Breaking Down the Barriers: Understanding Social Determinants of Health in Colorectal Cancer (CRC) Screening
Do you know what Social Determinants of Health (SDOH) factors could hinder you from getting screened for the second most deadly cancer in the world? We here at Bay Area Community Health know exactly what they are and how to mitigate them to ensure you have access to the medical care you need.
SDOH are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These encompass transportation, employment, and dependent support, access to specialty care, physical environment, financial health, food security, social environment, housing, caregiver thriving, and emotional health.
BACH's Clinical Director Gemma Jamena highlights the strong correlation between these factors and the likelihood of patients aged 45 and older getting screened. She emphasizes the importance of understanding both modifiable and non-modifiable factors that contribute to CRC development.
It is reported that more than 55% of cancers are prevented with modifying the factors we have control over, such as smoking, alcohol use, high body-mass index, and a diet high in processed and red meat, whereas the remaining of cases are related to non-modifiable risk factors including genetic factors, personal history of polyps or adenoma, or family history of CRC.
When we examine educational attainment, we find that individuals who graduated college or higher have a screening rate of 64% compared to only 48% for those who received some form of high school diploma.
Regarding income level and insurance status, only about 21% of uninsured patients undergo screenings compared to 52% of individuals who have Medicaid/Public/Dual eligibility, according to the American Cancer Society. However, here at BACH, we are now able to provide fecal immunochemical test (FIT) and Cologuard kits to insured patients as well which further increases the access to care for all our patients.
Both kits are noninvasive at-home colon cancer screening test that requires no prep. This also overcomes transportation barriers patients may encounter, ensuring access to care.
Language barriers are another significant obstacle, which is why BACH offers several services to ensure patients can communicate effectively, including our language call line, translation services, and culturally sensitive staff. By simplifying medical jargon and providing culturally sensitive care, we aim to decrease medical mistrust and increase the likelihood of patients undergoing necessary screenings.
Behavior patterns such as smoking and alcohol usage can raise cancer risk and impact CRC survival. We refer patients to our Harm Reduction team, which assists with cessation and makes referrals to programs like Kick It – a free program that helps Californians quit smoking, vaping, and smokeless tobacco using proven, science-based strategies.
Importance of Screening
Colorectal cancer screening plays a critical role in maintaining good health. By detecting precancerous polyps early, these screenings allow for their removal before they develop into cancer, significantly reducing the risk of colorectal cancer. Regular screenings can even prevent cancer altogether and help assess individual risk factors to guide personalized screening plans. Detecting colorectal cancer at an early stage increases the chances of successful treatment. Therefore, starting regular screenings around age 45 is crucial.
“When colorectal cancer is detected in its early stages, specifically during the first stage, the five-year survival rate can be as high as 90%. However, as the cancer progresses to the third and fourth stages, the survival rate dramatically decreases to only 14%.”
In an attempt to motivate patients to stay proactive, we have an ongoing raffle for all patients who participated in colorectal screening efforts throughout the year at BACH explains Dr Gemma.
This approach enables us to identify individuals who are at higher risk due to the absence of screening, subsequently leading to heightened levels of medical mistrust among patients. By pinpointing these at-risk individuals, we can actively engage with them, connecting them with the appropriate resources available at BACH to address their mistrust and ultimately enhance the screening rate. This concerted effort aims to mitigate disparities in healthcare access and provision.
ACS Colorectal Cancer Screening Guidelines
Age 45 – 75: People should start regular screening at age 45, and those in good health with a life expectancy of more than 10 years should continue regular colorectal screening through the age of 75.
Age 76 to 85: Shared decision making should be employed, considering a person’s preferences, life expectancy, overall health, and prior screening history.
High-risk individuals might need to start screening before age 45, undergo more frequent screenings, or have specific tests done.
Who are high-risk individuals?
Personal History: Hereditary/genetic and medical factors that increase risk:
Personal or family history of CRC or adenomatous polyps
Certain inherited genetic disorders (e.g., Lynch syndrome)
Personal history of chronic inflammatory bowel disease
Previous radiation to the abdomen or pelvic area to treat a prior cancer.
In conclusion, understanding and addressing SDOH factors are essential in improving CRC screening rates and overall health outcomes. By providing accessible and culturally sensitive care, offering effective screening methods, and promoting healthy lifestyle choices, we can work together to combat colorectal cancer and ensure better health for all.