How a team of doctors keep an eye on equity when it comes to colon cancer


“There is a lot of data that routine screening is associated with mortality benefits, with mortality rates ranging from 20 to 30 percent.”

Adam Berry/Getty Images Europe

Colorectal cancer is the second most common cause of cancer-related death among all Americans, and of all racial and ethnic groups, black Americans have the highest incidence and mortality rates.

but one New Team, Stand Up to Cancer, funded by Exact Sciences and the Providence Health System, is hoping to raise screening levels among underserved communities, including those in Greater Greeley Tribune.

The group — which has three different areas, including the Greater Greeley Tribune area, as well as Great Plains Tribal Communities in South Dakota and Los Angeles — also hopes to help build the careers of new doctors of color.

Screening rates drop during pandemic

Dr. Jennifer Haas of Massachusetts General Hospital is one of the leaders of the Stand Up to Cancer Colorectal Cancer Health Equity Dream Team. He said screening is the best way to prevent colorectal cancer.

“There’s a lot of data that routine screening is associated with mortality, with mortality rates ranging from 20 to 30 percent,” she told Greeley in a recent phone interview.

But due to the COVID-19 pandemic, screening rates declined in the initial days.

“Screening rates dropped tremendously,” she said. “They went overboard, we weren’t doing any screening.”

According to Haas, rates before the pandemic were around 65 percent, but COVID-19 dropped them to about a quarter. Then, as society began to live with the pandemic, screening resumed six to eight months after the start of the pandemic in March and April 2020.

The target is to increase the screening rates up to 80 percent in the identified areas through the team. according to a press release,

Part of increasing the screening rates hinges on working with community health centers. Nearly half to perhaps three-quarters of the difference between someone with a lower socioeconomic status being more likely to be diagnosed with colon cancer has to do with access.

“I think the concern is that those people are not getting tested frequently,” Haas said. “There may also be some risk factors for colon cancer in terms of diet, or behavioral risk factors. But this is mainly because of inadequate screening.”

“Some risk factors” may be related to diet and alcohol, she said. But, “I really think it’s a failure of care.”

What Screening Actually Involves

When someone thinks about colorectal cancer screening, they may automatically think of a colonoscopy procedure, which uses a tube and a light to inspect the colon. If any polyps are found, the doctor may remove a piece for biopsy. But home-based tests are now a big part of it.

There are two accepted home-screening tests available. According to Haas, there is an amino test that looks for blood in the stool. The second is a test that looks for DNA linked to colon cancer.

“Both are very relatively simple tests to do at home,” Haas said. “We send a pack in the mail and then you are notified of the results.”

Haas said these have become especially important now with a backlog of colonoscopies – 10,000 procedures were canceled during the height of the pandemic, and all need to be rebooked.

One way to catch up is with home-based testing. A positive test means the need for colonoscopy. However, using these can mean a lack of follow-up, even with positive results.

“I think a big issue at this point is that it’s very hard to book a follow-up colonoscopy,” she said.

What are the screening constraints?

Through the new team and associated grants, Haas said it is important to work with community health centers, as well as work in communities to promote screening.

“I think we’re very much looking forward to working with those community organizations,” she said. “We are in the process of adding four community health centers and working with clinicians and stakeholders – all of them have community advisory boards that include patient representatives – to understand what barriers their specific clinics have in common. but still with the pandemic going on, to encourage people to participate in both screening and clinical evaluation.”

It’s too early to say what the odds are, but according to Haas sometimes screening is when it’s opportunistic. Waiting for a patient to walk in and then see that they are overdue for screening means that a doctor may “lost an opportunity to intervene.”

Part of that is being proactive, and that’s something that health care systems have done, but not so much “with a view to equity,” Haas said. The overall screening rate may be higher, but they probably haven’t broken it down to look at screening rates of white patients versus black patients.

According to Haas, there should be a dedicated dashboard for equities.

A Pipeline for Colo’s DoctorsR

Part of the Stand Up to Cancer grant has to do with “promoting early-career investigators,” Haas said, noting that she’s working with three new doctors of color. “One of the keys” is to help them find a specific area of ​​expertise, and help them boost their careers.

But it’s not just recruitment, she said; It is already retaining doctors of color on board.

“Greeley Tribune has a complicated history with race,” she said. “I think it’s been very hard to recruit Black and Latinx physicians historically. I think that’s changing in Greeley Tribune. I think institutions are really making a concerted effort to recruit. I think That it’s not only recruiting people, but retaining what you have.”

He said the health care system is already investing in this area.

“I think it’s going to be tough, but I think hopefully we’re seeing a little bit of a turning point in terms of institutional investment and career growth,” Haas said.

There is evidence that suggests a variety of better outcomes when a patient can see a doctor of their race or ethnicity. Some of them include understanding the likelihood of getting cancer, willingness to get treated, and even how the patient feels about their time with the doctor. articles in Conversation by Ryan Huerto, a lecturer and physician at the University of Michigan, and Edwin Lindo, a lecturer at the University of Washington School of Medicine.

“In the current workforce, diversity among physicians is limited,” he said in the article. “This can create mistrust in the doctor-patient relationship, even during routine checkups. For example, black patients may feel more attentive to white physicians than black physicians, and white physicians less able to care for minority patients. You can feel comfortable.”

A Stanford University study showed black men to be positive when seeing a black doctor versus a white doctor.

“Men seen by black physicians were more likely to engage with them, and even consent to preventive services such as cardiac screening and vaccinations,” the article said.

The American Cancer Association recommends that you talk to your doctor about colorectal screening if you are 45 or older. While colorectal cancer often does not present symptoms during its early stages, some people should notice changes in bowel habits, bleeding, cramping and weakness and fatigue, according to the ACS. visit for details,