Teddi Mellencamp, celebrity known for her appearance on the

, is currently battling stage 2 melanoma. She discovered this at her 3-month checkup after an initial melanoma surgery. Right now, Mellencamp is using her celebrity platform to stress the importance of returning for checkups as instructed to do that by a physician.

I live in Florida which has been ranked second in the nation for new melanoma cases.

In 2018, there were 7940 cases of melanoma diagnosed in Florida, and it is estimated that nearly 1 out of every 10 Floridians receive a skin cancer diagnosis in their lifetime. Although I have seen many cases of metastatic melanoma in the hospital where I work, melanoma awareness should extend beyond Florida. It is a common disease which affects individuals all over the country.

In 2022, the American Cancer Society estimated that there were 99,780 new cases of melanoma and approximately 7650 cases are expected to be fatal.

At the very least, 3-month checkups after an initial diagnosis are required, which is why Mellencamp returned to the dermatologist. The American Society of Clinical Oncology recommends that physical and skin examinations be performed every 3 to 6 months for the first 2 to 3 years following surgery and annually thereafter.

 For some patients, a chest x-ray, CT scan, MRI, and/or PET-CT scan may also be recommended.

Mellencamp originally received a diagnosis of stage 0 melanoma, also known as in situ, in March 2022. This was not her first 3-month checkup and it was during the most recent appointment that new findings near the original spot were discovered. In addition, a PET scan revealed lymph node involvement1. At the time of writing, she is currently scheduled to receive genetic testing.

Mellencamp has a huge Instagram following of 1 million fans and she is posting her photos and updates about her treatment plan. Her hope is that other patients with melanoma will take her lead and return to the doctor in a timely fashion. Many times, in the hospital setting, patients become what is known as “lost to follow-up.” I have seen this more times than I can count. For RNs and social workers, the risk of patients not returning to their oncologist or primary care doctor for screenings or later check-ups is a serious reality. Patient education and discharge instructions are something that we are all familiar with and that cannot be stressed enough to patients. 

Celebrities can be huge in raising awareness. For instance, celebrity shows like Stand Up To Cancer have a huge impact.

 Every 2 years, Stand Up To Cancer (SU2C) produces a roadblock televised fundraising special, supporting urgently needed research and new treatments for cancer. The last program aired in 2021 during the middle of the Covid-19 pandemic. The program highlighted all the research this organization has completed in the past decade and featured performances by noted Hollywood stars. The show is coproduced by Reese Witherspoon and her husband, Jim Toth, who is a talent agent as well. The program also showcased survivor stories. The mission statement of this program is “collaborative, multidisciplinary, multi-institutional scientific cancer research.”

Working on surgical oncology floors at night, I frequently see patients watching TV and movies all night in between getting pain medications. I think that the RN working in oncology should have an awareness of the importance of everyday heroes like our favorite TV and movie stars who have survived cancer. I know that nurses and social workers unwind with things other than journals, and this is a good opportunity to blend the 2.

Mccarthy A. I feel blessed!’ ‘ROBH’ star Teddi Mellencamp, 40, celebrates ‘good news’ after her frightening close call with cancer. Survivornet. March 24, 2022. Accessed November 3, 2022. 

Melanoma by the state: Florida. Aim At Melanoma Foundation. Accessed November 3, 2022. 

Key statistics for melanoma skin cancer. American Cancer Society. Accessed November 3, 2022. 

Melanoma: follow-up care. Cancer.net. December 2021. Accessed November 3, 2022. 

What we do. Stand Up To Cancer. Accessed November 3, 2022. 

Articles

Celebrated reality star Teddi Mellencamp is using her Instagram as a platform to stress the importance of follow-up visits for patients with melanoma.

Opinion: Oncology Nurses Should Know the Celebrity Stars Raising Cancer Awareness

According to the World Health Organization

 there are over 1 billion individuals living with a disability, representing approximately 15% of the world’s population. In the United States, the Center for Disease Control reports that 1 in 4 adults have some type of disability.

Individuals with disabilities can be described as the largest minority group in the world; disability intersects across all demographics and rates of disability are increasing. Almost everyone will experience either a temporary or permanent disabling condition along their life span.

Early cancer detection saves lives, whereas delayed detection results in late-stage diagnoses and higher mortality. Compared with women without disabilities, women with disabilities have lower rates of breast and cervical cancer screenings. According to a study based on the 2013 National Health Interview Survey, prevalence of Papanicolaou tests among women with disabilities between ages 21 and 65 years ranged from 66% to 80%, compared with women without disabilities (81%).

 Prevalence of mammograms among women with disabilities between ages 50 and 74 years was 61% to 68% compared with women without disabilities (73%). Women with mobility limitations had the lowest prevalence of receiving a Papanicolaou test, and women with cognitive impairment had the lowest prevalence for mammograms. Among adults with disabilities ages 50 and 75 years, screening for colorectal cancer ranged from 49% to 65% and was 57% among adults without disabilities. Individuals with disabilities experience disparities in cancer screenings and are at higher risk for late-stage diagnoses.

