March is Colorectal Cancer Awareness Month, and the Indian Health Service (IHS) is raising the awareness of colorectal cancer (CRC), a leading cause of cancer deaths among American Indian and Alaska Native (AI/AN) men and women. Over the past two decades there has been a decline in the CRC death rate for most racial and ethnic groups, but a recent study revealed that from 1990-2009 there was no decrease in the CRC death rate for AI/AN .
Colorectal Cancer Screening
Screening is an effective way to reduce the number of deaths from CRC, since the likelihood of surviving CRC increases greatly when the cancer is detected in its earliest stages. CRC screening is recommended for all average-risk, asymptomatic, 50-75 year old women and men. Multiple CRC screening options are available, including: stool blood tests, stool DNA test, colonoscopy and CT colonography. Providers should discuss with patients the options that are available at their facility, and determine which one is preferred by each patient. The best test is the one that gets done!
The percentage of AI/ANs who are utilizing CRC screening services remains low. According to Government Performance and Results Act or GPRA data, only around 40% of the eligible IHS user population was up-to-date with CRC screening in 2016. While there are often many barriers to screening in AI/AN communities, there are also ways to make it easier for people to get screened. A recent study at three tribal health facilities, for example, demonstrated that CRC screening participation could be significantly increased, compared to usual care, by mailing FIT kits (requiring collection of only one stool sample), along with instructions, a letter from the clinic, and a stamped return envelope, directly to patients’ homes.
80% by 2018 Campaign
The National Colorectal Cancer Roundtable is leading a national effort to have 80% of adults ages 50 and older to be screened for CRC by the year 2018. The "80% by 2018" effort is designed to educate and mobilize those who are not getting screened. AI/AN specific colorectal health resources, such as digital stories, radio PSAs, videos, brochures, flip charts, reminder postcards, and more, can be found at the Albuquerque Area Southwest Tribal Epidemiology Center's Tribal Colorectal Health Program website and the Alaska Native Epidemiology Center's Colorectal Cancer Control Program website .
Donald Haverkamp, MPH, CPH, is an epidemiologist with the Division of Cancer Prevention and Control at CDC. As a field assignee in New Mexico, he collaborates with the Indian Health Service Division of Epidemiology and Disease Prevention and various Tribal organizations, implementing strategies and projects designed to increase colorectal cancer screening among American Indian and Alaska Native people.