How to increase screenings for colorectal cancer in underserved communities 

Colorectal cancer screening is a critical tool in catching this treatable disease earlier and saving lives. Yet screening rates remain low, particularly among Black and Latino Americans, due to lack of accessibility and psychological barriers such as mistrust in the health care system. In Chicago, for example, roughly 23% of Latino and 36% of Black residents have had a screening, compared with 38% of white residents.  

A recent study from University of Illinois Chicago researchers and colleagues looked at which interventions were most effective at boosting screening rates among the diverse patient population at UI Health’s Mile Square Health Center, a network of federally funded community clinics. They found that different tools worked better depending on the racial makeup of the specific clinic, but overall, the rate of colorectal screenings increased during the study. Their paper is published in the Journal of Environmental Research and Public Health. 

The study was conducted at three of Mile Square’s clinics — one that serves mostly Black patients, one that serves mostly Latino patients and one that is multi-ethnic. Mile Square primarily serves marginalized communities as a safety net provider.  

Patients 50 to 75 years old were offered one of three different services that encouraged them to receive screening for colorectal cancer. They either received a postcard around their birthday reminding them to get screened; met with a nonclinical staff member, known as a lay navigator, who shared the same racial or ethnic background as the patient and who provided education and helped set up an appointment if desired; or received education from their primary care provider, who helped set up an appointment if desired. 

All three of these services have been previously shown to be effective in boosting rates of screening within safety net settings. 

The researchers then tracked which patients completed a screening for colorectal cancer in the following 12 months. They found that, overall, 20% of patients were screened within the subsequent year, compared to 13% of comparable Mile Square patients who did not participate in the study. 

But, the effectiveness of the three options differed by clinic. The mailed birthday reminders were most effective with patients at the multi-ethnic clinic, lay navigation was most effective in the predominately Black clinic, and provider-delivered education was most effective at the predominately Latino clinic. 

“This study goes to show that there is not a ‘one-size-fits-all’ approach to tackling health disparities. We should be selecting and tailoring interventions according to patient needs,” said Ashley Hughes, senior author and assistant professor of biomedical and health information sciences at UIC’s College of Applied Health Sciences and member of the University of Illinois Cancer Center. 

The authors would like to see future research dive deeper into these findings. They write that the results of this study, “suggest that the implementation of interventions should be nuanced and holistic in order to be effective.” 

The study was conducted as part of the Mile Square Health Center Colorectal Cancer Awareness, Referral and Education Program, funded by the American Cancer Society. The other UIC authors on the study are Dr. Nicole Gastala, Liliana San Miguel, Scott Grumeretz, Dr. Masahito Jimbo, Dr. Keith Naylor and Yamilé Molina, representing Mile Square, the School of Public Health, the College of Medicine and the University of Illinois Cancer Center.