A mixed methods systematic review investigated the barriers and facilitators of access to cancer services for people with physical disabilities.

 Five themes emerged from eighteen studies including: reasons for not engaging in preventive health care behaviors; interactions with health care providers (HCPs); external factors; accessibility of facilities; and positioning for procedures. Barriers to care included a lack of knowledge, personal beliefs systems, time constraints, and competing priorities. HCPs with poor attitudes, lack of knowledge and sensitivity, or failure to give needed referrals or information also were viewed as barriers. Receiving letters, post cards, or phone calls as reminders were viewed as facilitators as well as treating the person with a disability as an expert in their own care.

Women with disabilities were more likely to return for repeat mammograms when initially treated with sensitivity. External factors such as finances, transportation and accessible facilities could be improved with reliable transportation, and disabled parking spaces. Referrals to clinics with accessible equipment, ramps, and allotting additional time for appointments to allow for personal needs such as dressing or undressing were seen as facilitators. Regarding positioning, having a second technician to assist with safety, handrails, or being able to sit for a mammogram were suggested.

Resources for Evidenced-Based Care for People With Disabilities

To be part of the solution, nurses and other HCPs need the right tools to gain the competencies as well as the confidence to advocate for change for indivduals with disabilities. 

Alliance for Disability in Health Care Education

offers a set of core competencies that define standards and care for interprofessional teams to address health care disparities and improve outcomes for individuals with disabilities.

It is never too early to introduce nursing competences specific to the care of people with disabilities within prelicensure curriculum. A set of 12 simple, yet flexible, competencies distinctly specific to disability culture and care were developed by this author and colleagues. These competences were divided into 4 dimensions—environment and care, communication, culture, and referral—and are adaptable to any nursing curricula (

National League for Nurses (NLN) has developed the Advancing Care Excellence for Persons with Disabilities Program

 to support nursing education so that high quality care is delivered by nurses who are both knowledgeable and sensitive to the needs of individuals with disabilities. This online resource provides case studies, teaching strategies, and other resources to expand nurses’ abilities.

Caring for People with Disabilities: The Nurse Practitioner Tool Kit

to help prepare nurse practitioner (NP) students and practicing NPs as frontline workers to be part of the solution and fill a significant gap in NP training.

To summarize, it is imperative that nurses and other HCPs not only recognize the disparities in preventive screenings, but also to be part of the solution. Early detection and cancer treatment must be accessible and will save lives.

Disability and health. World Health Organization. November 24, 2021. Accessed October 26, 2022. 

Disability and health overview. Centers for Disease Control and Prevention. Updated September 16, 2020. Accessed October 26, 2022. 

Steele CB, Townsend JS, Courtney-Long EA, Young M. Prevalence of cancer screening among adults with disabilities, United States, 2013. 

 2017;14:160312. doi:10.5888/pcd14.160312

Edwards D J, Sakellariou D, Anstey S. Barriers to, and facilitators of, access to cancer services and experiences of cancer care for adults with a physical disability: a mixed methods systematic review.

2020;13(1):100844. doi:10.1016/j.dhjo.2019.100844

Teaching and learning resources. Alliance for Disability in Health Care Education. Accessed October 26, 2022. 

Advancing care excellence for persons with disabilities. National League for Nursing. Accessed October 26, 2022.

Caring for people with disabilities: the nurse practitioner tool kit. Villanova University M. Louise Fitzpatrick College of Nursing. Accessed October 26, 2022. 

Kronk R, Colbert AM, Smeltzer SC, Blunt E. Development of prelicensure nursing competencies in caring for people with disabilities through Delphi methodology. 

2020;45(3):E21-E25. doi:10.1097/NNE.0000000000000712

Development of Prelicensure Nursing Competencies in Caring for People With Disabilities Through Delphi Methodology; Nurse Educator45(3):E21-E25, May/June 2020.

It is imperative that nurses and other health care professionals not only recognize the disparities in preventive screenings but become part of the solution. Early detection and cancer treatment must be accessible for those with disabilities, as it can help save lives.     

Improvements in Accessibility to Cancer Screenings Are Needed for Individuals With Disabilities

Guidelines suggesting that women initiate colorectal cancer (CRC) screening before the age of 50 years are now backed by empirical evidence, according to a study published in 

 The findings identified a greater absolute reduction in CRC risk among women who received an endoscopy before age 50 years.

Overall, compared with those receiving no endoscopy, there was a significantly lowered risk of CRC incidence among those receiving an endoscopy before age 45 years (HR, 0.37; 95% CI, 0.26-0.53) compared with 45 to 49 years (HR, 0.43; 95% CI, 0.29-0.62), 50 to 54 years (HR, 0.47; 95% CI, 0.35-0.62), or 55 years or older (HR, 0.46; 95% CI, 0.30-0.69).

Compared with women receiving an endoscopy between 50 to 54 years, the absolute reduction in the cumulative incidence of CRC was 72 per 100,000 persons for women who were screened between 45 to 49 years. Moreover, compared with no endoscopy, an endoscopy before the age 50 years was linked to a reduced risk of CRC diagnosis before the age of 55 (< 45 years: HR, 0.45; 95% CI, 0.29-0.70; 45 to 49 years: HR, 0.43; 95% CI, 0.24-0.76).

