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Colorectal Health

Colorectal Health — What Everyone Needs to Know About Screenings, Equity, and Access

black-communities of color-screening-colonoscopy-lgbtq
black-communities of color-screening-colonoscopy-lgbtq

Audrey Davis, LPC, PM-LPC, serves as the Senior Director, Health Equity at the Cancer Support Community, a nonprofit that uplifts and strengthens people impacted by cancer. We talked to her about her own personal experiences with colorectal cancer, and the resources available for those looking to lower their risk of, get screened for, or cope with the consequences of a diagnosis.

Audrey Davis

Senior Director, Health Equity, Cancer Support Community

“I have personally felt the pain of losing my dad, a Black Haitian-American immigrant, to colorectal cancer, and I now work to ensure that other patients and loved ones do not experience the same heartache.”

Tell us about your personal connection to colorectal cancer. 

My personal connection is threefold: My dad was diagnosed with colorectal cancer when I was a senior in college; he passed away a few years later. Two of my maternal uncles have also been diagnosed with colorectal cancer. One has been in survivorship for over eight years, while the other was recently diagnosed and will start chemotherapy soon. I am also acutely aware that I am at increased risk for colorectal cancer due to my family health history and my own diagnosis of Crohn’s disease, and so must be vigilant about timely screenings.

What do you think hospitals can do better to help increase colorectal cancer health equity? 

Hospitals and healthcare systems can leverage the power of established and respected community- and faith-based organizations and partnerships that already exist in medically underserved and historically under-resourced communities through sincere and humble community engagement.

The Cancer Support Community’s research with patients from the Black and African American, Hispanic and Latino Spanish-speaking, rural, and LGBTQ+ communities indicates that efforts at increasing cancer health equity through screening and prevention events can be impactful and successful, when done in partnership with leaders that already have a proven track record and earned trust with these groups.

What are some of the biggest obstacles you see people facing when it comes to getting colorectal cancer screenings?

There are several obstacles. Lower health literacy levels and understanding of screening test options and screening guidelines are certainly contributors. Many people immediately think of colonoscopies and are intimidated by the multi-step process and invasive procedure involved. They are also offput by the amount of time needed for colonoscopy preparation, setting up a ride to and from the procedure, and time taken away from work and other activities. Moreover, a lot of people remain unaware of other colorectal cancer screening methods (depending on risk level), such as stool tests.

There is also a lot of misunderstanding about when and how often one should be screened. For those who are at average risk of developing colorectal cancer, screenings should begin at 45 years old (not 50!). These should occur annually if using fecal stool tests, every five years via sigmoidoscopy (which checks the lower part of the colon or large intestine), and every ten years for a traditional colonoscopy (five years if via virtual colonoscopy).

Out-of-pocket costs can also become an obstacle. While it is true that through the Affordable Care Act, Medicare and private insurance companies are required to pay for colorectal cancer screenings. If one needs a colonoscopy to confirm or rule out CRC after an abnormal fecal stool test, for example, then an insurance company may classify this instead as a diagnostic test, and related deductibles and co-pays must be addressed.

Finally, justified medical mistrust still exists among many patient communities. This is due not only to historical injustices, but also contemporary experiences of racism and bias in healthcare. People from communities of color and the LGBTQ+ community are less likely to engage in preventative care and screenings, and experience discrimination and mistreatment when they do present for care.

Why do you think it’s important to address health equity in colorectal cancer?

Despite improved screening methodologies and adjusted guidelines, people from communities of color are still experiencing higher combined incidence and mortality rates than their white compatriots. If we do not address health equity issues in colorectal cancer, then the communities who are disproportionately impacted by it will continue to suffer disproportionately, too.

Audrey and her father at her highschool graduation.

We must address colorectal cancer disparities collaboratively and collectively as patient advocates, healthcare providers, and researchers so that those who have been historically and contemporarily disenfranchised and mistreated may survive, thrive, and have years of cherished moments, milestones, and memories with their loved ones.

I have personally felt the pain of losing my dad, a Black Haitian-American immigrant, to colorectal cancer, and I now work to ensure that other patients and loved ones do not experience the same heartache.

Is there anything healthcare providers can do better to ensure more equitable care for colorectal cancer?

Healthcare providers, on an individual basis, can engage in a few different behaviors to ensure more equitable care for colorectal cancer. I believe it’s vital for them to be mindful of the mistrust and fear patients often experience when visiting their doctor, including those in the LGBTQ+ community and individuals from communities of color. This can be accomplished by enhancing their own learning, as well as their cultural competency, and embracing cultural humility.

They can also make time to ask their patients questions about their experiences, and can actively and attentively listen to and believe their patients and their loved ones when questions are asked or concerns about treatment side effects, prognosis, or their care are shared.

The Cancer Support Community’s involvement with the White House’s Cancer Moonshot and CancerX initiatives has helped garner increased support for navigation services to be made available to more than 150 million Americans, including cancer patients. Practitioners should work closely with their internal navigation teams, who are already tasked to help mitigate barriers to care so patients focus on their care and wellness, instead of concerns about how to get to their appointments, how much their medications will cost, and other worries.  

Providers can also partner with external navigation resources, such as the Cancer Support Community’s global network of 200 locations and its Cancer Support Helpline. These services offer professionally led navigation and emotional support at no cost to impacted people to help ensure more equitable and comprehensive care for all cancer types, including colorectal cancer.

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