With March’s designation as Colorectal Cancer Awareness Month, nurses everywhere can help remind their patients of the potentially life-saving benefits of prevention and early detection.
No matter what specialty you are in, you can help spread awareness about colorectal cancer with the people you treat every day.
Remind patients to get a colonoscopy
In the absence of a family history of CRC or other diseases such as ulcerative colitis or Crohn’s disease, all of which raise the lifetime risk for CRC, most people only need a colonoscopy every 10 years starting in the mid 40s. According to the American Cancer Society, people with an average risk of colorectal cancer can talk with their healthcare team to determine the best screening method for their personal health. Some people may be able to choose a stool-based test while others will decide they need a colonoscopy.
Talk about prevention
Screening is often thought as something to catch colorectal cancer early, and in some cases, removing any precancerous findings can even help prevent it. The Colorectal Cancer Alliance has great tips, including screening, to help prevent this cancer. Other prevention strategies include a healthy lifestyle. Exercise is known to help prevent or decrease the chances of developing certain cancers including colorectal as are cutting out smoking and reducing drinking alcohol. A plant-based diet that’s high in fruits, vegetables, nuts, and legumes packs in nutrients and fiber–all of which offer protective health benefits. In particular, patients who enjoy red meats or processed meats like hot dogs, sausages, or deli meats should know those foods can up the risk of colorectal cancer.
Give patients the facts about risk
Guiding patients to find out more about their family history, to the extent they are able, can help show familial patterns of colorectal cancer. While many people who have a family history of colorectal cancer or precancerous polyps will not go on to develop the disease, some do. And many people who are eventually diagnosed have no meaningful or known history of anything that would indicate a higher risk. But remind your patients that it’s worthwhile to know the diseases that are present in their immediate and extended families. For those who aren’t able to find out anything about their family history, asking their primary healthcare about genetic counseling and screening could help.
Helping patients become aware of colorectal cancer and the importance of prevention and screening is something healthcare providers can do for their patients. People often forget about the things they can do or put off getting screening tests. Reminding them about why it’s so important can help–and may even save a life.
Unfortunately, some issues or diseases are more prone to affect people in certain communities—case in point, colorectal cancer has been known to disproportionately affect the Black community as compared with white communities. In fact, according to the American Cancer Society, Black people are up to 20% more likely to get colorectal cancer and are also about 40% more likely to die from it.
We interviewed Phyllis Morgan, PhD, FNP-BC, CNE, FAANP, academic coordinator for Walden University’s MSN-FNP program, as she has conducted research on colorectal cancer in men as well as Black men and women’s health issues, including disparity in health and health care.
Phyllis Morgan, PhD, FNP-BC, CNE, FAANP
Why does colorectal cancer disproportionately affect the Black community?
There are several reasons why colorectal cancer disproportionately affects the Black community. First, there is a general lack of knowledge about screening for colorectal cancer, which contributes to inadequate prevention and screening behaviors. There are also various fears that come into play, such as fear of cancer and of a cancer diagnosis, and fatalistic views about cancer.
A recent study showed that in Black Americans, the right side of the colon ages much faster than the left side, which could contribute to this population’s increased risk for colorectal cancer, particularly on the right side of the colon, and at a younger age.
Other factors may include delayed treatment and the fact that Black individuals have a higher incidence of obesity and more often consume a high fat, low fiber diet, which increases risk.
Why are Black people who get colorectal cancer about 40% more likely to die of it than other groups?
In addition to factors such as inadequate prevention and screening behaviors as well as delayed treatment, racial inequities in care also contribute to the fact that Black people who get colorectal cancer are more likely to die of it than other groups. There is a widespread lack of access to care for many people in this population, and some have no health insurance or inadequate health insurance for treatment.
Additionally, lifestyle factors such as diet and exercise can contribute to this.
What are the challenges facing the Black community regarding colorectal cancer?
Some challenges facing the Black community regarding colorectal cancer include inequities in health care, lack of access to quality care, and a lack of adequate resources to educate about the importance of colorectal cancer screening. It is crucial that we increase screening by providing better education for the Black community regarding screening and the importance of polyps being removed from the colon.
Additionally, we need more diverse health care providers, so patients can have providers who look like them and with whom they can connect and relate. Black health care providers can play an important role in helping patients to understand the seriousness of colorectal cancer in their community.
What can nurses do in order to get people in minority communities to go for tests, pay attention to symptoms, etc.?
First, nurses can help by providing more colorectal cancer resources for their communities. In addition, culturally appropriate educational programs and community or faith-based educational programs can be helpful in encouraging people in minority communities to undergo screening.
As an African American woman and advanced practice nurse, I have participated in many projects and studies to identify ways to increase awareness, prevention, and treatment of health issues that impact the Black community. Specifically, I worked on a community and faith-based education program to increase awareness of prostate cancer among Black men, which resulted in an increase in participants’ general knowledge of prostate cancer and treatment by over 40%. I have also implemented successful community and faith-based education programs in North Carolina and Virginia to help educate Black people about colorectal cancer and increase screening behaviors. These types of programs are proven to make a difference.
Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities. It’s critically important for research to be conducted, especially in developing culturally appropriate models for diverse communities, so more contributions toward reducing health disparities can be made available to effect positive social change.
