Q&A: Personalized care, outreach key to boosting CRC screening among Hispanic patients
In 2021, an estimated 16,500 Hispanic men and women were diagnosed with cancer of the colon or rectum and about 4,700 Hispanic individuals died from the disease.
Hispanics represent the largest and one of the fastest growing minority populations in the U.S. and have lower survival from colorectal cancer than non-Hispanic whites. Mortality from CRC dropped by 15.1% among non-Hispanic whites from 2000 to 2011 but by only 5.9% among Hispanics. Currently, CRC is the second most common malignancy among Hispanics in the U.S., and low CRC screening rates in this group are a contributor.
Early screening is critical to prevent and treat CRC in Latinos. Yet, according to the National Colorectal Cancer Roundtable, one in two Hispanic adults aged 50 to 75 years are not getting tested as recommended. Because of lower screening rates, colon cancer causes about 11% of cancer deaths among Hispanic men and 9% among Hispanic women.
However, the national statistics tell only part of the story. Some states are making greater strides in overcoming CRC screening barriers and boosting compliance among Hispanics. For example, a recent annual survey conducted by the CDC found that 69.9% of Hispanics in New York underwent colonoscopy in the past 10 years — nearly the same percentage as whites (71.4%).
Jose Lantin, MD, is CEO of Gastroenterology of Westchester in Yonkers, New York, a community comprised of 38% Hispanic residents. Moreover, approximately 90% of the patient population served by Gastroenterology of Westchester is Hispanic. Healio spoke with Lantin, who shared insights on how New York state — and, more specifically, his practice — have boosted screening rates among this population.
Healio: What is your experience with Hispanic patients when it comes to undergoing a colonoscopy?
Lantin: While the national statistics tell another story, my experience with this patient population is actually very positive — many do comply with screening. Approximately 90% of my patients are Hispanic, so I would like to share what I have found to be beneficial in motivating them to undergo CRC screenings.
First, I explain the importance of screening, so they understand the need for it. I explain the process, including what preparation entails, and I always compare performing colonoscopy with driving a car. Essentially, the better we can see the path, the better we can serve them to stay in good health. Patients find the discussion helpful, and it sets the stage for their interest in colonoscopy.
In addition, we run ads on social media that help ease patient anxiety about undergoing colonoscopy. So, patients are very interested once we explain the process to them and they understand the benefits.
Healio: What do you think are some of the biggest barriers to screening, specifically for Hispanics?
Lantin: Cost and lack of insurance. For many Hispanic people, there is a lack of access as to where to go for screening as well as a lack of overall health care — basic, primary care. One key to solving these problems is making funding available for community centers at a government level — not only for screening CRC, but also for other health services. Over the past 10 years, funding improved tremendously here in New York.
I have found the most success with the community centers because they do outreach and assist people in getting screenings. They employ primary care doctors to treat people in financial need. They act as a referral service to my surgical center for patient screenings.
Thanks to these community centers with funded health care services, the screening rate in New York — and the incidence of CRC in New York — is far better than many other states. The national data is highly skewed by the poorest of poor areas in this country and that comes back to lack of federal aid.
In other words, health care in New York, compared with some other parts of the country, is readily available for today’s poorer populations and that is why I could say that the screening rates for Hispanics are improved here.
Healio: What impact does health insurance coverage have on CRC screening compliance among Hispanic patients?
Lantin: Without insurance many of these patients cannot afford any kind of health care, let alone a colonoscopy. According to the American Cancer Society, Hispanic men and women continue to be the least likely of any major racial or ethnic group to have health insurance. Among those aged 18 to 64 years, 26% of Hispanic individuals were uninsured during 2017 to 2018 compared with 9% of non-Hispanic whites.
I would say that about 20% of the patients that come to my surgical center have been sent by one of those community centers. Understanding my location is in an area of great need, the Department of Health granted me a certified participant of Article 28 — the New York State Medicaid Collaborative Care Program — making us eligible to receive supplemental Medicaid payments for Collaborative Care services provided to Medicaid fee-for-service and Medicaid managed care.
We have also offered our services for free at times or at a much lower cost than what the hospital would offer, and people would flock to us. Clearly, lack of health insurance is a barrier to screening.
Healio: How do you prepare a patient for the procedure?
Lantin: I spend a good deal of time educating patients and walking them through the process, so they feel more comfortable going through with the prep and the procedure.
As for the technology, we do talk about it, but we do not get very many questions about it; it does not seem a high priority for this patient population. Sometimes they ask about artificial intelligence and how we can use it in gastroenterology, but it is not as big of a factor to them.
They are more concerned with, ‘How am I going to feel? Am I a good candidate? Am I going to be comfortable?’ They are more afraid about the complications that can happen during colonoscopy and potentially having to repeat the procedure if we find anything concerning. The unknown is the biggest factor. That is when I reassure them that we have both the best technology and skills to address any polyps or other concerns during their screening, as opposed to making them repeat the process.
Healio: What have you and your practice done to educate the Hispanic population in your community about CRC screenings?
Lantin: We try to demonstrate our competency through obtaining and promoting reviews from happy patients. In our local area we have very good reviews on how we take care of patients and on patient outcomes. We try to make the process as seamless as possible, and people tend to like that. We also teach patients how to use the patient portal so they can easily schedule appointments.
In addition, all my assistants are well trained to answer questions about the preparation, as are my nurse practitioners. Ninety-five percent of my staff is Hispanic or Spanish-speaking. For patients undergoing a screening, there is no language barrier and that is important.
Initially, I knew a lot of medical Spanish, which meant I could explain what polyps look like and so on. I continue to learn as much Spanish as possible so I can truly engage my patients, converse with them and make them more comfortable. People feel appreciated and seen when you try to learn their basic conversational language.
Finally, it is also important to increase access for this patient population. For example, we have extended our availability. My surgical center is open on the second Saturday of the month to screen people — we are the only one in lower Westchester to do that. People who have to work during standard business hours now have another time to come in. We reserve those slots for people who do not want to miss work and so far, we have had a tremendous response.
Healio: How important is it to build awareness for CRC screening in the Hispanic community?
Lantin: It is very important. Tapping into community resources to educate Hispanic patients is critical. I have given talks to retired police officer groups, and I have reached out to clergy, as well as primary care doctors at community centers, about the importance of screening.
Social media has a big influence as to why people want to get screened, especially where there are a lot of Hispanic people posting reviews. The Hispanic community relies heavily on word of mouth. Posting positive experiences lets other patients know screening is OK. It gives them confidence and influences others to undergo the procedure.
References:
- Cancer Facts & Figures for Hispanic/Latino People 2021-2023.
- https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-hispanics-and-latinos/hispanic-latino-2021-2023-cancer-facts-and-figures.pdf. Accessed Dec. 12, 2022.
- Colorectal Cancer Screening New York State Adults ages 50-75, 2020. https://www.health.ny.gov/statistics/brfss/reports/docs/2022-05_brfss_colorectal_cancer.pdf Accessed Dec. 12, 2022.
- Viramontes O, et al. Prev Med. 2020;doi:10.1016/j.ypmed.2020.106146.
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