Racial disparities in colon cancer

Abstract

Colon cancer is a condition whose far‐reaching effects have been well documented nationally and within the state of South Carolina. Fortunately, the disease is amenable to both primary and secondary prevention through screening colonoscopy. Despite the conceptual simplicity of recommending colonoscopy, barriers exist to universal (or even widespread) screening. Currently the infrastructure necessary to achieve screening goals set by the American Cancer Society (ACS), the American College of Gastroenterology (ACG), and the South Carolina Department of Health and Environmental Control (DHEC) has not been established. At current rates of training gastroenterologists, the medical community will not be able to come close to achieving widespread screening. Given the discrepancy between the public health benefit of achieving the goals and the deaths that have occurred because of the resource shortfall, we propose alternative measures to screen the at‐risk population for consideration. This need is most acute in the black community, in which where screening rates tend to be lower and polyps have been found to progress more quickly than among white populations. In South Carolina, one model has used primary care physicians as the labor force to provide routine screening colonoscopy for their own patients. This model makes screening much more accessible to minority patients, as the wait is shorter and the cost typically lower. In combination with a faith‐based partnership with minority religious organizations, this model has begun to make needed inroads toward addressing the disparities associated with colon cancer. Cancer 2007. © 2006 American Cancer Society.

Interventions to Improve Care Related to Colorectal Cancer Among Racial and Ethnic Minorities: A Systematic Review

“…The DB scores ranged from 5–25 with a median of 19. Ten of the studies had DB scores within the good or very good range,40 , 41 , 43 – 50 two were fair,20 , 42 and one was poor 51…”

“…al. 200751PPScreening-completion of colonoscopyPSLTraining primary care physician to perform screening colonoscopy.Outpt CommN = 50NAThe proportion of primary care patients screened by colonoscopy increased from 20 % pre- to 80 % post-intervention (p-value not provided).5No patient race/ethnicity data reported.List of abbreviations for Table 1CRC, Colorectal Cancer; FOBT, Fecal Occult Blood Test; Outpt, Outpatient; Inpt, Inpatient/Hospital; Comm, Community; HP, Health Plan/Health Insurance; RT, Randomized Trial; PP, Pre/Post; Hisp/Lat, Hispanic/Latino; CI, Confidence Interval; PL-E, Patient-level Education; PL-N, Patient-level Navigation; PL-O, Patient-level Other; PSL, Provider/system level.

Figure 3.Breakdown of studies by intervention type (# of total studies, n = 33).

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“…Of these 13 studies, six utilized a pre-test/post-test design,20 , 42 , 43 , 45 , 46 , 50 , 51 five were randomized controlled trials,47 , 48 and two were cohort studies 40 , 41. The DB scores ranged from 5–25 with a median of 19.…”

“…In those studies with a comparator arm (n = 4), absolute improvement in CRC screening completion among the intervention group ranged from 4.2 % to 16 % (median 8.9 %) 44 , 48 , 49. In those studies with a pre-test/post-test design (n = 6), the absolute improvement in CRC screening completion in the post-intervention setting ranged from 12.3 % to 55.8 % (median 17.7 %) 20 , 42 , 43 , 46 , 50 , 51. In the randomized study by Ferreira and colleagues48 which measured the effect of didactic educational sessions (aimed at communicating with patients with low literacy) on CRC screening completion, the effect was particularly pronounced in patients with health literacy skills less than the ninth grade level (55.7 % FOBT completion in the intervention arm vs. 30 % of the controls, p < 0.01).…”