Screening for colorectal cancer is a true public health success story. According to the most recent data from the Centers for Disease Control and Prevention (CDC), rates of screening for colorectal cancer have increased dramatically over the past two decades. That means that we are preventing more colorectal cancers and picking up many more in the earliest stages, when treatment may be more successful.
Although fewer people are being screened for colorectal cancer screening than we would like, improved screening rates are proof positive that research and outreach can and does have a big impact on people’s lives.
But there is another part of this story that is equally important but is cause for concern rather than celebration. Our progress against colorectal cancer has not been experienced equally.
African Americans, for example, have higher rates of new colorectal cancer cases and deaths than all other racial and ethnic groups. And although colorectal cancer is the fourth most common cancer overall, it’s the second most common cancer among Hispanics. Underlying these statistics, in part at least, is another well documented disparity.
Although widely accepted screening recommendations call for most people to be screened for colorectal cancer once they reach age 50, screening rates are lowest among those with lower education and income, Hispanics, American Indians/Alaska Natives, and people in rural areas. Screening rates are also low in people who are new or recent immigrants to the United States.
In short, the colorectal cancer disparities gap is significant, and the evidence that colorectal cancer screening saves lives is well documented. So we’re taking concrete steps to increase screening rates and, in so doing, alter the story line.
Earlier this year, the National Cancer Institute (NCI) launched an initiative called Screen to Save that aims to increase colorectal cancer screening rates among men and women age 50–75 from racially and ethnically diverse populations and in rural areas.
As part of this initiative, NCI-sponsored community health educators from 44 different institutions nationwide are fanning out in diverse communities across the country to educate people about the benefits of colorectal cancer screening. These educators are using evidence-based, proven strategies and tactics for motivating people who live in underserved communities to get screened.
Because we know that certain culturally-tailored outreach methods work better in specific communities and populations than in others, educators are using only those methods that have been proven to work, saving time and money. Community hospitals and clinics can incorporate these tools and techniques into their education and outreach arsenal to increase colorectal cancer screening among the communities they serve.
Effective techniques for improving screening don’t have to be fancy or expensive. For example, a recent study showed that sending text message reminders about colorectal cancer screening substantially improved screening rates in American Indian and Alaskan Native women. Another recent study showed that simply providing written information about the fecal immunohistochemical test, or FIT kit—an effective, but often overlooked, screening test for colorectal cancer—to African Americans age 50 and older increased their screening rates.
The latest data, in fact, show that, when it comes to screening for colorectal cancer, rates among African Americans have nearly caught up to the rates among White Americans. Now our challenge is to further accelerate that trend and replicate it in other populations where rates continue to lag.
NCI, CDC, and professional societies, like the American Cancer Society have supported research aimed at addressing cancer health disparities for years, and have laid the foundation for national programs such as NCI’s Screen to Save.
Moving forward, NCI and its partners―including national organizations and smaller, local nonprofits―hope to expand this program to include a larger network of hospitals and clinics that can identify people who are eligible for screening and can provide the appropriate follow-up and linkages to needed care for those who undergo screening.
This is a unique opportunity to help reduce the number of deaths from colorectal cancer. Because the best way to continue the progress we’ve made against this cancer over the past 20 years is to ensure that everybody who should be screened has the opportunity, knowledge, and resources to do so.
Dr. Springfield is Director of the Center to Reduce Cancer Health Disparities at the National Cancer Institute and Dr. Martinez holds the Sam M. Walton Endowed Chair for Cancer Research, Professor of Family Medicine and Public Health, and Co-director of the Reducing Cancer Disparities Program, at the University of California San Diego Moores Cancer Center