Following a growing number of patients under age 50 years receiving a diagnosis of CRC, the American Society of Clinical Oncology updated their guidelines in 2018 to recommended CRC screenings begin when a patient reached age 45 years.

Recently, the US Preventative Services Task Force supported this recommendation with their own statement.

However, despite these guideline updates, the benefits of endoscopies in younger populations are largely undocumented.

To that end, investigators launched a prospective cohort study which followed the data of women who enrolled in the Nurses’ Health Study II, which began in 1991, and for whom follow-data for subsequent CRC risk were available until 2017. Participating patients were between the ages of 26 to 46 years when they enrolled, allowing investigators a unique opportunity to assess the link between endoscopy age and risk.

The cohort included 111,801 women residing across 14 states. The study did not include individuals with a history of cancer (except for nonmelanoma skin cancer), inflammatory bowel disease, and colorectal polyps. These women were asked to complete baseline assessments and follow-up every 2 years to provide updates on demographics, medical history, and lifestyle factors.

Participants were asked to report if they underwent a sigmoidoscopy or colonoscopy and, if so, to say whether it was a routine screening, or because of a family history of CRC, or CRC symptoms. If patients reported having undergone polypectomy, their endoscopic and pathologic reports were reviewed.

Of note, the results showed that women who initiated an endoscopy before the age 45 years, or between ages 45 to 49 years, were more likely to have a family history of CRC, and a lower prevalence of hypertension, hypercholesterolemia, diabetes, and cancer, compared with women over the age 50 years. Moreover, women under the age 50 years were more likely to get an endoscopy because of relevant symptoms than because of their family history or as part of a routine screening.

“Our findings support guidelines from the past 4 years that recommend screening for CRC at 45 years of age and provide empirical evidence for patients, physicians, and policy makers to consider when making decisions about CRC screening in a younger population,” study authors concluded.

Ma W, Wang M, Wang K, et al. Age at initiation of lower gastrointestinal endoscopy and colorectal cancer risk among US women. 

. 2022;8(7):986-993. doi:10.1001/jamaoncol.2022.0883

Wolf AMD﻿, Fontham ETH﻿, Church TR﻿, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society.﻿

. 2018;68(4):250-281. doi:10.3322/caac.21457

Davidson KW﻿, Barry MJ﻿, Mangione CM﻿, et al; US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.﻿

. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238

Younger women who underwent endoscopies had a reduced risk of colorectal cancer incidence, according to findings of a prospective cohort study. 

Endoscopies for Women 50 Years or Younger Reduce Colorectal Cancer Risk

Characteristics of community-based breast imaging facilities may play a role in addressing disparities in diagnostic mammography performance across different racial and ethnic groups, according to findings from a study recently published 

Cancer Epidemiology, Biomarkers & Prevention

“Our model-based analysis suggests that imaging facility characteristics may play a role in the higher frequency of short interval follow-up that was observed among non-Hispanic Black women,” Sarah J. Nyante, PhD, assistant professor of radiology, Department of Radiology, at the University of North Carolina at Chapel Hill, and coinvestigations, wrote in the study.“We did not have detailed information on the characteristics of each imaging facility in this study. However, prior studies have shown that Black women are less likely to obtain mammograms at facilities accredited by the National Consortium of Breast Centers or American College of Radiology’s Breast Imaging Center of Excellence programs and therefore may receive a lower quality of care.”

“Diagnostic mammography performance studies should include racially and ethnically diverse populations to include racially and ethnically diverse populations to provide an accurate view of the population–level effects,” they added.

Overall, the invasive cancer detection rate (iCDR) per 1000 mammograms was 70% among non-Hispanic White women, 13% among non-Hispanic Black women, 10% among Asian/Pacific Islander women, and 7% among Hispanic women. The positive predictive value (PPV2) was highest among non-Hispanic White women (iCDR, 35.8; 95% CI, 35.0-36.7; PPV2 27.8; 95% CI, 27.3-28.3) and lowest among Hispanic women (iCDR, 22.3; 95% CI, 20.2-24.6; PPV2, 19.4; 95% CI, 18.0-20.9).

Non-Hispanic Black women were most likely to receive short interval follow-up recommendations (31.0%; 95% CI, 30.6%-31.5%) compared with other groups (range, 16.6%-23.6%). This would require patients to return for additional imaging approximately 6 months following the first assessment. Further, false-positive biopsy recommendations were most common among Asian/Pacific Islander women compared with other groups. Per every 1000 mammograms, 169.2 incidences of false-positive recommendations occurred (95% CI, 164.173.7) compared with other groups (range, 126.5-136.1).

Study authors explained that racial and ethnic differences in breast cancer incidence and mortality are well documented. For example, in the US, the rate of breast cancer incidence is highest and associated mortality rates are known to be highest among non-Hispanic Black women. In contrast, both rates are lowest for Hispanic and Asian/Pacific Islander women.

