The onset of the COVID-19 pandemic ushered in an era of unfathomable disruption, shifting offices, classrooms, and even medical appointments into the home. Analysis is still unfolding on the pros and cons of these shifts, but what’s clear more than three years later is that the appetite for pre-2020 status quo is low.
It’s this notion that’s the basis of a Project for Progress (P4P) from 2022, awarded to a cohort from the Abramson Cancer Center, that continues to investigate what is the most effective and accessible way to reduce health inequities in West Philadelphia. The Projects for Progress awards are managed by the Office of Social Equity & Community and launched in 2021 to promote equity and inclusion in Philadelphia by addressing health care, education, and environmental justice.
For this winning project, the team strives to move the needle on screenings for colorectal cancer, which notably took the life of actor Chadwick Boseman in 2020 and continues to—still somewhat mysteriously—strike younger populations. (Boseman was 44.) It’s also the third-most diagnosed and lethal cancer in Black men and women.
The goal: decentralize cancer screenings—starting with colorectal cancer, but not stopping there.
“I think the pandemic caused societal changes that made a lot of people recalibrate how we do things, and there are things community members and ourselves don’t want to go back to doing the way we were doing,” says Carmen Guerra, the Ruth C. and Raymond G. Perelman Professor of Medicine, who is one of the award recipients. “For community members, it was this sense of being able to benefit from a test right in their own community or home, and therefore not have to battle all these barriers that get in the way just to access a preventive test when you’re feeling fine—or, I can imagine, even if you’re not feeling fine.”
Adapting a community model
Before winning the prize, the Abramson Cancer Center team had adapted a “Flu-FIT” model in which they worked with community partners like Enon Tabernacle Baptist Church and Einstein Health Care Network to offer no-cost, take-home colon cancer screening kits known as “FIT kits” (Fecal Immunochemical Test) to people who arrived for flu shots. At the time, because of the pandemic, they were working out of a parking lot and worked with a drive-through model; it became a way for the North Philadelphia community to access screenings as well as safely communicate during the crisis.
In its current form, the project focuses specifically on West Philadelphia, working with partners like the Lazarex Cancer Wellness HUB, among others. They launched with Christian Stronghold Baptist Church at 47th Street and Lancaster Avenue, which doubled as a way to distribute the COVID-19 vaccine as they came to market.
“I think the pilots in North Philadelphia really let us know the concept of taking screenings out of clinics into the community is actually feasible,” says Guerra. “And so, the idea of Projects for Progress was to really test that with other cancer screenings beyond FIT cards for colon cancer, and in our proposal, we offered a concept of decentralizing cancer screenings for colon cancer, but also prostate cancer and breast cancer through mobile mammography and on-site blood tests for prostate cancer.
“I think we’re on to something.”
Armenta Washington, a senior research coordinator at the Abramson Cancer Center, says the group continues to find new people to work with in the community. They recently teamed up with an alumni chapter of the Omega Psi Phi fraternity, for a men’s wellness day on Sept. 30 at Irvine Auditorium, during which they offered cancer and other health screenings. The group worked with Associate Professor of Clinical Surgery Julia Glaser to conduct peripheral artery disease screening. Other partners for the event included the Center for AIDS Research, Men of Color at Penn, and the African American Resource Center.
“As we are out in the community, we are finding more and more partners,” says Washington.
Much of that progress, she says, is owed to work building trust over time and lessening suspicion that surrounds medical providers in underserved neighborhoods—especially with cancer.
To learn more about this, as well as cultivate communication strategies for community outreach, Associate Professor of Radiation Oncology Gary Kao took what he dubs a “staybattical” and embedded himself in the screening events. Kao says he became aware of what Guerra and the team were working on and wanted to bring back knowledge to his department that would make it more inclusive and effective.
“Despite being at Penn for more than 20 years, this is the first time I’ve gone into the community to help with cancer screening,” Kao says. “And quite frankly, I’ve gotten so much out of it. I feel I’ve been given a gift, with the revelations and things I’ve participated in. These are things they don’t teach in medical school or residency.”
