Addressing colorectal cancer disparities: the identification of geographic targets for screening interventions in Miami-Dade County, Florida

Abstract

This paper describes an analysis of spatial clustering of colorectal cancer (CRC) in Miami-Dade County, Florida. The objective was to identify geographically based targets for colorectal cancer screening interventions for Blacks and Hispanic Whites, two groups with demonstrated disparities in stage at diagnosis and mortality for CRC. The initial cluster detection analysis identified areas with high risk of late stage CRC, however, none of the results were statistically significant. The analysis was not based on an academic research question, but instead was an application intended to guide appropriate and targeted strategies for high risk populations. Only about 50% of the general population receives CRC screening, so, while all groups would benefit from increased CRC screening, high risk communities may potentially benefit the most. Because public health resources are limited, geographically targeting high risk populations for enhanced screening efforts is pragmatic public health policy. Despite the lack of statically significant results, we still needed to develop a helpful answer to the question, where should we market a screening intervention? The selected geographic areas must have real potential for attenuating excess CRC burden through increased screening efforts. Through evaluating a combination of clusters of late stage and overall CRC risk (two separate models of cluster detection), probable communities with low CRC screening uptake were identified. Although they did not meet statistical significance, they were determined to have public health importance.