In addition, the type of diagnoses tends to differ between these groups as well. For instance, non-Hispanic Black women are at an increased risk of receiving a diagnosis of breast cancer with poorer prognostic factors (eg, large tumor size, high grade, hormone receptor–negative status) compared with other groups. Hispanic women are more likely receive a diagnosis of breast cancer with larger, distant-stage or metastatic tumors, than non-Hispanic White women.

Investigators have attempted to uncover the root cause of these difference by studying different risk factors, socioeconomic status, health insurance coverage, provider actions/inaction, access to timely treatment, and access to high-quality care as contributors. However, even after controlling for these factors, the trends remain suggesting that additional factors may be at play.

Investigators therefore conducted a cohort study which assessed 267,868 diagnostic mammograms across 98 facilities in the Breast Cancer Surveillance Consortium between 2005 and 2017. Assessments were recorded prospectively within a year of the mammogram. Investigators calculated performance statistics with 95% confidence intervals for each group and multivariable regression was used to control for personal characteristics and imaging facility.

The findings showed that ultrasound, in addition to mammography, was used to determine the Breast Imaging Reporting and Data System assessment for approximately half of the exams, with Hispanic women representing the highest number of women receiving this assessment strategy (55%) and non-Hispanic Black women representing the lowest (43%).

The cancer detection rate was highest among Asian/Pacific Islander women (54.3 per 1000) and lowest among Hispanic women (32.8 per 1000). Asian/Pacific Islander women also had the highest overall mammogram sensitivity (94.2%; 95% CI, 93.0%-95.3%) and highest false-positive rate (169.2 per 1000; 95% CI, 164.8-173.7). In comparison, non-Hispanic Black women had the highest false-negative rate overall (4.6 per 1000; 95% CI, 3.9-5.4).

Ultimately, the location of the mammogram was deemed to be the key factor in determining if a woman received an ultrasound and/or an MRI during the diagnostic work-up and imaging. After adjusting for ultrasound and/or MRI, the reduced difference in cancer detection rates between Black and White patients was model 7 odds ratio (OR), 0.84 (95% CI, 0.79-0.90) vs model 8 OR, 0.98 (95% CI, 0.91-1.05). Moreover, adjustments for imaging facility further attenuate the differences in the short interval follow-up recommendations—model 8 OR, 1.39; (95% CI, 1.35-1.43) vs model 9 OR, 1.03 (95% CI, 0.99-1.07). Adjustment for other factors did not yield any explanation for the racial/ethnic differences in mammography performance.

The study authors concluded that the results suggest non-Hispanic Black women may be at risk of more potential harm related to diagnostic mammography than other groups.

“Exams conducted among non-Hispanic Black women had the lowest sensitivity and highest false-negative rate, indicating that this group may experience a delayed diagnosis more often.”

“Our findings indicate that factors associated with the imaging facility, rather than individual characteristics, may explain some of these differences, [because] the study population consisted of women who had already received a screening mammogram.”

These findings underscore the need to ensure that sufficient racial and ethnic diversity are present in studies which determine mammography recommendations, they concluded.

Nyante SJ, Abraham L, Aiello Bowles EJ, et al; Breast Cancer Surveillance Consortium. Diagnostic mammography performance across racial and ethnic groups in a national network of community-based breast imaging facilities. 

. Published online June 17, 2022. doi:10.1158/1055-9965.EPI-21-1379

Facility characteristics at community-based breast imaging facilities may be linked to screening disparities across ethnic and racial groups. 

Variations in Diagnostic Mammograms Emphasizes Need for Racially and Ethnically Diverse Performance Studies

A significantly higher proportion of African American patients were screened for lung cancer through a centralized lung cancer screening program after criteria were expanded to include younger participants and those with a lower smoking intensity threshold, according to a retrospective cross-sectional study recently published in 

The Journal of the American Medical Association

In March 2021, the US Preventive Services Taskforce expanded lung cancer screening eligibility by lowering the minimum age stipulated in the 2013 criteria from at least 55 years to 50 years and decreasing the smoking intensity threshold from at least 30 pack-years to 20 pack-years.,

 Between March 9, 2021, and December 9, 2021, patients who were newly eligible under the 2021 criteria (n = 161) and patients who were eligible under the 2013 criteria (n = 654) were screened for lung cancer at an urban, academic medical center.

Notably, the 2021 criteria cohort had a higher proportion of African American patients compared with the 2013 criteria cohort, 54.0% compared with 39.5%, respectively (

 = .02). There was also a proportional increase in the number of patients who reported their current smoking status, 65.2% vs 55.0% (

The study followed the Reporting of Observational Studies in Epidemiology reporting guideline. Study authors identified patients in the lung cancer screening program registry of the single institution and divided them into a US Preventive Services Taskforce 2013 criteria-eligible cohort (age ≥ 55 years; smoking ≥ 30 pack-years; quit smoking < 15 years ago) and a US Preventive Services Taskforce 2021-eligible cohort (age 50-54 years; smoking 20-29 pack-years; quit smoking < 15 years ago).

