Colon cancer is a highly curable disease if caught in early stages...drop trou and get to it!
Image Source: cancer.ca
No one wants to talk about it but it’s time to face the music and get screened for colon cancer. Colon cancer is the second most deadly cancer in the United States (cancer.org, 2016). It’s also highly treatable if found in early stages (cancer.org, 2016). The problem is getting screened for colon cancer is not the most fun thing to do because it has to do with your BUM! Push your modesty aside and let the professionals do their jobs.
Screening for colon cancer can be done in a variety of ways, each detecting colon cancers at different rates. A smear of stool, called a “guaiac based fecal occult blood test (gFOBT)” can detect blood in stool, which could warrant more advanced tests such as a flexible sigmoidoscopy or a colonoscopy (cancer.org, 2016). The gFBOT is not completely accurate with detecting all cancers and pre cancers, but it is a relatively simple and inexpensive test that may be done annually as part of a screening for low risk patients (cancer.org, 2016). Higher risk patients, such as those with a personal or family history of colon cancer or bowel related diseases, such as Crohn’s or colitis, should be screened according to recommendations from their doctors (cancer.org, 2016).
To help promote colon cancer screenings, the Centers for Disease Control (CDC) adapted the social ecological model (SEM) of health promotion (CDC.gov, 2015). The SEM is a multi level model that places individuals in the center of five concentric rings that represent different levels of influence that may affect the individual in their choice and opportunity to be screened for colon cancer (CDC.gov, 2015). The levels are: individual, interpersonal, organizational, community and policy (CDC.Gov, 2015). The implementation of multiple interventions across many levels of influences maximizes the impact on individuals, increasing the chances of colon cancer detection rates (CDC.gov, 2015).
The Individual Level-At the individual level, the focus is on the beliefs, perceptions and knowledge of the individual (CDC.gov, 2015). Demographic characteristics such as gender, race and socioeconomic level are also considered at this level (Moore, Buchanan, Temeika, & Smith, 2015). By influencing the individual from other levels in the model, an individual’s attitude towards being screened for colon cancer may be impacted.
The interpersonal Level-At the interpersonal level, promotion for colon cancer screening is influenced by friends, family, and other social networks (Moore et al, 2015). Promotion may be completed at the doctor’s office, with discussion aimed towards the individual’s risk factors (CDC.gov, 2015). If colon cancer screening is seen as a routine test, individuals are more likely to comply with recommendations (Greene, 2012). Patient navigators can help overcome logistical barriers (such as transportation to appointments) to complete screenings (CDC.gov, 2015).
The Organizational Level-At the organizational level, funding and payment for colon cancer screening is a very important factor to people when considering the screening process. Thus, publicly funded and private insurances policies are a crucial component of this level of influence (Greene, 2012). Workplaces can adopt policies to encourage preventative care and healthcare organizations can utilize reminder systems to encourage screenings (CDC.gov, 2015).
The Community Level-At the community level of the SEM are influences such as media, community organizations and research institutions (CDC.gov, 2015). Community and regional wide educational interventions may impact screening rates, such as this video produced by the Massachusetts Department of Public Health:
Community impacts can be very influential as the promotion may be tailored to the community’s needs based upon factors such as language, culture and socioeconomic factors (Greene, 2015).
Federal and Policy Level-The final level of the SEM is policy implementation (CDC.gov, 2015). This involves interpreting and implementing policies and recommendations (CDC.gov, 2015). Examples include federal initiatives such as Healthy People 2020 goals for reducing deaths related to colon cancer (CDC.gov, 2015). Legislation is an important component of this level. In 2010, The Affordable Care Act enacted legislation that new insurance policies and Medicare cover the complete cost of colon cancer screenings (cancer.org, 2016).
In a 2012 article published in Medical Sociology Online, Dana M. Greene explored the application of the SEM in the disparities in colon cancer screenings related to race, socioeconomic background, education level, ethnicity and regional location. The author noted overall screening rates are low for all populations, however particularly low for African Americans, especially female African Americans. An alarming fact is the death rate of African Americans from colon cancer is double the rate of Caucasians (Greene, 2012). Although the incidence of colon cancer and mortality related to it are highest in African Americans (for unknown reasons), the fact remains the disease is 100% preventable if screened for and caught early (CDC.gov, 2016; Greene, 2012).
Greene presented reasons for which low screenings rates may be the case, citing embarrassment related to the nature of the testing, lack of education at the individual and healthcare provider level, as well as disparity in the way certain groups are treated by healthcare providers and institutions (Greene, 2012). Noting the policy of complete payment for colon cancer screening by Medicare and Medicaid insurances, as well as all new insurance policies, Greene posits the concentration of influence should take place at the community level so as to trickle down to organizations, to interpersonal relationships, and finally to individual levels to increase rates of colon cancer screening (Greene, 2012).
Greene proposed educational programs be presented regarding the outcome of screening for colon cancer. For example, it is not necessarily resection of the colon in the case cancer is found; however, focusing on early detection, it can be explained less intervention is required the sooner something is discovered (Greene, 2012). Another proposal is to make gFOBT part of routine medical exams, so it is not seen as a special test (Greene, 2012). Healthcare providers and clinic personal should be aware of current screening guidelines and policy related to payments so individuals can have accurate information to make decisions for further screening if indicated (Greene, 2012). Furthermore, Greene posits individuals must trust and identify with their healthcare providers to undergo tests that may be considered scary (Greene, 2012).
It’s time to remove the stigma and embarrassment of screening for colon cancer. There is no excuse for not being checked for early signs of colon cancer. Addressing barriers at multiple levels of influence can help promote screening rates for the entire population.
References
https://www.youtube.com/watch?v=HBGjhQDMFek&feature=youtu.be
Greene, D. (2012). Health disparities in colorectal cancer screening in the United States: An application of the social ecological model. Medical Sociology Online. 6(2). 3-11. Retrieved from: http://www.medicalsociologyonline.org/resources/Vol6Iss2/MSo_6003_Health_Disparities_Greene.pdf
Moore, A., Buchanan, N., Temeika, F., & Smith, J. (2015). Public action model of cancer survivorship. American Journal of Preventative Medicine. 40(6). 470-476. https://doi.org/10.1016/j.amepre.2015.09.001