In partnership with the Michigan Department of Health & Human Services and the Michigan Public Health Institute, MiCHWA compiled resources that illustrate the vital role CHWs play in cancer control and prevention. This page is specific to Colorectal Cancer. For other health conditions that are covered by MiCHWA, refer to the sidebar to the right.
Health Disparities in Colorectal Cancer
Colorectal Cancer (CRC) is highly preventable through routine screening but is the third most common cancer in the United States with more than 102,000 new diagnoses per year.1 CRC is the second leading cause of cancer-related deaths in the US. Although men are diagnosed with and die from CRC more often than women, strong racial and socioeconomic disparities exist among both men and women.
|Black men are more likely to die from CRC than White males (29.1 vs. 19.5 deaths per 100,000 cases, respectively)2||Black men are more likely to die from CRC than White males (29.4 vs. 18.4 deaths per 100,000 cases, respectively)2|
|Black women are more likely to die from CRC than White women (19.7 vs. 13.7 deaths per 100,000 cases, respectively)2||Black women are more likely to die from CRC than White women (18.5 vs. 13.7 deaths per 100,000 cases, respectively)2|
|Lower income (47.6%) and less educated (45.4%) adults aged 50-75 are less likely to screen for CRC3||Although higher than national levels, lower income (62%) and less educated (66.9%) adults aged 50-75 are less likely to screen for CRC4|
Community Health Worker (CHW) Interventions
Educational CHW interventions have been shown to increase client knowledge and awareness about CRC,5 as well as CRC screening.6 A study of a medically underserved region in Appalachian Kentucky examined the effectiveness of face-to-face CHWs delivering cancer education to male participants. The study found that men had a higher understanding of CRC six months following the CHW-provided education, and a higher percentage of participants reported asking their doctor about colorectal cancer.7
Education, outreach, and patient navigation are all methods by which CHWs promote CRC screening. A group of Chinese American lay health workers (LHWs) provided education about CRC screening to 81 Chinese American community members. Following the education sessions, fecal occult blood testing (FOBT) for CRC among the participants increased from 0% to 55.7%. In addition to screening rates, participant awareness of screening options, FOBT, sigmoidoscopy, and colonoscopy increased significantly, and the number of participants who believed that screening can prevent CRC increased from 39% to 82.9%.8
Health System Navigation
Patient navigation has been recommended and documented to increase CRC screening and appropriate follow-up care.9 A study comparing individuals from East Harlem, New York City both with and without patient navigators found that patient navigation can significantly improve screening rates among patients referred for CRC screening. Three months after the referral, 18.4% of patients with navigators had appointments for an endoscopy, compared to 0% of the control group. The navigation group was also more likely to complete an endoscopy 6 months following the referral (23.7% vs. 5.0%).10 A randomized trial of individuals with abnormal colorectal screenings found that patients with a patient navigator had their diagnoses resolved at a significantly quicker rate when compared to patients without a navigator.11
Article abstracts available by clicking the hyperlinked article titles above; full citations are located in the References category.
Fact Sheet: CHWs & Colorectal Cancer
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1. Downs LS, Smith JS, Scarinci I, Flowers L, Parham G. The disparity of cervical cancer in diverse populations. Gynecol Oncol 2008;109(2 Suppl):S22-S30. doi:10.1016/j.ygyno.2008.01.003.
2. Michigan Public Health Institute and Michigan Department of Community Health. The Cancer Burden In Michigan: Selected Statistics 1993-2011. Report. https://www.michigan.gov/documents/mdch/Ca_burden_MI_select_stats_1993-2011_371092_7.pdf. Accessed July 13, 2015.
3. Wu T-Y. Reducing Health Disparities in Asian American: Michigan Experience. Heal Asian Am Proj. http://www.michiganmhc.com/Documents/Tsu Yin Wu Presentation.pdf. Accessed August 17, 2015.
4. Cancer Prevention & Early Detection Facts & Figures 2015-2016. http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-045101.pdf. Accessed August 17, 2015.
5. Michigan Public Health Institute and the Michigan Department of Community. Special Cancer Behavioral Risk Factor Survey, 2008.; 2010. http://www.michigancancer.org/PDFs/Publications_Products/MCCSpecialRpt/SCBRFS_2008-042910.pdf. Accessed July 13, 2015.
6. O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-1192. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2947642&tool=pmcentrez&rendertype=abstract. Accessed May 18, 2015.
7. Schuster AL, Frick KD, Huh B-Y, Kim KB, Kim M, Han H-R. Economic evaluation of a community health worker-led health literacy intervention to promote cancer screening among korean american women. J Health Care Poor Underserved. 2015;26(2):431-440. doi:10.1353/hpu.2015.0050.
8. Mann L, Foley KL, Tanner AE, Sun CJ, Rhodes SD. Increasing Cervical Cancer Screening Among US Hispanics/Latinas: A Qualitative Systematic Review. J Cancer Educ. 2015;30(2):374- 387. doi:10.1007/s13187-014-0716-9.
9. Parra-Medina D, Morales-Campos DY, Mojica C, Ramirez AG. Promotora Outreach, Education and Navigation Support for HPV Vaccination to Hispanic Women with Unvaccinated Daughters. J Cancer Educ. 2015;30(2):353-359. doi:10.1007/s13187-014-0680-4.
10. Barrett RE, Cho YI, Weaver KE, et al. Neighborhood change and distant metastasis at diagnosis of breast cancer. Ann Epidemiol. 2008;18(1):43-47. doi:10.1016/j.annepidem.2007.07.001.
11. Markossian TW, Darnell JS, Calhoun EA. Follow-up and timeliness after an abnormal cancer screening among underserved, urban women in a patient navigation program. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1691-1700. http://cebp.aacrjournals.org/content/21/10/1691.short. Accessed May 18, 2015.