colorectal cancer or screening within the last 10 years.


There were 2616 women eligible for CRCS, of these women 2005 (77%) refused to participate in the study, and 611 (23%) women were enrolled. There was a high interest in CRCS including among those who declined to participate in the study. The major barrier was lack of medical insurance, which was partially overcome by alternative funding. Of the 611 women enrolled, 337 (55%) went on to have screening colonoscopy. Forty-nine (15%) women had adenomatous polyps.


Offering CRCS to minority women at the time of mammography and without a physician's referral is an effective way to expand screening. Screening colonoscopy findings are similar to those in the general population. Alternatives to traditional medical insurance are needed for the uninsured. Cancer 2011. © 2010 American Cancer Society.