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Colorectal cancer screening advocacy improved uptake in underserved communities

Promotion of fecal immunochemical testing by community health workers was successful in increasing screening rates among Haitians and Hispanics, according to findings published in JAMA Internal Medicine.

“Reduction in colorectal cancer incidence and mortality is substantially higher among racial/ethnic minorities, recent immigrants, and low-income individuals,” Natasha Schaefer Solle, RN, PhD, of the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, and colleagues wrote. “In South Florida, this disparity is most prominent for foreign-born Hispanics and Haitians ... Late-stage diagnoses and poorer survival in these enclaves primarily reflect lack of access to preventive cancer screening. Improving [colorectal cancer] screening is a particular challenge for specific population subgroups, namely, the uninsured and recent immigrants.”

Schaefer Solle and colleagues evaluated whether colorectal cancer screening rates improved among underserved immigrants who participated in an intervention in which community health workers promoted fecal immunochemical testing (FIT). Those with a history of colorectal cancer or inflammatory bowel disease, those who had undergone partial or total colectomy and those who were not capable of performing the FIT themselves were excluded from the study. A total of 688 individuals met eligibility criteria, of whom 483 agreed to participate. A majority of participants were foreign-born residing in the Little Haiti or Hialeah communities of Florida (49% Hispanic; 51% Haitian; aged 50 to 75 years). Most participants lived below the poverty line (71%) and were uninsured (71%).

The FIT kit was returned by 85% of participants (89% Haitian vs. 82% Hispanic) and 71% of participants completed follow-up with a community health worker. The researchers noted that FIT completion did not differ by age, sex, education or employment. Six participants had positive FIT results and three underwent diagnostic colonoscopies.

“Given that the mean national screening rate for recent immigrants and uninsured patients is approximately 21%, the 85% overall screening rate demonstrated by our participants supports [community health worker] + FIT as a viable strategy for improving [colorectal cancer] screening within these populations,” Schaefer Solle and colleagues concluded. “Our numbers are also favorable when compared with Florida’s statewide [colorectal cancer] screening rate of 68%. Eighty percent or more completed the screening in both groups, aligning with the goals of Healthy People 2020 to achieve 80% population [colorectal cancer] screening rates by 2018.” – by Alaina Tedesco

Disclosure: The researchers report receiving support a grant from Bankhead Coley Cancer Research Program to the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and the Jay Weiss Institute for Health Equity.