Self-reporting was used to compile data on patient race, ethnicity, and gender. Race was recoded as African American, White, and other. There was also an additional, historical cohort from the same 9-month span in 2019 that was identified for further comparison.

In terms of statistical analysis, descriptive statistics, independent 

 < .05 significance threshold. All statistical analyses were also 2-sided.

Additional findings from the study showed that a lower proportion of patients who were newly eligible under the 2021 criteria had Medicare insurance compared with those who were eligible under the 2013 criteria (17.4% vs 39.6%). Notably, patients who were eligible for screening under the newer criteria had a lower mean lung cancer risk by the PLCOm2012 model (3.27 vs 6.64).

No significant differences were reported between the 2 criteria in terms of educational attainment, or Lung Imaging Reporting and Data System (Lung-RADS) results. There were also no major divergences between the 2013-eligible cohort and the historical cohort that was pulled from 2019 concerning age, gender, race, smoking history, PLCOm2012 risk, or Lung-RADS distribution.

Investigators noted that the study was limited by its single-institution design. Additionally, there was a small pool of patients reporting to be a minority race/ethnicity besides African American.

Study authors noted that the expansion of screening criteria is an important step in reaching lung cancer screening equity for all high-risk populations, but additional obstacles persist. Efforts to expand community outreach, overcome logistical barriers, and facilitate screening adherence must still be made, they concluded.

Shusted CS, Evans NR, Kane GC, et al. Analysis of lung cancer screening by race after USPSTF expansion of screening eligibility in 2021. 

. 2022;5(6):e2217578. doi:10.1001/jamanetworkopen.2022.17578

US Preventive Services Task Force; Krist AH﻿, Davidson KW﻿, Mangione CM﻿, et al. Screening for lung cancer: US Preventive Services Task Force recommendation statement. 

. 2021;325(10):962-970. doi:10.1001/jama.2021.1117

The expansion of screening criteria is an important step in decreasing lung cancer screening disparities in high-risk populations. Efforts to expand community outreach, overcome logistical barriers, and facilitate screening adherence must still be made, experts say.

Updates in Lung Cancer Screening Criteria Increase African American Patient Participation 

Oncology providers can implement strategies to help improve colorectal cancer [CRC] screening rates among their patients, according to Denalee O'Malley, PhD. Structural racism, income inequality, and geographic barriers can all affect screening access, however, leveraging the provision of resources and support available to qualified health centers can be useful in combatting these barriers.

“The barriers are multilevel, but most of them can be resolved with additional resources. At the patient level, there are [barriers to] transportation, time off work, and access to appointments,” O’Malley, an assistant professor of family medicine and community health at Rutgers Robert Wood Johnson Medical School, said interview with 

®. “The centers at the clinic sites need test kits to be able to send to patients for first-line screening. They need personnel to prepare and mail them, postage, staff time to follow-up and coordinate both the abnormal and the positive results, and they need to [be able to] support patients in the transition to oncology [care].”

One strategy that is being used to improve screening rates in underserved communities is through programs such as ScreenNJ, which partners with community organizations, federally qualified health centers, and others to improve outreach and community education, support provider awareness, and strengthen peer support/patient navigation programming.

In the interview, O'Malley, who is also a member of the Cancer Prevention and Control Program and a research member of the Cancer Health Equity Center of Excellence at Rutgers Cancer Institute of New Jersey, shed light on racial and ethnic disparities in CRC screening, and strategies that can be used to address existing barriers in the clinic and beyond.

®: Please discuss the research you are currently conducting in the realm of racial disparities in CRC screening and care.

: I am currently working on a project funded by the National Cancer Institute called “Optimizing CRC Screening Among Patients with Diabetes in Safety-Net Primary Care Settings,” to target implementation approaches. This study examines differences in the types of CRC screenings utilized by patients who receive most of their care in the community health-center system, which is the primary care safety net.

The goal is to identify and overcome barriers at multiple levels—the patient, the clinic, and the health system—that can all affect optimal use of CRC screening tests, and then develop strategies that can be implemented based on context-specific needs of clinics.

How can racial disparities affect CRC screening? What are some existing barriers to testing and appropriate care?

There is structural racism embedded in the health care delivery system, and the disparities that affect CRC screening are intersectional. Racism, income inequality, geographic disparities, and how healthcare is organized and delivered all have an effect on CRC screening and care.

Multiple types of CRC screening tests [exist], which makes [this] more complicated, and they have different levels of efficacy and [need to be performed in] different intervals. For example, a FIT test needs to be administered every year. A colonoscopy, if the test comes back normal, has a 10-year interval, based on the current guidelines.

Community health centers are considered the primary care safety net. A little over 20% of community health center patient populations are uninsured, and the largest payer nationally in the community health setting is Medicaid.

When you use a first-line FIT test, there are multiple steps between an abnormal FIT test and a cancer diagnosis and transition to care. There is the screening itself, the cancer detection, the pathology report, and then, the transition to a cancer center or an oncologist. Barriers at the patient level can include not having a reliable telephone to get the [test result] information [returned to them], not being able to take off work to get a colonoscopy if the test is found to be abnormal, the inability to get an appointment that accommodates their schedule, and the need to get transportation if anesthesia is involved.

