Researchers Spur New Efforts to Ensure Equitable Access to Colorectal Cancer Screenings

As colorectal cancer incidences continued to increase across the nation, the 2021 revision to the national screening guidelines recommended those at average-risk should be screened starting at age 45, instead of age 50. But questions about the impact of dropping the screening age were raised, from whether this would divert resources away from older adults, how the new screening information would reach the younger ones, and how overall outcomes would be affected.  
 
Three studies have begun answering those questions, setting up a pivotal opportunity in detecting and preventing early-onset colorectal cancer, according to UTHealth Houston School of Public Health researchers in a recent editorial in the August issue of the Journal of the American Medical Association (JAMA).  
 
Coauthors of the editorial included Ami Sedani, PhD, assistant professor of epidemiology; Bijal Balasubramanian, MBBS, PhD, professor of epidemiology and the Rockwell Distinguished Chair in Society and Health; along with former faculty, Caitlin Murphy, PhD, professor of pediatrics at the University of Chicago.   
 
With the 2021 recommendation revisions, initiated by the U.S. Preventive Services Task Force, researchers like Sedani are examining the many obstacles for equitable implementation. "Awareness is still a major issue; research shows many adults don't know the current recommended starting age or the range of available screening options," she said. Current screening options for colorectal cancer include exams such as a colonoscopy and stool-based tests. "Others face real-life obstacles like no paid time off, trouble getting to a clinic, or competing needs like housing or food," Sedani said. 
 
Implementation scientists have worked to design evidence-based interventions to address obstacles such as transportation, time-off, and convenience. According to one new study, researchers in this special edition of JAMA found that using mailed fecal immunochemical tests increased screening participation amongst newly eligible patients for colorectal screening.  
 
Now, Sedani and the authors are underscoring the need to expand implementation across vulnerable and underserved populations. "That means connecting screening data with cancer registries and insurance records, tracking whether people get timely follow-up after a positive stool-based test, and looking closely at differences by sociodemographic factors," Sedani said. 
 
Researchers can tailor screening programs to address the social and environmental conditions that influence cancer risk, and ensure equitable implementation of colorectal cancer screenings and prevention methods. "Addressing these challenges requires a coordinated, multi-level approach: clear and consistent public messaging, policies that guarantee coverage for testing and follow-up, investments in patient navigation and community-based programs, and broader efforts to address the social and economic conditions that influence health," Sedani said. 
 
"Without strong policy and system support, even the best new technology risks benefiting only those who already have the most access," Sedani said.