March is National Colorectal Cancer Awareness Month



The month of March is National Colorectal Cancer (CRC) Awareness Month. I dedicate this month’s article to all CRC survivors and the loved ones of persons impacted by CRC. Together, we will continue to champion CRC prevention, treatment and control efforts.

According for the Centers for Disease Control, CRC is cancer that occurs in the colon or rectum. CRC affects men and women of all racial and ethnic groups. It is often found in persons aged 50 years and older, but it can also be found in younger persons. In the United States, CRC is the third most common cancer for men and women.

In terms of death rates, CRC is the third-leading cancer killer in the United States for both men and women. However, for Latinos, CRC is the second-leading cancer killer in the United States. Also, Latinos have more late-stage diagnosis of CRC. Late-stage CRC is more difficult to treat. The good news is that early detection of CRC improves survivorship.

Can CRC be prevented? The answer is yes. CRC is one of the most preventable cancers. Detection and removal of adenomatous polyps has been shown through randomized clinical trials to reduce CRC incidence and mortality rates.

Testing can stop CRC before it starts or find it early, when it is likely to be easier to treat. Diet and exercise also play an important role in CRC prevention.


CRC Risk Factors

Modifiable risk factors (things you can change) include: high red/processed meat intake, cooking meats in high temperatures, low dietary fiber intake, low physical fitness levels, overweight/obesity, smoking and diabetes. Non-modifiable risk factors (things you cannot change) include: age, genetics, family history of CRC, having had polyps or CRC and having a history of bowel disease.


Underutilization of CRC Screening

CRC screening can save lives. Unfortunately, CRC screening rates remain low for Latinos in the United States, including Pennsylvania. In Pa., in 2010, only 64 percent of adults 50 years and older said they were “up-to-date” with CRC screening. “Up-to-date” means the person had a fecal occult blood test (FOBT) during the previous year, a sigmoidoscopy within the past five and a FOBT within the previous three years, or a colonoscopy within the previous 10 years. These screening rates are much lower for Latinos. This may be due to existing or perceived barriers to CRC screenings.


Barriers to CRC

Barriers reported to CRC screening among Latinos in the United States include: lack of health care coverage, low levels of education, fatalism, lack of knowledge about or awareness of CRC, language barriers, lack of insurance, undocumented legal status, seeking health care only when sick, fear, denial, other needs more pressing than preventive care, use of home remedies rather than biomedical care, lack of communication skills and self-efficacy skills to act on motivation, unavailability and inaccessibility of FOBT test kits, perceived lack of social support and physician recommendation.


Barriers to CRC Among Latinos in Pennsylvania

In 2012, we (Drs. Oralia Dominic and Eugene Lengerich) published results of a first-ever research study in Pennsylvania comparing CRC screening behaviors of Latinos by geography (urban and rural) and gender status. They also examined barriers to CRC screening among this population.

In this study, we found substantial barriers by sex and geography, including urban residents who received screenings during annual check-ups, while rural residents received screenings in response to symptoms. Low levels of health literacy, knowledge and awareness of CRC risk and screening were reported barriers across groups. The family unit and strong social support were also factors reported as influencing their CRC screening behavior. Participants identified 57 barriers to CRC screening that fit into five categories: (a) physical environment, (b) structural factors, (c) sociocultural factors, (d) individual factors and (e) physician-related barriers. Latino participants also identified potential strategies to overcome each reported barrier. These findings suggest that a targeted CRC screening intervention utilizing a physician-recommended home fecal immunochemical test with instructions is preferred among Latinos over a non-targeted approach.

In 2013, we conducted (Drs. Oralia Dominic, Eugene Lengerich, and Thomas McGarrity, and Jimithy Hawkins) a free CRC screening among Medically Underserved Adults Utilizing Medical Facilities and FQHCs: A Centers for Disease Control-Pennsylvanian Department of Health (PADOH) Funded Project in Pennsylvania. The purpose of this work was to develop, implement and evaluate a targeted CRC screening intervention to increase CRC screening uptake among medically underserved adults residing in Central Pa. who did not have a CRC screening based on the USPSTF screening guidelines. We measured actual CRC uptake as a method to determinate completion rates. The project was a community-based participatory research (CBPR) designed to determine completion of a provider-recommended, take-home FIT kit with education and social support components among a sample of average- or increased-risk adults age 50 and older not currently adherent to national CRC screening guidelines. This screening opportunity was offered at partnered community-based sites utilizing five health facilities (one academic institution, one medical center, two FQHC and a community clinic). Each consented participant attended a one-time CRC screening offered at one of the participating project sites located in Central Pa. This project demonstrated increased completion rate from baseline 24 percent to 66 percent at post project intervention among previously non-adherent medically underserved adults in Central Pa. A CBPR approach utilizing this model seems to be effective strategy for improving CRC screening uptake among these medically underserved adults.

To learn more about this project, please contact me by email at


Talk with Your Doctor about CRC Risk

Talk with your doctor about finding ways you can prevent, control and treat CRC. Talk to your doctor about CRC screening options for your and your loved ones. CRC screening saves lives. Remember, early CRC detection improves survivorship. If you have diabetes, please talk with your doctor about CRC risk.


Remember, you can protect yourself from CRC. You can send your health questions to ¡Hola, Oralia! at Together we can help keep Pennsylvania residents healthy! ¡Salud!

Oralia Dominic

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