Racial disparities in colorectal cancer (CRC) have been documented previously—a disparity recently highlighted by the tragic death of Hollywood actor Chadwick Bosman, who died from colon cancer at the young age of 43 this past summer. Screening is widely regarded as a useful tool in cancer, making possible earlier detection and, subsequently, earlier treatment.
Disparities are also present in screening, however. A study found that minority patients were less likely than their White counterparts to be aware of the recommended screening age for CRC, as well as the multitarget-stool DNA (mt-sDNA) test. The results of the study were presented at the American College of Gastroenterology 2020 Virtual Annual Scientific Meeting & Postgraduate Course (ACG 2020).
Urban Health Today interviewed study author Paul Limburg, MD, Mayo Clinic gastroenterologist and chief medical officer for screening at Exact Sciences, about the study.
What prompted you to undertake this study?
Dr. Limburg: Despite multiple guideline-endorsed options for average-risk CRC screening, disparities in screening participation remain. We initiated this study to better understand how awareness, knowledge, and utilization of CRC screening options differ across population groups, defined by race/ethnicity or socioeconomic status (SES), to better inform interventions designed to increase uptake of this important preventive service.
What are the key takeaways from the study?
Dr. Limburg: Data from our study showed that racial/ethnic minorities (vs. non-Hispanic Whites) were less likely to be aware of the mt-sDNA test and the recommended age to begin CRC screening. Also, people with a high school education or less (vs. bachelor’s degree or higher) and people who were uninsured (vs. private insurance) were less likely to know the recommended screening interval for mt-sDNA. These data support the need to increase awareness, knowledge, and utilization of this noninvasive, home-based CRC screening test among specific SES and racial/ethnic groups. Interventions to address inequalities in social and economic resources in these populations are also needed to facilitate more equitable adoption of average-risk screening options and reduce disparities in CRC-related health outcomes.
Did any of the study’s findings surprise you?
Dr. Limburg: Our findings on the SES and racial/ethnic disparities in the awareness, knowledge, and utilization of CRC screening modalities are consistent with previous studies in this area, which demonstrate that inequities in social and economic resources are associated with imbalanced diffusion of medical innovations.
What limitations did the study have?
Dr. Limburg: Our cross-sectional survey design limited the ability to examine potentially causal relationships between different stages of adoption for medical innovation, and also precluded detailed examination of CRC screening adoption trends over time. Our study also relied on self-reported data to measure CRC screening utilization, without confirmation from medical records. Further, we were unable to rigorously examine potential interactions between race/ethnicity and SES indicators, due to the limited number of participants in some race/ethnicity and SES categories.
Do you have any future research plans pertaining to this area?
Dr. Limburg: Future longitudinal research is encouraged to follow people prospectively and examine how SES and racial/ethnic differences in awareness and knowledge of CRC screening modalities influence utilization, and how these adoption patterns change over time. Investigation of additional factors that may be indicative of social and economic resources, such as immigration status, rural-urban status, and area-level deprivation, would also be informative.
Any information not addressed by the previous questions that you would like to share?
Dr. Limburg: The public health benefits of population-level CRC screening have been consistently and convincingly demonstrated. Further efforts are needed to understand, and address, the unique needs of population groups defined by race/ethnicity, SES, and/or other factors to reduce existing disparities.
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