At the health-system level, there can be an insufficient number of specialists who offer the diagnostic tests at different centers. There can be there can be any constellation of these problems. In the study focused on patients with diabetes, there is also a cumulative risk involved with having another medical condition. Patients who have diabetes have a 27% greater lifetime risk of having CRC. Diabetes disproportionately affects the Hispanic and African American population, and in the in the community health center setting, we see a much larger proportion of uncontrolled diabetes than you would in a traditional primary care setting. What that means in the care space is that if a patient comes in with an acute health need, preventative health needs might take a backseat.

How can some of these barriers be addressed?

Within the medical neighborhood, the resources that the clinics need [include] receptive diagnostic centers and oncology colleagues who they can transition patients to who are in need diagnostic workups or cancer care.

What strategies are needed to help improve CRC screening in high-priority populations to prevent loss of life?

These are contextually bound strategies. The answer lies in partnering with different types of community health centers, seeing what the barriers are, and coming up with strategies that fit the needs of the context. This requires a partnership between researchers, community members, community health-center staff, and clinicians who are the experts on how their organization operates and the barriers that they face.

How can your colleagues in the community work to better address existing disparities to help close the gap?

Awareness about prevention and clear messaging is important. We are living in a time where misinformation is abundantly available. [Ensuring] that we have outlets in the community that can provide patients with reliable information about the benefits of screening is important.

[We also need] to develop creative solutions, based in the community, for the barriers that [these] populations face. [Some of these] can be universal; we [may] see [some of them] across different sites, but others may be different. Some places have an environment that has better transportation, so that may not be an issue in 1 place and a huge barrier in another.

The other piece is to be more mindful about what we accept as a normal course of business and interrogate why we do things the way we do them. [We need to ask ourselves, who] is this intervention benefiting and who is it potentially leaving out? Those are ways that we can do a better job at closing that gap.

How pivotal is screening in terms of diagnosis and outcomes in CRC?

With most prevention, the famous slogan to follow is, “An ounce of prevention is worth a pound of cure.” CRC is a clear example of that. If CRC was prevented, such as removing a polyp [prior to diagnosis], the potential life saved would be 6.5 years on average. The main takeaway is that [screening and treatment of CRC] is all connected. Our primary care system and its strength affect what we see later down the road in cancer care.

This is all connected in the sense that a patient who comes in for cancer care comes as a whole person who has other illnesses. Since cancer is generally a condition of the aging, chances of someone coming to a cancer diagnosis with chronic illness matters and affects that journey. We need to be intentional about that earlier in the care pathway because we could be more intentional about preventing what can be more cumulative risks as someone lives longer.

Exploring racial and ethnic disparities in colorectal cancer screening. Rutgers Cancer Institute of New Jersey. March 1, 2022. Accessed May 19, 2022. 

This article was originally published on 

 as “Addressing Barriers Contributing to Disparities in CRC Screening in Underserved Populations.”

Strategies to combat ethnic disparities in colorectal cancer screening are not limited to the clinic.  

How Oncology Providers Can Help Mitigate CRC Screening Disparities 

The Biden-Harris administration has committed to reviving the Cancer Moonshot Initiative, according to a White House press briefing that was hosted on Wednesday, February 2, 2022.

The program, which was first initiated by President Joe Biden in 2016 during his vice presidency with the Obama administration, encompasses efforts to increase screening rates, address inequity, fast track clinical trials, and support advances like using mRNA to target cancer with the goal of reducing the age-adjusted mortality rate associated with cancer by at least 50% over the next year.

The administration hopes that these efforts will improve the experience of people and families who are living with and surviving cancer.

Following the initial launch of the Cancer Moonshot program in 2016, novel efforts to investigate immune-oncology, cancer drug sensitivity and resistance, pediatric cancers, patient engagement, cancer health disparities, and clinical implementation science, as well as the funding of the Human Tumor Atlas Network, have been supported and sustained by the National Cancer Institute. Furthermore, the launch created more than 70 initiatives, 240 projects, and 69 million hours of analysis spanning between 2013 and 2020, engaging over 70,000 users each month.

“[Because of] the progress over the last 25 years, the death rate has fallen by more than 25%, but despite the progress of lives extended and lives saved cancer is still the number 2 cause of death in America,” President Joe Biden said in a press release.

"We’ll bring a fierce sense of urgency to the fight against cancer," he added. "I refuse to believe this is beyond our capacity. I refuse to believe it."

Issue a call to action on cancer screening and early detection;

Host a White House Cancer Moonshot summit;

Build on a White House cancer roundtable conversation series; and

Require an all-hands-on-deck approach with the help of the private sector, foundations, academic institutions, health care providers, and all Americans.