He describes these small group efforts as having an outsized effect on how welcome people feel when coming to Penn. Kao has returned to his department with a better understanding of the myriad challenges people face to get a screening.
“A single mom in the shelter told me during a hot August day what a struggle it is just to get water, because the shelter only allowed six small bottles of water, so every other day she had to go to the drug store to buy water to stay hydrated,” Kao recalls. “So, you can see that when just getting water is a challenge, getting a cancer screening as a priority is lost among many other high priorities.”
As a first step toward advancing inclusion, Kao is increasing his department’s social media presence and being more intentional about messaging.
Out of the lab and into the community
The project has also been an opportunity, says Erin Hollander, an MD/Ph.D. candidate, for doctoral candidates to get out of the lab and into the field. The project awardees also include Ph.D. candidates Roderick “Ricky” Braithwaite, Michael Noji, and Max Klapholz.
“It’s mostly Ph.Ds. volunteering with this and I love that,” Hollander says. “I think it’s a great idea to get these Ph.Ds., for whom colorectal cancer is cells in a petri dish, to get out and see people and talk to people and know the medicine side of it, and feel the difference.”
She describes the screening events as “like a party,” with music, food, and plenty of kids. She enjoys demystifying colonoscopies for those who might need a screening based on family history and are nervous about the procedure. She’s also able to convey to some patients how quickly a polyp can progress in just 10 years if not detected and removed early.
“And I always encourage people, especially if they’re 25, to check with parents, aunts, and uncles, now that they know it’s so important,” she says. “I love to talk to people where they are and getting to translate some of this medicine from this strange, scary requirement to, ‘OK, that makes sense. I’m going to do that.’”
Hollander, who has been at Penn since 2019, says the project has pointed her to resources she was previously unaware of and has also allowed collaborations to blossom with people like Guerra. They’ve begun discussions about how to conduct HPV self-sampling and are working on a similar decentralized format for increasing screenings.
For Brathwaite, he says he became interested in the project to increase access to current health care interventions and reduce health care professionals’ burnout. It’s also personal.
“Reducing health disparities is important to me, specifically in cancer, because I have lost a couple people dear to me from it,” says Brathwaite. “With Black people having a higher rate of cancer and worse outcomes, I wanted to help out the [approximately] 70% Black population in West Philly become aware of these disparities and informed about what they can do about them.”
The decentralized screenings, says Guerra, have been successful in expanding who receives a cancer screening in a community that is not only more likely to have colon cancer, but also to have a poor outcome. The unusually large number of colonoscopy screenings that have turned up pre-cancerous polyps have only confirmed that they’re working with a high-risk population.
“It showed how important it was for us to devote resources to early detection and prevention,” she says.
At a recent Men’s Wellness Day event on Sept. 30 at Irvine Auditorium, the team was able to screen 160 people for a combination of blood pressure/sugar, HIV, peripheral artery disease, hepatitis, prostate cancer, and colon cancer. One hundred and twelve of them were men.
The screenings are especially helpful in the context of delayed screenings since the COVID-19 pandemic, creating longer-than-usual waits for colonoscopies. The take-home kits have become convenient, cost-effective ways to fill the gap for people who are not experiencing immediate symptoms or have a family history.
Washington recalls one attendee who, through the event, only intended to get a flu shot but walked away with a FIT kit that would turn up a positive result. After consultation, she realized she was high-risk because of her family’s history not with colon cancer, but a different form of stomach and gastrointestinal cancers. She immediately prioritized a colonoscopy as a result.
“It makes all of what we do worth it,” Washington says. “Often times, we may go to events where there are as many as a thousand people and we screen a lot of them, but we may also go somewhere we have 10 people we encounter. But if we save one person, it’s worth it in this broader effort to address the inequities in the communities we are serving.”