Research Validates Tools to Increase Screening in Communities of Color
Reduced adherence to recommended screening and prevention relates to a lack of knowledge and barriers like inadequate insurance, low engagement with primary care, time constraints, and misconceptions about risks of screening or their individual risk of developing cancer. We must do a better job of educating people about cancer screening and linking them to affordable or free services.
Kin Keeper is a breast and cervical cancer education intervention for diverse women. We conducted a study to identify how familial cancer, communication, and screening intention influenced Black, Latina, and Arab American women who had not received their recommended breast and cervical cancer screening. Our statistical modeling showed that Kin Keeper and highly communicative families increased women’s intent to have breast and cervical cancer screening. A family history of breast cancer did increase (https://doi.org/10.1177/0969141320920900) screening intention, but history of cervical cancer did not. So, our findings show the benefit of family-focused communication on cancer awareness and education.
Screening intention is not the best predictor of actual screening, but it is an important metric to consider in inadherence. If we can identify factors that color intention, we can innovate solutions. In our case, we found that an approach that causes families to discuss cancer awareness might improve intention.
We have made some strides in closing gaps to following screening guidelines. Thanks to community outreach programs for individuals with low or no insurance, screenings are increasing across most patient populations. The prevalence of U.S. mammography adherence (https://doi.org/10.3322/caac.21583) is now 69% among Black, 65% in non-Hispanic White, 61% in Hispanic, 60% in Native American and Alaska Native, and 59% in Asian women. For adherence to Pap tests (https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.html), it’s 86% in Black, 85% in non-Hispanic White, 79% in Hispanic, 75% in Asian, and 70% in Native American and Alaska Native women.
We have more work to do on all fronts because no population is 100%, but we need to prioritize people of color who have higher mortality rates, disparities in follow-up for abnormal findings, and generally more negative social determinants of health like discrimination, reduced access to care, and poorer quality of screenings received as compared to non-Hispanic Whites.
To reduce those disparities, oncology nurses should (https://doi.org/10.1016/j.soncn.2017.02.008):
- Stay abreast of screening guidelines.
- Be culturally humble in delivering care.
- Conduct research.
- Implement best practices.
- Seek to diversify the workforce.
Nurses must step outside of the walls of their institutions and into the communities they serve. Particularly for communities of color, relationship and trust building are essential tools for cancer prevention and health promotion education. We have to be partners in our patients’ care and promote discussions about cancer, advocate for screenings, and target preexisting social conditions that prevent adherence.
So, my fellow oncology nurses, attend health fairs in the communities you serve and share information in barber and beauty shops, churches, and schools. Encourage your patients to have family conversations. Especially in populations of color, a community-based approach can and will save lives.