With these efforts, the White House hopes to:

Increase screening access to promote early diagnoses;

Explore avenues in cancer prevention—including research with mRNA vaccines;

Address and reduce inequities in health care;

Increase targeted treatment options and availability;

Focus energy on rare and less understood cancers—including pediatric cancer; and

“I can confidently say that this is the most exciting moment in the history of our field,” said Edjah Nduom, MD, FAANS, associate professor, Department of Neurosurgery, Winship Cancer Institute of Emory University, during the White House briefing, where he referred to the president as the country’s “patient advocate in chief.”

“We have identified several research areas that warrant prioritization in a Moonshot 2.0 initiative,” David B. Agus, CEO of the Lawrence J. Ellison Institute for Transformative Medicine and lead author of an editorial published in 

, which called for another Moonshot effort, concluded. “Research in these priority areas could also identify ways to take advantage of real-world data and facilitate access to quality care for individuals in low socioeconomic and rural areas who have received a disproportionately lower benefit from advances during the past 7 years.”

Biden to relaunch cancer moonshot, hoping to cut deaths by 50%. Axios. February 2, 2022. Accessed February 4, 2022. 

Fact sheet: President Biden reignites cancer moonshot to end cancer as we know it. The White House. February 2, 2022. Accessed February 4, 2022. 

Agus DB, Jaffee EM, Dang CV. Cancer Moonshot 2.0. 

. 2021;22(2):P164-165. doi:10.1016/S1470-2045(21)00003-6s

President Biden hosts an event at the White House to reignite the Cancer Moonshot. Youtube. February 2, 2022. Accessed February 4, 2022. 

https://www.youtube.com/watch?v=M9Yc_zKb5N8

Gangitino A. Biden relaunches cancer moonshot: “Let’s end cancer as we know it.” The Hill. February 2, 2022. Accessed February 4, 2022. https://bit.ly/3IUhHLk

The program is designed to reduce the age-adjusted death rate associated with cancer by at least 50% over the next 25 years.

 President Biden Vows to Revive Cancer Moonshot Program

A predictive model demonstrated that cervical cancer may soon be almost entirely prevented in communities with low poverty rates. However, this elimination may not apply to communities with high poverty rates, according to data published in the journal of 

Specifically, it is estimated that this disease subtype may be virtually eliminated by 2030 in low poverty American communities. The anticipated time in high poverty communities is unfortunately doubled, with the model predicting a near elimination by 2044 in these areas.

“Other studies have predicted that, as a whole, the U.S. will hit the elimination target in the middle of that range. The fact that some places will hit it a decade before other places is a little bit of a ‘gut punch,’” commented Jennifer Spencer, PhD, an assistant professor at the University of Texas at Austin, who performed this work as a research fellow at the Harvard School of Public Health, in a press release.

In the United States, roughly 14,000 cases of cervical cancer are diagnosed every year and there are estimated to be around 4,000 case-related deaths. Human papillomavirus (HPV) infections are the cause behind over 90% of cervical cancer diagnoses. HPV is a sexually transmitted infection that can also cause anal, penile, vaginal, vulvar, and oropharyngeal tumors.

Since 2006, available HPV vaccines have served to protect against 9 different HPV types, including 7 out of the 14 which are associated with an increased risk of cancer. All adolescents are advised to receive a full vaccination, which consists of 2 doses for children aged 9 to 15 and 3 doses for individuals between 15 and 26 years of age. According to the World Health Organization, a “near-elimination” of cervical cancer equates to less than 4 cases per 100,000 individuals. The vaccine is over 90% effective in preventing HPV-related cancers and is therefore expected to help the United States reach “near-elimination” status.

However, most patients do not develop cervical cancer until they are older than 30 years old. Therefore, scientists are not yet able to quantify the effects of widespread vaccination effort—the first round of vaccinated adolescents are only now beginning to enter the age range of increased risk. Because of this, researchers have turned to tools like predictive models.

Spencer and her colleagues used previous models to design a model of HPV spread and progression. The model considered the risk of HPV transmission among vaccinated vs unvaccinated individuals, the probably of HPV progressing to cervical cancer, rates of cervical cancer screenings, and the odds of effective cancer treatment.

The model was designed into 2 separate versions. One represents a hypothetical county in the lowest poverty quartile while the other represents one of a county in the highest poverty quartile. Researchers used immunization data from the National Immunization Survey-Teen (NIS0Teen), screening and follow-up data from the National Health Interview Survey (NHIS), and HPV prevalence data from the National Health and Nutrition Examination Survey (NHANES), to compare immunization data between low and high poverty areas.

The results predicted that there will be 21,604 excess cases of cervical cancer in high-poverty areas compared with those in low-poverty areas. Despite this, the rate of excess cases is still believed to improve. Specifically, the disparity in excess cervical cancer rates in high-poverty areas is anticipated to decrease from 2.5 excess cases per 100,000 women to an excess of 1.0 case per 100,000 women by 2070. Although the model did not demonstrate that near elimination would be achieved sooner if vaccination rates reached 80%, vaccination efforts are still predicted to reduce around 1,000 excess cases over the next 50 years.

