August 2019 Dallas Medical Journal 21
Hispanic women are up to date with
the recommended CRC screening,
compared to 60% of Non-Hispanic
Whites.4 To increase screening
rates in Hispanics, considerations
need to be taken into account that
address the barriers impacting this
patient population. Strategies that
have proven beneficial at increasing
screening rates in Hispanics
revolve around reducing structural
barriers and incorporating culturally
appropriate interventions.
Tailoring to individual needs by
using patient navigators, lay health
educators who provide languageappropriate
instructions/education,
and explore and address individual
barriers, can be an effective
strategy.21 In a study in Texas, the
use of patient navigators resulted in
a statistically significant higher rate
of screening (43.7%), compared to
32.1% in the non-navigated group.22
Furthermore, direct mailing of fecal
occult blood testing (FOBT) kits can
be beneficial. A study examining
the effectiveness of mailing FOBT
kits directly to patients, in addition
to using patient navigators, found
that the outreach group had a
statistically significant higher rate of
screening (30%), compared to 5% in
the usual care group.23 Because of
the financial barriers to colonoscopy
and reported embarrassment,24
the mailing of FOBT kits can be
an effective strategy at increasing
screening rates in this population.
The efficacy of FOBT screening
is considered successful only if
positive tests are followed-up with
colonoscopy. Methods that have
proven successful at increasing
follow-up colonoscopy after a
positive FOBT include the use of
navigators to aid patients’ journey
through the complex medical
system and the implementation
of systems that directly notify a
Gastroenterologist of positive FOBT
results.25 Despite the outreach
efforts, screening rates in the
intervention groups are still far below
the Healthy People 2020 benchmark
of 70.5%.22,23 Addressing the limited
access to primary care providers
and increasing awareness could
potentially improve screening rates.
CONCLUSION
Hispanics are the largest and
fastest-growing minority group in
the US.26 Additionally, the median
age for Hispanics of Mexican origin
is 25 years, the lowest compared to
other Hispanic subgroups,27 and as
the population ages, it is anticipated
that the relative incidence of CRC
will rise. Efforts at increasing
awareness, decreasing the barriers
to CRC screening, and promoting
healthy lifestyle habits are needed to
change future trends. DMJ
continued on page 23 ►►
Colorectal cancer
(CRC) is the third
most common
cause of cancerrelated
death in
men and women,
accounting for
9% and 8%,
respectively, of
all cancer-related
deaths in the US.