health

THE MICHIGAN CHRONICLE

March 31-April 6, 2010

Awareness, earlier screening key to reducing colorectal cancer deaths, disparities for African Americans

Physician experts from the American College

of Gastroenterology raised concern that the majority of African Americans are not aware of the recommendation that they should undergo colorectal cancer screening beginning at age 45 — five years before current guidelines general- ly recommend. They urge primary care doctors, family physicians and other community health care practitioners to understand the scientific data that supports the College’s guideline and educate their patients about the potential life- saving benefits of the earlier screening age.

“The American College of Gastroenterology

COVENANT HOUSE MICHIGAN recently received blanket

donations from Molina Healthcare of Michigan.

Molina Healthcare

provides blankets to homeless teens

To support the Covenant

House Michigan’s (CHM) goal to serve homeless and at-risk youths, Molina Healthcare of Michigan recently donated boxes of brand-new blankets to the organization.

“It’s so amazing to see Cov-

enant House’s commitment to protect and safeguard these neglected and vulnerable chil- dren,” said Jesse Thomas, president of Molina Healthcare of Michigan.

“Covenant House actually

has outreach staff that drives around the city in search for homeless teens so they can encourage them to come to CHM for help. Sometimes the kids refuse, but now at least the staff will be able to leave behind a clean and warm blan- ket for these at-risk youths.”

Covenant House Michigan

is a faith-based nonprofit orga- nization that provides hope to homeless, runaway and at-risk youth ages 13-22. CHM pro- vides shelter, educational and vocational programs as well as other support services to help youth overcome hurdles such as homelessness, unemploy-

ment, inadequate education, violence, drugs and gangs.

CHM’s goal is to redirect

these youths onto a path toward meaningful and suc- cessful adulthood. More than 35,069 youth have been served by CHM since its inception in September 1997.

Molina Healthcare,

Inc. is a multi-state managed care organization that arranges for the delivery of health care services to persons eligible for Medicaid, Medicare, and other government-sponsored pro- grams for low-income families and individuals.

Altogether, Molina Health-

care’s licensed health plan subsidiaries in California, Florida, Michigan, Missouri, New Mexico, Ohio, Texas, Utah, and Washington cur- rently serve approximately 1.5 million members.

For more information about

Molina Healthcare, Inc. and Molina Healthcare of Michigan can be obtained at www.moli- nahealthcare.com.

firmly believes — and the science supports — that colorectal cancer screening of African Americans by colonoscopy beginning at age 45 offers an opportunity to save lives and reduce the racial disparities that exist in colorectal cancer deaths,” said Dr. Philip O. Katz, presi- dent of the American College of Gastroenterol- ogy.

“As a whole the health care community

needs to do a better job of educating African Americans about colorectal cancer, their indi- vidual risk factors, the important differences in colorectal cancer between African Americans and Caucasians, and the lifesaving reasons for getting screened starting at age 45.”

Based on a review of scientific literature and

colorectal cancer data the American College of Gastroenterology in 2005 issued a new recom- mendation that colorectal cancer screening in African Americans should start at age 45, rather than age 50. The recommendation became part of the official ACG guideline on colorectal cancer screening, stating that colonoscopy is the preferred method of screening for colorec- tal cancer and recommending that African Americans begin screening at a younger age because of the higher incidence and mortality of colorectal cancer as well as a greater preva- lence of proximal or right-sided polyps and cancer in this population. The ACG guideline on colorectal cancer screening was published in the March 2009 issue of The American Jour- nal of Gastroenterology.

Colorectal cancer is the second leading cause

of cancer deaths in the United States. However, the survival rate for colorectal cancer is 90 percent if it is detected early. African Ameri- cans are diagnosed with colorectal cancer at a younger age than whites, and once diagnosed with colorectal cancer have decreased surviv- al compared with whites — colorectal cancer deaths are 48 percent higher for African Ameri- cans than for Whites, according to the Ameri- can Cancer Society.

While overall colorectal cancer rates are declining, increasing incidence in men and

women younger than 50 years of age is of con- cern, according to the latest National Cancer Institutes Annual Report to the Nation.

Although colorectal cancer screening has

been found to be an effective tool for the con- trol and prevention of this cancer it is unde- rutilized by African Americans — one reason for the racial disparities in colorectal survival rates.

“Efforts to increase awareness of the new

guideline and promote benefits of colorectal cancer screening are still needed among Afri- can Americans and their primary care doctors,” said A. Steven McIntosh, MD, FACG, a gastro- enterologist in Snellville, Ga.

“Every day I see African American patients

who come into my office at 50, 51, 53 who are completely unaware that they should have been screened for colorectal cancer at age 45 — ‘My doctor never told me that. I thought it was 50,’ they tell me,” said McIntosh.

Overall colorectal cancer screening rates fall

short of desirable levels, according to a recent National Institutes of Health State-of-the-Sci- ence Conference Statement. The report calls for targeted initiatives to improve screening rates and reduce disparities in underscreened com- munities, which could further reduce colorec- tal cancer morbidity and mortality.

The NIH report also calls for a number of

measures aimed at increasing screening rates, including:

• Widely implementing interventions that

have proven effective at increasing colorectal cancer screening such as patient reminder sys- tems and one-on-one interactions with provid- ers, educators or navigators.

• Tailoring specific approaches to match

characteristics and preferences of target pop- ulation groups to increase colorectal cancer screening.

• Implementing systems to ensure appro-

priate follow-up of positive colorectal cancer screening results.

• Eliminating financial barriers to colorectal

cancer screening and appropriate follow-up. Recognizing the racial disparities that exist in

colorectal cancer diagnosis and survival, some health systems are implementing the College's guidelines and screening African Americans at an earlier age. In Minnesota, HealthPartners Medical Group announced in January that it is using patient health data to generate electronic messages to inform African American patients 45 and over that they are due for a colonoscopy — based on the College’s guidelines.

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Page C-5

Blacks and colorectal cancer

African Americans have the

highest incidence of colorec- tal cancer and highest mortal- ity rate of any racial or ethnic group.

Approximately 16,520 cases

of colorectal cancer and 7,120 deaths were estimated among African Americans in 2009.

During 2001-2005 average

colorectal cancer incidence rates for African American men were 71.2 per 100,000 com- pared to 58.9 for White men and 54.5 for African American women compared to 43.2 for White women. As a group, in- cidence rates for Caucasians were 50.1 per 100,000 com- pared with 61.2 per 100,000 for African Americans.

In 2001-2005, incidence

rates in African Americans as a group were 22 percent higher than those in Caucasians; 21 percent higher in African- American men when com- pared to Caucasian men, and 26 percent higher in African American women when com- pared to Caucasian women.

Colorectal cancer mortality

rates in 2001-2005 were 18.3 per 100,000 in Caucasians and 26.1 per 100,000 in Afri- can Americans — 43 percent higher in African American than in Caucasians.

During 2001-2005 mortal-

ity rates for African-American men were 31.8 per 100,000 compared to 22.1 for Cauca- sian men; and 22.4 for African American women compared to 15.3 for Caucasian women.

African Americans with

colorectal cancer have de- creased survival compared with whites. From 1999-2005, the five-year survival rate in African Americans was 56 per- cent, and 66 percent in Cauca- sians.

Part of the explanation for

the decreased survival of Afri- can Americans with colorectal cancer is that a greater pro- portion present with Stage IV diseases. This effect has been ascribed to lower screen- ing rates, less use of diagnos- tic tests, and less access to health care. Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36