Last but not least, Walden University and the National League for Nursing are excited to launch the Institute for Social Determinants of Health and Social Change, where nurse educators and inter-professional colleagues will play an instrumental role in achieving health equity across various demographics. The institute is designed to cultivate these health care professionals into leaders who address the impact of structural racism, socioeconomic status, environment, education, adequate housing, and food insecurity on health and well-being.
According to the American Cancer Society, minorities get colorectal cancer (CRC) more often than other groups. A diet low in animal fats and high in fruits, vegetables and whole grains may reduce the risk for CRC. Diet? Which diet? This is where confusion sets in and where nurses can help. Previous studies have shown that just recommending an increase in fruits, vegetables and whole grains does not work. Nurses can give an evidence-based specific recommendation on the type of diet that is low in animal fats and high in fruits, vegetables, and whole grains. Research has shown that a Mediterranean diet that is low in animal fats and high in fruits, vegetables, and whole grains has been shown can reduce the risk for CRC by up to 14%.
What is the Mediterranean diet? According to Oldways Preservation and Trust, it includes:
Whole grains, fruits, vegetables, beans
Herbs, spices, nuts
Healthy fats such as olive oil
Fish and seafood are typically eaten at least twice a week
Dairy foods like yogurt and traditional cheeses
Eggs and poultry (chicken, duck)
Red meat (beef, lamb, pork, mutton, goat) and sweets are rarely eaten
Water and red wine (in moderation, for those who drink)
Many of the foods that comprise the Mediterranean diet are mainstays of the diets of other cultures. For example, kale, greens, and collards that can be part of an African American diet are part of the Mediterranean diet. Chickpeas, polenta, and chilies that can be part of a Hispanic diet are part of the Mediterranean diet. Having foods that are already part of your patient’s diet may make the transition to the Mediterranean diet a bit easier.
Another benefit of the Mediterranean diet is that is also a heart healthy diet. The diet has been shown to lower low-density lipoprotein (LDL) cholesterol, which is “bad” cholesterol. According to the Mayo Clinic, it is also associated with a reduced incidence of Parkinson’s, Alzheimer’s disease, and a reduced risk of breast cancer among women who used extra-virgin olive oil and mixed nuts in their diet.
Finally, a foundation of the Mediterranean diet is activity and social connections. Enjoying meals and being active with friends and family are important to staying healthy and fully recouping the benefits of the Mediterranean diet.
The Mediterranean diet is a great way to reduce colorectal cancer risk while improving heart health. As a nurse, knowing about the Mediterranean diet, its benefits, and how it is similar to your patient’s current diet can be a way to increase the likelihood that you can help your patient get on the path to great health.
About one in three adults aged 50 to 75 years have not been tested for colorectal cancer as recommended by the United States Preventive Services Task Force (USPSTF), according to a new Vital Signs report from the Centers for Disease Control and Prevention (CDC). Despite research that shows colorectal cancer screening tests save lives, screening rates remain too low.
“There are more than 20 million adults in this country who haven’t had any recommended screening for colorectal cancer and who may therefore get cancer and die from a preventable tragedy,” said CDC Director Tom Frieden, MD, MPH. “Screening for colorectal cancer is effective and can save your life.”
Colorectal cancer is the second leading cancer killer among men and women in the United States, after lung cancer. Screening tests can prevent cancer or detect it at an early stage, when treatment can be highly effective. Adults aged 50 years and older should get tested with one or a combination of these screening tests:
• Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) done at home every year;
• Flexible sigmoidoscopy, done every five years, with FOBT/FIT done every three years;
• Colonoscopy done every 10 years.
A colonoscopy can detect cancer early, and it can find precancerous polyps so they can be removed before they turn into cancer. An FOBT/FIT is a simple at-home test that can detect cancer early by identifying blood in the stool, a possible sign of cancer. People are not always offered a choice of colorectal cancer tests, but studies have shown that people who are able to choose the test they prefer are more likely to get the test done.
CDC researchers reviewed colorectal cancer screening data from CDC’s 2012 Behavioral Risk Factor Surveillance System to estimate the percentage of people aged 50 to 75 years who reported getting screened as recommended by type of test.
• Among adults who were screened as recommended, colonoscopy was by far the most common screening test (62%). Use of the other USPSTF-recommended tests was much lower: FOBT (10%), and flexible sigmoidoscopy in combination with FOBT/FIT (less than 1%).
• The highest percentage of adults who were up-to-date with colorectal cancer screening was in Massachusetts (76%).
• The percentage of people screened for colorectal cancer using the FOBT within one year was more than twice as high in California (20%) when compared with most states.
• Blacks and whites had similar screening rates, but a higher percentage of blacks across all income and education levels used FOBT.
The authors noted that increasing use of all tests may increase screening rates. Furthermore, research shows that more people may get tested if health care providers used an organized approach to identify people who need to be screened: contact them at their home or community setting; advise them of each test; and carefully monitor to make sure they complete their test.
CDC provides funding to 25 states and four tribal organizations across the United States to help increase colorectal cancer screening rates among men and women aged 50 years and older through organized screening methods. Through the Affordable Care Act, more Americans will have access to health coverage and preventive services like colorectal cancer screening tests. The tests will be available at no additional cost. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more.
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