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Barriers to break for health's sake

Economic realities, gender beliefs hinder access to colon-cancer screening among Hispanics in Lower Yakima Valley
Drs. Gloria Coronado (left) and Beti Thompson
Drs. Gloria Coronado (left) and Beti Thompson found a variety of obstacles and attitudes stood in the way of colon-cancer screening in the study population, including inability to take time off from work, pride and fear. Photo by Todd McNaught

Hispanics are more likely to have more advanced-stage colon cancer or larger tumors at the time of diagnosis than non-Hispanic whites, primarily because of barriers related to the use of screening services. A new study from researchers in the Public Health Sciences Division is the first-ever to assess those barriers, a key to devising better strategies for overcoming impediments to getting screening tests and ultimately saving lives.

Drs. Beti Thompson, Gloria Coronado, Marian Neuhouser and Lu Chen — all part of the Cancer Prevention Program — analyzed interviews from a National Cancer Institute (NCI) — funded community randomized trial of nearly 1,800 adults in Washington's Lower Yakima Valley, which included questions about colon-cancer screenings, attitudes and beliefs. Results of the study were published in the June 15 issue of the journal Cancer.

The scientists found that Hispanics were less likely than non-Hispanic whites to have ever received basic colon-cancer screening tests: a fecal occult blood test (a simple lab test that detects blood in a small stool sample) or sigmoidoscopy/colonoscopy (an examination of the bowels using a slender tool with a light and camera).

Cancers found at an early stage are more easily treated. Among patients whose colon cancer is caught early, nine out of 10 will be alive five years later.

The researchers found a variety of obstacles and attitudes stood in the way of colon-cancer screening in the study population, ranging from lack of insurance and the inability to take time off from work to embarrassment, pride and fears about cancer.

Only 73 percent of Hispanics in the study population had health insurance compared to more than 93 percent of non-Hispanic whites. "That means 27 percent — more than a quarter of Hispanics studied — have no Medicaid, no Medicare, no private insurance, nothing," Thompson said.

An estimated 65 percent of the Hispanics in the Lower Yakima Valley are employed by the agricultural industry, working the fields and applying farm chemicals, among other tasks. The seasonal, intensive labor produces preventive-care hurdles.

About 25 percent of the respondents said they could not take time off from work to obtain cancer-screening tests, and a similar percentage had no transportation to get to a clinic or physician. "They have to travel to area hospitals that do the sigmoidoscopies and colonoscopies, and that's a big burden," Thompson said. "It's really hard for them to go for screening because when they're not working, they're losing money."

The prevalence of recent screening using fecal occult blood tests has improved among the Hispanics, but less than 25 percent reported recent use of sigmoidoscopies and colonoscopies. "The fecal tests are done at nearby clinics where the Hispanics receive their care, ones that offer sliding-fee scales," Coronado said. However, those clinics are busy dealing with acute care needs, and don't have much time to deal with prevention, she says.

Gender beliefs influenced behavior, too. Hispanic men are the least frequently screened populations for colon cancer. This is due, in part, to fears about being seen as weak, Coronado said. "Many Hispanic men don't go to the doctor because there's a belief that if they can take care of illness on their own, they're strong," she said.

Given the invasive nature of sigmoidoscopies and colonoscopies, embarrassment is also a factor for Hispanic males. "We've heard from health care providers that these men feel anything penetrating the colon is considered 'gay,' so there's a lot of reluc-tance to get this type of exam," Coronado said.

Coronado and Thompson recently started work on another project in the Lower Yakima Valley, a five-year NCI-funded grant to reduce cancer disparities in the area through community collaboration. While the researchers are advocating for screening programs as part of the efforts, they also know the screening rates reflect the distraction of day-to-day concerns. "When you're struggling to make a living and put food on the table, one of the last things you worry about is your own long-term health," Thompson said. "It's difficult to change these basic priorities and attitudes without a change in living standards. The root problem is poverty."

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