By Dr Rachel Issaka
The U.S. Preventive Services Task Force (USPSTF) recently recommended that colorectal cancer screening should begin at 45, rather than 50. This update is good news and will save lives, but healthcare providers can’t stop there and consider the job done.
Entire communities, especially Black communities, will continue to die from this disease without concerted, creative and intentional outreach. To be clear, I’m pleased with the USPSTF recommendations. They mean that insurers will have to cover the cost of colorectal cancer screening, which will eliminate a common barrier for many, including Black people.
But I want to focus on one number: 40 %.
In the United States, Black people are 20% more likely than other racial/ethnic groups to be diagnosed with colorectal cancer and about 40% more likely to die from it once diagnosed. Black men and women also have one of the lower screening rates.
Starting screening five years earlier means that about 22 million more people in the U.S. will now be eligible for colon cancer screening – a volume that exceeds the colonoscopy capacity of U.S. healthcare providers today.
We need to balance screening of the newly eligible individuals while not taking resources away from those who are over 50, or underserved Black communities, who are still struggling to receive basic preventive healthcare.
Three ideas will make a difference.
First, a recent JAMA study, which I led, shows that even a small increase in at-home testing can change the dynamic. Increasing at-home screenings in the U.S. from 15 % to 22 % resulted in an additional 655,825 colorectal cancer screenings and 2,715 colorectal cancer diagnoses, of which 72% were at the early stage. When colon cancer is discovered in the early stage, over 90% of people survive five years or more.
However, increased use of at-home or FIT tests, is only the beginning.
Providing immediate follow-up if the test is abnormal is also essential. Another study I led underscores this. Increasing screening and earlier detection of colorectal cancers could reduce the disparity in colorectal cancer deaths between Black and white people by half!
Second, screening must go to the community. Mobile vans that offer healthcare services including collecting detailed family histories, performing physical examination, and disseminating at-home colorectal cancer screening options can be deployed to churches, barber and beauty shops, and other community gathering spaces in urban and rural Black communities. COVID-19 testing and vaccinations have shown us that this is possible. I know, I know, colorectal cancer screening is not what anyone wants to discuss right after church or getting a trim, but one study shows that this type of approach is successful.
Outreach could have an even greater impact in reducing colorectal cancer disparities for Black communities if states pay for screening costs or provide navigators to health systems that prioritize this issue.
Finally, we need to talk about this. The death of actor Chadwick Boseman at age 43 last year, and author Ibrim X. Kendi talking about his journey through colon cancer in a GQ article, put colorectal cancer in the national spotlight. Even so, Black people are less likely than white people to know their complete family history of cancer and more likely to have inaccurate information about their family history of cancer. Screened family members are also less likely to tell their relatives about the finding of colon polyps. This knowledge is power and could be especially important if a doctor is reluctant to recommend screening because a patient is too young or too healthy.
Forty percent is way too high. We can change that number.
Dr Rachel Issaka is a gastroenterologist with the University of Washington School of Medicine.