A medical-oncologist shares how local research is tackling key barriers to care to help improve rates of screening and early detection.
Most people know that they should exercise, eat healthily, go to their doctors and take care of themselves, in general; however, as researchers, we’ve seen that just knowing is often not enough, suggests medical oncologist Ana María López, MD, MPH
The same rings true when it comes to cancer screenings. Unfortunately, barriers to screenings – and misconceptions that surround them – prevent many people from catching disease early when it is more likely to be cured, says Dr. Lopez.
What are the top barriers to colorectal cancer screening?
Colonoscopy and at-home screenings are recommended to start at age 45 for people at average risk for colorectal cancer. While screening rates have increased over the past decade, there are still many people not being screened – roughly 35% of adults over the age of 50 in the U.S., according to the American Cancer Society.
“Primarily, it’s an issue of access,” continues Dr. Lopez. “When screening guidelines are missed and cancers are found late, it points to concerning healthcare disparities – not everyone has the same opportunities.”
People may face insurance troubles or have no insurance at all. Others may have a hard time setting aside a day or two for the preparation and procedure (for the colonoscopy), especially if they don’t have sick time, can’t afford to take off work, or are busy with family responsibilities. For many, this is coupled with a lack of understanding due to ineffective education.
People are also simply nervous, continues Dr. Lopez. “When it comes to cancer, there’s the big question: ‘Do I really want to know?’ They may think cancer is not curable ever, which, of course, isn’t true.”
To help study this question – and learn what encourages and keeps people from screening – Dr. Lopez was awarded a grant to run a National Cancer Institute (NCI)-funded colorectal cancer screening trial. We spoke with Dr. Lopez to find out more about how the study works and how patients can get involved.
What can we do to break these barriers?
As researchers and healthcare professionals, we must work closely with our communities, educate them and learn together how to effectively communicate.
Most people never consider participating in a research study. First, we have to understand why. Studies show that different communities have different perceptions of clinical trial participation; hesitancies vary between Black, Asian American, and Latinx people.
We also have to emphasize how critical it is to know your family history. Cancer doesn’t develop for one sole reason; there’s usually a combination of risk factors at play. But if you feel something is wrong, or you know you’ve had family members who’ve been diagnosed with cancer, speaking up could be lifesaving. It could help you identify disease early and even prevent other cancers.
What is the purpose of the colorectal cancer screening research study?
We already know a lot about the barriers: lack of knowledge, access to screening and insurance. In this study, we proactively counter knowledge with an educational platform available in English, Spanish, and Mandarin. Screening is then provided at no cost. Thus, the most prominent barriers to care are removed.
Our work will let us know if this effort will increase screening behavior or peoples’ perceptions of screening. We need to take a hard look at how we educate and facilitate screening and if our efforts make a difference.
Cross-cultural communication is necessary to reach people from all different walks of life. Not everyone will resonate with the same message; not only must you respect language barriers, but connecting through meaningful, relatable experiences can make a difference.
What does the study require participants to do?
Participants have the opportunity to learn through a pre-and post-evaluation to measure how helpful the education platform is. Then, if the person is at average risk for colorectal cancer and is eligible for screening, they are offered an at-home FIT (fecal immunochemical test), which tests for occult (or hidden) blood in the stool. If the person is at more than average risk, they are referred to their primary care physician for further care – which may involve a colonoscopy.
How long does a research study usually last?
Research studies vary in time length. Ours was recently renewed and will have been fully funded for four years.
Patients’ participation doesn’t take long. The educational portion of the study may take around 15 to 20 minutes. The FIT process also takes no more than a few minutes, and results typically return within one to two weeks.
Who is eligible?
Any adult can participate in the education portion of this study. We want everyone to learn about colorectal cancer screening and the benefits of early detection. Everyone can help move knowledge forward.
Any closing comments?
As an oncologist, I see the amount of pain that a cancer diagnosis can cause. Our study’s overarching goal is to spare people that pain.
[Main photo credit: iStock.com/PeterPencil]