Limitations of this study include the fact that the model only accounted for heterosexual transmission, and it did not factor in infections with more than one type of HPV, which could alter vaccine efficacy predictions. Additionally, the authors acknowledge that, in the coming years, an improved understanding of disease progression following HPV infection and cervical cancer carcinogenesis could affect the accuracy of these predictions.

“Vaccination can do a lot of good, but it’s unlikely that the disparities can be addressed through just vaccination,” concluded Spencer. “The next step is to identify what policies we can use to close these gaps in the future.”

Low-poverty U.S. communities may eliminate cervical cancer by 2030 but high-poverty communities may lag behind. American Association for Cancer Research. News release. September 9, 2021. Accessed January 17, 2021. 

As the HPV vaccine becomes more prevalent, cervical cancer rates are expected to decrease significantly by 2030. However, this trend may differ across socioeconomic communities. 

Cervical Cancer Advances May Heighten Preexisting Health Disparities

The significance of cancer screening is undeniable. With routine testing, there is an increased chance of detecting cancer early when it is most treatable. Not only can screening identify cancer at its earliest stages, it can also find abnormalities before they become malignant.

Due to COVID-19, access to potentially lifesaving tests have been reduced. In the beginning of the pandemic, many patients throughout the United States were challenged with the decision to risk exposure to the novel coronavirus, or delay their medical care. At the same time, some cancer screening centers were closed. Updated guidelines suggested to postpone certain procedures to reduce the possibility of infection. States issued stay-at-home orders and across the country there was apprehension to enter medical facilities. These influences led to a sharp decline in cancer screenings. According to one study, at the beginning of the pandemic, breast, colon, lung and prostate cancer screenings decreased by 85%, 75%, 56% and 74% respectively, compared to the previous year.1

To many professionals in oncology, this trend was alarming. Without screening, new cancers may not be detected and treatment may be deferred. This disruption could lead to cancer being diagnosed at an advanced stage and the need for more complex medical care. Consequent negative impacts and adverse outcomes could result for years to come.1

Being aware of the effect of COVID-19 allows for the opportunity to help people overcome existing uncertainties. We can provide education on the importance of screening, and how to do so safely. Using guidance from the Centers for Disease Control and Prevention (CDC), we can equip patients with the tools they need to return to the doctor’s office confidently. This direction includes protective measures taken in a public health clinical setting to ensure risk of exposure is minimized.2 Patients will understand how to protect themselves, while feeling their doctors are prioritizing their well-being.

Health care professionals should consider how cultural and environmental conditions contribute to access to screening. Understanding barriers to care is crucial to efficiently empower patients. Social determinants of health, including race, ethnicity, education, insurance status, employment and location all shape a patient’s ability to get screened for cancer. Although these factors have been present pre-pandemic, COVID-19 has highlighted and often accentuated the fact that these inequalities exist.3

Overall, the COVID-19 pandemic disproportionally affected medically underserved populations, including communities of color.3It has been previously established that there are racial disparities in cancer screening for Black and African American patients, as well as Hispanic patients. During the pandemic, access to cancer screening dropped at higher rates within these populations. Existing fears or mistrust of doctors were compounded by new ones related to COVID-19. Lack of access to care was exacerbated by COVID-19-related changes to public transportation, work schedules or the loss of employment and insurance within these groups.3 If these health disparities are ignored, it is impossible to create comprehensive solutions for cancer screening.

Although there has been improvement in cancer screenings since the beginning of the pandemic, it is our responsibility to make substantial attempts to address gaps to care. To maintain the momentum of recovery, inequities have to be acknowledged. Health care professionals should recognize disparities and contribute to efforts that expand access. There is a necessity to implement outreach, continue campaigns and offer education—especially for vulnerable communities. These initiatives are crucial in getting resources to underserved areas.4 Furthermore, to be successful, programs must be done in a culturally and linguistically appropriate manner.

Time to Screen is an example of a national campaign encouraging people to take control of their health by getting recommended cancer screenings back on track. This collaboration between Cancer

 and the Community Oncology Alliance stresses the importance of screening, educates the public on getting screened safely and provides guidance on getting connected to care. Delivering this service through a health disparities lens, patients will learn how to overcome barriers and obtain their screening. Through these continued efforts, we will be able to make positive impacts and ensure equitable resources to individuals in need. 

For more information on Time to Screen, you can call 1-855-53-SCREEN or go to 

Marissa Fors is Director of Specialized Programs at CancerCare.

 is the leading national organization providing free, professional support services and information to help people manage the emotional, practical and financial challenges of cancer. Our comprehensive services include case management, counseling and support groups over the phone, online and in-person, educational workshops, publications and financial and co-payment assistance. All Cancer

 services are provided by master’s-prepared oncology social workers and world-leading cancer experts.

Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on cancer care: How the pandemic is delaying cancer diagnosis and treatment for American seniors. 

. 2020; 4:1059-1071. doi:10.1200/CCI.20.00134

Public Health Activity Guidance.Centers for Disease Control and Prevention.April 8, 2020. Accessed December 15, 202. https://bit.ly/3Fs1nPW

Early detection is key to improving prognosis and achieving better outcomes for patients. 

Prevention