Black Kentuckians need more information about colon cancer screening, especially the availability of in-home tests, study finds

By Elizabeth Chapin

University of Kentucky

A recent study at the University of Kentucky’s Markey Cancer Center highlights the need for increased outreach and education to reduce colorectal cancer screening disparities in Black communities.

According to the study, published in the Journal of Cancer Education, people in Kentucky’s Black communities may not be aware of all of the colorectal-cancer screening options available to them, particularly stool-based tests.

Black communities are disproportionately affected by colorectal cancer. In Kentucky, Blacks who have colorectal cancer are more likely to die from the disease than whites.

Since about half of the racial gap can be explained by differences in screening rates, educating Black communities about screening options can save lives, says Markey Cancer Center researcher Aaron Kruse-Diehr, the study’s principal investigator.

“In the colorectal-cancer screening world, we like to say ‘the best test is the one a patient completes’ — and giving people multiple options has been shown in previous studies to increase their likelihood of completing screening,” said Kruse-Diehr, who is an associate professor in the UK College of Medicine. “To reduce the Black-white colorectal cancer mortality rate, we need to make sure Black people of screening age are being provided all available options.”

Regular screening, beginning at age 45 is the key to preventing colorectal cancer and finding it early. Two types of tests are recommended by the U.S. Preventive Services Task Force: visual exams (primarily colonoscopies) and tests that check a stool sample for signs of cancer. Stool-based tests are less invasive and, for many, more accessible since they can be done at home.

Kruse-Diehr said, “Home tests can reduce a number of both individual-level and structural barriers that often exist for many people with respect to completing colonoscopy, such as needing to take time off work, finding an individual to drive the person to/from the procedure, and travel distance to a provider who can perform colonoscopy.”

The research team partnered with five Black churches in Louisville, which has bihg racial differences in screening, to conduct focus groups exploring screening barriers and facilitators for cancer education and outreach.

While focus-group participants overwhelmingly recognized the importance of being up to date with screening, nearly all reported that they had never heard about stool-based tests or heard health-care providers offer them as an option.

To address this knowledge gap, participants stressed community-based outreach and communication from trusted individuals, such as local Black medical providers and colorectal cancer survivors.

Kruse-Diehr led the study with Elizabeth Holtsclaw, cancer support strategic partnerships manager at the American Cancer Society. Two of the study’s co-authors, College of Public Health undergraduates Carlee Combs and Rose Wood, helped analyze the data and write the results as part of an independent-study course.

The research team is now planning to pilot a church-based screening program with one of the partner churches, with hopes of eventually expanding the program across Kentucky.

“These study results are informing outreach efforts that we hope will make a huge dent in the death rates from colorectal cancer among Black Kentuckians,” said Kruse-Diehr.

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