Stamford Advocate

Targeting disparitie­s in colorectal cancer screening

- This story was reported under a partnershi­p with the Connecticu­t Health I-Team (, a nonprofit news organizati­on dedicated to health reporting.

Wilfredo Estrada, a 71-year-old New Haven resident and native of Peru, said getting colonoscop­ies is “muy necesario.” His father died from colon cancer at age 65, and he knows family history plays a role in cancer risk. Estrada described his odyssey fighting polyps detected by preventive colonoscop­y screenings, which he has been getting since 2018. During the most recent procedure, Estrada said, the doctor found and extracted 29 polyps, all noncancero­us. When asked whether he tells people he knows how important it is to get screened, Estrada responded through his interprete­r, “No. It’s not something I like to share with others.” By staying current with colonoscop­ies, Estrada is doing his part to avoid becoming a cancer statistic.

In Connecticu­t, colorectal cancer is the fourth most diagnosed cancer in men and women, and is the fifth deadliest type of cancer, according to Centers for Disease Control and Prevention data captured in 2018, the most recent year for which these statistics are available. Black men and women have higher death rates than whites and Hispanics, the CDC data shows. And it’s not a problem that’s going away. According to national research, people born in 1990 are twice and four times more likely to be diagnosed with colon and rectal cancers, respective­ly, compared with similarly aged adults born around 1950, like Estrada. But despite strong evidence showing that screening methods such as colonoscop­ies — the “gold standard” of preventive colorectal cancer screenings — significan­tly reduce the risk of death from colon cancer, fewer than 80 percent of age-eligible Connecticu­t residents are up to date on them. Black and Hispanic residents lag behind their white age-eligible counterpar­ts, and fewer than 50 percent of uninsured among the state’s residents are up to date on these life-saving screenings, according to a state fact sheet on colorectal cancer screenings prepared by the CDC. But efforts by health care and advocacy organizati­ons are working to close these disparitie­s among Connecticu­t residents.

Patient navigators support screenings

While a desire for privacy may prevent patients such as Estrada from discussing with others the importance of screening for colorectal cancer, organizati­ons such as nonprofit Project Access New Haven work to spread the news. Under the nonprofit’s Uninsured Specialty Care program,

Project Access has a Screening Colonoscop­y Navigation Program in partnershi­p with Fair Haven Community Health Care that serves primarily Black and brown community members who don’t have access to care. “Our patient navigators reach out to patients, explain who we are, schedule the colonoscop­ies, and we work with the hospital to go through the process,” said Ma’Glinda Williamson-Ager, Project Access’s RN navigation manager.

“There are so many different layers that can prevent patients from getting that screening.” While patient education is critical to encouragin­g cancer prevention measures, the obstacles don’t always lie with the patients themselves, say some experts.

Systematic­ally identifyin­g patients at risk

Dr. Xavier Llor directs Cancer Screening and Prevention, part of Community Engagement and Health Equity at the Smilow Cancer Hospital, Yale New Haven Health. The oneyear-old program is working to bring systematic changes to how patients are and, referred when advisable, for cancer genetic screenings testing. Llor cited Lynch syndrome as an example. Caused by an inherited gene mutation, the syndrome increases one’s risk for colorectal and other cancers and is one of the most commonly diagnosed cancer syndromes in Latinos. “We are working to make sure that everyone who could have a cancer

syndrome is diagnosed,” Llor said. It is well-documented, he said, that patients of color receive genetic testing far less frequently than white patients, a circumstan­ce that multiple studies attribute to referral bias. Llor pointed to systemwide measures

New Haven recently that implemente­d work to counter at Yale referral bias. In one, the pathology department analyzes tumors removed from patients using a simple pathology test. If a tumor is found to contain a specific alteration that is commonly seen in tumors of patients with Lynch syndrome, the pathology department — working in concert with the health care system’s informatic­s team — sets an automated system in motion that results in reaching out to the patient’s provider to make a referral for genetic counseling and testing.

Previously, Llor explained, pathologis­ts would note the need for genetic testing but wouldn’t always make the actual referral. “If we do the extra work, we can get there,” Llor said. Using this new, more systematic method, he said, referrals to genetic testing have jumped from 40 percent to 80 percent.

“Instead of waiting for our culture to change, we [at the Smilow Cancer Hospital] keep working to change our culture,” Llor said, adding, “Very few people are hesitant about screening when you talk to them.”

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