Taking CRC Screening to the Underserved
Taking CRC Screening to the Underserved
Hello. I am David Kerr, Professor of Cancer Medicine at University of Oxford, in the United Kingdom.
Fairness, inequity-- what does that mean to each or any of us? When I was a youngster growing up in Glasgow, there was a very famous left-wing theater company called 7:84. The implication of the name was that 84% of Scotland's wealth was in the hands of 7% of the population.
There is no doubt that because of public health interventions, technical advances in medicine, improved living conditions, and nutrition, all of us are living longer, better lives. But the gap between rich and poor grows ever wider, which is something I always find puzzling.
There is a very interesting and thought-provoking article in the Journal of the National Cancer Institute by Samir Gupta and colleagues, who have looked at colorectal cancer screening in underserved populations in the United States. They have brought together a coalition of the willing -- epidemiologists, gastroenterologists, public health specialists, primary care physicians -- to look at the problem of colorectal cancer screening in underserved groups. They define these as recent immigrants, people who are uninsured, certain racial and ethnic groups, and people who have low levels of education.
There is very striking evidence that despite the huge benefits of colorectal cancer screening in reducing the incidence and mortality associated with the disease, large swaths of the US population are untouched, and the whole concept of screening is passing them by. This sad reality is replicated in other countries. Even a socialized healthcare system like ours in the United Kingdom suffers from the same problems of underserved populations.
Having defined the population loosely but I think appropriately, this group has come up with a set of ideas about how we may reach out and better serve those populations. They would argue, I think reasonably, that it is in everyone's economic interest to help. The strong should help the weak; the rich should help the poor. We should come together as a more interwoven society to help those who are at the moment a bit beyond the reach of the society.
They propose 4 strategies. The first is to use the simplest, best test. I understand we have different screening options, all of which come with a different price tag. We should offer the simplest and best screening procedure we have rather than waiting for the gold standard, colonoscopy, which is expensive and not always available. There are geographic areas of the United States and elsewhere that simply do not have enough colonoscopic services to serve the whole population in those regions. Fecal occult blood testing is a cost-effective means for screening these sorts of populations.
Second, find a way to identify those who are not attending screening. Gupta and colleagues propose several clever ideas about tagging those who are not being screened through Medicare usage and using a variety of other public health measures to identify those who are not engaging with the screening program.
Third, they underscore the idea of reception -- how we can reach out better, and how we can make our screening more relevant, more practical? If a person is offered colonoscopy, that could require taking a day off work, coming with a family or partner, losing a day's wage, and a significant economic impact on any poor family. How can we make it easier? How can we take screening to the population, rather than asking the population to come to us?
Fourth, as always, there is a call for better funding of programs at the national, state, and local levels to move efforts forward.
The Kaiser Permanente Health System in San Diego, California, had some very interesting ideas. They implemented what they call "Super Saturdays," in which groups of volunteers would come together and offer medical, nursing, and other skills, such as student sigmoidoscopies and point-of-contact fecal occult blood tests, and so on. I like that notion. I like the sense of volunteerism and the notion of communities coming together and saying that regularly, on certain Saturdays, we will make the effort to reach out and make ourselves available in some way to serve the underserved.
Gupta and his coalition of colleagues offer a general point about health inequities, a more specific set of points around colorectal cancer screening, some good ideas as to how one might address these inequities, and a few decent examples of "big society" and volunteerism making a difference. This is, in a way, the micro-economy of health diplomacy.
I am interested in your comments. Thanks for listening. Medscapers ahoy!
Hello. I am David Kerr, Professor of Cancer Medicine at University of Oxford, in the United Kingdom.
Fairness, inequity-- what does that mean to each or any of us? When I was a youngster growing up in Glasgow, there was a very famous left-wing theater company called 7:84. The implication of the name was that 84% of Scotland's wealth was in the hands of 7% of the population.
There is no doubt that because of public health interventions, technical advances in medicine, improved living conditions, and nutrition, all of us are living longer, better lives. But the gap between rich and poor grows ever wider, which is something I always find puzzling.
There is a very interesting and thought-provoking article in the Journal of the National Cancer Institute by Samir Gupta and colleagues, who have looked at colorectal cancer screening in underserved populations in the United States. They have brought together a coalition of the willing -- epidemiologists, gastroenterologists, public health specialists, primary care physicians -- to look at the problem of colorectal cancer screening in underserved groups. They define these as recent immigrants, people who are uninsured, certain racial and ethnic groups, and people who have low levels of education.
There is very striking evidence that despite the huge benefits of colorectal cancer screening in reducing the incidence and mortality associated with the disease, large swaths of the US population are untouched, and the whole concept of screening is passing them by. This sad reality is replicated in other countries. Even a socialized healthcare system like ours in the United Kingdom suffers from the same problems of underserved populations.
Four Ideas to Improve Access to Screening
Having defined the population loosely but I think appropriately, this group has come up with a set of ideas about how we may reach out and better serve those populations. They would argue, I think reasonably, that it is in everyone's economic interest to help. The strong should help the weak; the rich should help the poor. We should come together as a more interwoven society to help those who are at the moment a bit beyond the reach of the society.
They propose 4 strategies. The first is to use the simplest, best test. I understand we have different screening options, all of which come with a different price tag. We should offer the simplest and best screening procedure we have rather than waiting for the gold standard, colonoscopy, which is expensive and not always available. There are geographic areas of the United States and elsewhere that simply do not have enough colonoscopic services to serve the whole population in those regions. Fecal occult blood testing is a cost-effective means for screening these sorts of populations.
Second, find a way to identify those who are not attending screening. Gupta and colleagues propose several clever ideas about tagging those who are not being screened through Medicare usage and using a variety of other public health measures to identify those who are not engaging with the screening program.
Third, they underscore the idea of reception -- how we can reach out better, and how we can make our screening more relevant, more practical? If a person is offered colonoscopy, that could require taking a day off work, coming with a family or partner, losing a day's wage, and a significant economic impact on any poor family. How can we make it easier? How can we take screening to the population, rather than asking the population to come to us?
Fourth, as always, there is a call for better funding of programs at the national, state, and local levels to move efforts forward.
Volunteerism to Serve the Underserved
The Kaiser Permanente Health System in San Diego, California, had some very interesting ideas. They implemented what they call "Super Saturdays," in which groups of volunteers would come together and offer medical, nursing, and other skills, such as student sigmoidoscopies and point-of-contact fecal occult blood tests, and so on. I like that notion. I like the sense of volunteerism and the notion of communities coming together and saying that regularly, on certain Saturdays, we will make the effort to reach out and make ourselves available in some way to serve the underserved.
Gupta and his coalition of colleagues offer a general point about health inequities, a more specific set of points around colorectal cancer screening, some good ideas as to how one might address these inequities, and a few decent examples of "big society" and volunteerism making a difference. This is, in a way, the micro-economy of health diplomacy.
I am interested in your comments. Thanks for listening. Medscapers ahoy!
