Using population data to reduce disparities in colorectal cancer screening, Arkansas, 2006

Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: A review of the literature

The LGBTQ+ community is at higher risk of certain cancers but is less likely to participate in screening programs or engage with preventive healthcare. Despite this, the barriers and facilitators to cancer screening are not well understood in this population. We conducted a literature review of research related to LGBTQ+ participation in cancer screening, as well as barriers and facilitators to participation. Following abstract and full-text screening, 50 studies were included in the final synthesis. Compared to their heterosexual counterparts, lesbian and bisexual women were less likely to participate in cervical cancer screening and mammography, but gay and bisexual men were more likely to participate in anal and colorectal cancer screening. Transgender individuals had lower rates of screening than cisgender individuals for all cancer types. Barriers to participation were found at the individual-, provider-, and administrator-level, and good communication with a healthcare provider was the strongest facilitator. These results provide reasonable first steps toward improving participation rates for LGBTQ+ populations in cancer screening. Patient-centered approaches should draw on core guiding principles to inform the provision of care, including anticipating LGBTQ+ patients, improving knowledge about care for these patients, and confronting individually-held biases that may affect care, in order to improve care experiences and participation rates in preventive services.

Colonoscopy and sigmoidoscopy use among older adults in different countries: A systematic review

Screening for colorectal cancer (CRC) by colonoscopy and sigmoidoscopy has been demonstrated to be effective in reducing CRC incidence and mortality, and they are increasingly employed as screening tests and for diagnostic purposes in many countries. We conducted a systematic review to provide up-to-date estimates on the utilization of lower gastrointestinal endoscopy (colonoscopy and sigmoidoscopy) in the general average-risk population in different countries. PubMed and Web of Science were searched for relevant articles published between 1 September 2008 and 31 October 2016. A total of 23 studies from the US and 20 studies from other countries were included in this review. Estimates from the US were highest, continued to increase over the past decade and reached 62% for colonoscopy use within 10years in people aged 50-75years in 2012. Endoscopy use in other countries was substantially lower (12-44% for lifetime colonoscopy use and 13-30% for recent colonoscopy use), except for Germany, where 55% of the screening-eligible population reported colonoscopy utilization within the previous 10years in 2008-2011. Both lifetime and recent endoscopy use increased with age and peaked at approximately 70-75years. Although several European and Asian countries have started to collect endoscopy utilization data through periodic national health surveys, more data are still much needed from non-US countries. With the implementation of CRC screening programs in an increasing number of countries, especially European countries, an increase in endoscopy use and subsequent reduction in CRC incidence and mortality in the years to come might be expected in those countries.

Decisional stage distribution for colorectal cancer screening among diverse, low-income study participants

Colorectal cancer (CRC) screening uptake among minorities and those with lower incomes is suboptimal. Behavioral interventions specifically tailored to these populations can increase screening rates and save lives. The Precaution Adoption Process Model (PAPM) allows assignment of a decisional stage for adoption of a behavior such as CRC screening. Here, we characterize the PAPM decisional stage distribution among 470 low income, racially and ethnically diverse study participants at intake into a behavioral intervention study designed to increase CRC screening uptake. We staged participants for stool blood test (SBT) and colonoscopy separately and used the highest stage for the two tests as the 'overall' stage for CRC screening. For SBT, sex, language (English versus Spanish) and doctor recommendation were significantly related to PAPM stage for CRC screening. For colonoscopy, language, education level, doctor recommendation and self-efficacy were related to stage. For overall CRC screening stage, all the variables associated with either SBT or colonoscopy, with the exception of language were significant. This study suggests attending to these key variables in designing interventions to promote CRC screening, particularly with respect to medically underserved populations.

Predictors of Colorectal Cancer Screening: Does Rurality Play a Role?

PURPOSE

The purpose of this study was to explore the associations between sociodemographic factors such as residence, health care access, and colorectal cancer (CRC) screening among residents of Texas.

METHODS

Using the 2012 Behavioral Risk Factor Surveillance Survey, we performed logistic regression analyses to determine predictors of CRC screening among Texas residents, including rural versus urban differences. Our outcomes of interest were previous (1) CRC screening using any CRC test, (2) fecal occult blood test (FOBT), or (3) endoscopy, as well as up-to-date screening using (4) any CRC test, (5) FOBT, or (6) endoscopy. The independent variable of interest was rural versus urban residence; we controlled for other sociodemographic and health care access variables such as lack of health insurance.

RESULTS

Multivariate analysis showed that individuals who were residents of a rural/non-Metropolitan Statistical Area (MSA) location (OR = 0.70, 95% CI = 0.51-0.97) or a suburban county (OR = 0.61, 95% CI = 0.39-0.95) were less likely to report ever having any CRC screening compared to residents of a center city of an MSA. Residents of a rural/non-MSA location were less likely (OR = 0.49, 95% CI = 0.28-0.87) than residents of a center city of an MSA to be up-to-date using FOBT. There was decreased likelihood of ever being screened for CRC among the uninsured (OR = 0.43, 95% CI = 0.31-0.59).

CONCLUSIONS

Effective development and implementation of strategies to improve screening rates should aim at improving access to health care, taking into account demographic characteristics such as rural versus urban residence.

Reducing cancer disparities through community engagement in policy development: the role of cancer councils

Cancer is the second leading cause of death in the U.S and a source of large racial and ethnic disparities in population health. Policy development is a powerful but sometimes overlooked public health tool for reducing cancer burden and disparities. Along with other partners in the public health system, community-based organizations such as local cancer councils can play valuable roles in developing policies that are responsive to community needs and in mobilizing resources to support policy adoption and implementation. This paper examines the current and potential roles played by local cancer councils to reduce cancer burden and disparities. Responsive public health systems require vehicles for communities to engage in policy development. Cancer councils provide promising models of engagement. Untapped opportunities exist for enhancing policy development through cancer councils, such as expanding targets of engagement to include private-sector stakeholders and expanding methods of engagement utilizing the Affordable Care Act's Prevention and Public Health Fund.