Colorectal cancer is one of the most preventable cancers, yet it has one of the highest rates in the nation.1 Although rates have been decreasing over the last decade, there is unequal distribution of burden among various groups.2 Copious research on disparities based on socioeconomic status (SES) and racial/ethnic groups exists for incidence, mortality, and treatment of colorectal cancer. Additionally, recent research shows the increased risk of the disease for disabled individuals compared to others.3 Colorectal cancer remains a major priority area in public health, and there is an exigency to act to accelerate its reduction significantly. The Cancer Moonshot Blue Ribbon Panel has listed colorectal cancer screening as one of its implementation science priority areas, which will create new funding opportunities at the National Cancer Institute (NCI) for researchers to partner and accelerate their work to increase screening. While there are continued efforts at the national, state, and local levels to lower the cancer burden, I’m reminded that addressing colorectal cancer screening requires a tripartite exploration of the individual, community, and partnerships.
Individual responsibility is extremely important, as the final decision on food intake, physical activity, smoking, screening, and other health behaviors that modify the risk of colorectal cancer rest with the individual. However, challenging circumstances such as health literacy, low SES, the built environment (i.e., food deserts, greenspace, transportation, neighborhood safety), and other key issues may present obstacles for the individual to make appropriate health decisions. In addition, one can be susceptible to a genetic predisposition for colorectal cancer, such as inheriting Lynch Syndrome. Targeted evidence-based/evidence-informed strategies and behavioral models should be employed to modify individual behavior.
The community plays a vital role in providing its residents with services to advance health. NCI has partnered with other federal agencies to provide data and evidence-based resources to cancer control planners and health practitioners to aid individuals in the community with overcoming barriers to achieving optimum health. Community health workers, leaders, and advocates can access colorectal cancer screening interventions and various evidence-based approaches to adopt in their community. Physicians within the community also have great influence on directing patients to seek preventive care, using the most current national screening guidelines. However, there are people who live distant from a health care provider or who balk at seeking health care for a variety of reasons (e.g., distrust, fear, financial, cultural). Much effort is still needed to assist those who are disadvantaged to receive the message about screening and obtain access and follow-up.
Partnering is salient and many organizations in cancer control realize the importance of partnering, whether with private or public organizations, to advance their efforts. The Comprehensive Cancer Control National Partnership is convening an 80% by 2018 Colorectal Cancer Forum in July and September 2017, assisting states to enhance partnerships with cancer control coalitions and Federally Qualified Health Centers to increase screening. NCI also partners with the National Colorectal Cancer Roundtable, collaborating to advance efforts in improving colorectal cancer screening rates. Lastly, NCI recently organized a group concept mapping initiative, requesting research questions from internal and external stakeholders, researchers, and practitioners that address increasing implementation of colorectal cancer screening. This is intended to help guide development of funding opportunities and set research priorities.
Individuals need to feel empowered to make wise decisions about their health. Each person makes up the community and should be sought, educated, and welcomed in discussions about colorectal cancer. Community awareness is essential in spreading the message about colorectal cancer screening. However, partnerships between community and relevant organizations allow cancer control professionals to leverage resources to complement their cancer control efforts. They can also adopt evidence-based approaches and interventions to their targeted communities.
It is unlikely that colorectal cancer will be eradicated, but the risk and burden of disease can be significantly reduced. What are some of your thoughts on addressing colorectal cancer screening?
- Howlader N et al (eds). SEER Cancer Statistics Review, 1975-2014, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER website, April 2017.
- Ahmedin J et al. Annual report to the nation on the status of cancer, 1975–2014, featuring survival. J Natl Cancer Inst. 2017 Sep 1;109(9).
- Deroche C et al. Colorectal cancer screening adherence in selected disabilities over 10 years. Am J Prev Med. 2017 Jun;52(6):735-41.