Disparities in Colorectal Cancer Screening

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Among cancers that affect both men and women, colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Fortunately, there is an effective means of prevention, through one of several relatively simple CRC screening tests.

Although CRC screening rates in the United States have increased steadily over the past decade, this increase has not been seen equally across all populations. Screenings are still underused, particularly among certain populations, including racial and ethnic minorities, people without insurance, and those with lower educational and household income levels.

According to the Centers for Disease Control and Prevention (CDC), increasing the use of evidence-based interventions (EBIs) in health care clinics and systems that serve populations with low CRC screening rates could substantially increase CRC screening rates, and therefore significantly lower death rates from CRC. These and other findings, including case studies of successful interventions, are described in the CDC’s report entitled, “Use of Evidence-Based Interventions to Address Disparities in Colorectal Cancer Screening.” The report makes it clear that state health departments, tribal organizations, and other public health entities can play a key role in partnering with healthcare providers to support the use of EBIs in clinical settings.

Funding is available for many of thee programs. Since 2009, CDC’s Colorectal Cancer Control Program (CRCCP) has supported state health departments in implementing evidence-based interventions to increase use of CRC screening rates among vulnerable populations. Their primary focus is adults aged 50–75 years who are uninsured or underinsured and below 250% of the federal poverty level. The goal of the CRCCP is to increase CRC screening to 80% in the populations that they target.

Program funds are used primarily to implement evidence-based interventions (EBIs) or strategies recommended by the CDC to increase use of CRC screening tests. These strategies focus on:

  • Client reminders, either by telephone or by mail, advising clients that they are due or overdue for a screening.
  • A separate system for reminding healthcare providers that a patient is due or overdue for a screening.
  • A system to provide healthcare providers assessment and feedback to evaluate their performance in delivering and offering screening to clients.
  • Videos or printed materials, such as letters, brochures, and newsletters, to inform and motivate people to be screened for cancer.
  • Reducing the obstacles that make access to screening services difficult.

Many studies have reported an increased risk of CRC associated with smoking cigarette, so it would seem logical that CRC screening efforts be coordinated by a state’s tobacco control program.

The CDC report highlights the successful implementation of evidence-based interventions by two CRCCP grantees: the Alaska Native Tribal Health Consortium (ANTHC) and the Washington State’s Breast, Cervical, and Colon Health Program (BCCHP).

Alaska Native persons were found to have the highest incidence of CRC among all racial or ethnic groups in the United States, and their CRC mortality rate was twice that among whites. Not surprisingly, the proportion of American Indians and Alaska Natives who were up-to-date with CRC screening was substantially lower than other racial or ethnic groups. ANTHC partnered with regional tribal health organizations to increase CRC screening rates. As a result, the proportion of Alaska Native adults aged 50-80 years who were up-to-date with CRC screening rose from 50.9% in 2009 to 58.4% in 2012.

In Washington, staff was specifically assigned to set up a system to support screening, including the use of client reminders. In the participating clinics, the proportion of adults aged 50-75 years who were up-to-date with screening rose from 24% in 2011, to 48% in 2014.

The programs in Alaska and Washington had a number of common denominators that contributed to their success. Both programs used electronic health record systems to implement systems to remind healthcare professionals and their clients of the importance of screening. They both also found that using multi-component interventions in a single clinical site or facility increased screening rates more than relying on a single strategy.

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