Colorectal cancer is the second-leading cause of cancer-related deaths in the US. While the Affordable Care Act (ACA) covers colorectal cancer screening (CRCS) procedures that can catch colorectal cancer early, when it’s most treatable, there are disparities in utilization rates. 

Dr. Aldenise Ewing, a USF College of Public Health (COPH) alum, and her colleagues wanted to find out why. Their research, “The Early Impact of the Affordable Care Act Upon Colorectal Screening Utilization in Florida,” was published in the fall issue of the Journal of Health Disparities Research and Practice. The study was conducted with the help of fellow COPHers Drs. Marlene Joannie Bewa, Claudia Parvanta and Dinorah Martinez Tyson, as well as others.

The research was a collaborative effort and conducted as part of a larger study funded through a Centers for Disease Control and Prevention (CDC) grant to the Florida Prevention Research Center (FPRC). The FPRC was previously designated as one of 26 Health Promotion and Disease Prevention Centers in the nation funded by the CDC.

“Recommended screening for adults age 50 and older could prevent more than 50 percent of [colon cancer] deaths, yet rates in Florida vary based on certain demographic factors including race/ethnicity, gender and insurance status,” said Ewing, who is now an applied postdoctoral fellow in the behavioral oncology program at Moffitt Cancer Center. “Knowing that Florida has not expanded Medicaid, and the age for recommended screening has now been lowered to 45 nationwide, it was important for us to enhance our knowledge of remaining barriers by speaking with health care providers.”

The researchers interviewed a total of 22 health care providers about their experience with the ACA and CRCS utilization. The providers noted that some of the individual-level barriers patients faced in utilizing CRCS were a general lack of knowledge of the importance of the screening and fear of the procedures. But the biggest barriers of all, said Ewing, were at the organizational level. These barriers included unaffordable health care and out-of-pocket costs (such as lab fees) associated with the screening methods, even with ACA coverage.

“Our country has decidedly linked health care to employment,” Ewing said. “Yet for many working adults, doctor visits for routine cancer screenings are still not affordable. With regard to colorectal cancer specifically, even effective at-home based alternatives to a colonoscopy—still the gold standard—require organized clinic partnerships for laboratory testing and follow-up diagnostic colonoscopies as needed. Federally Qualified Healthcare Centers (FQHCs) provide these services on a sliding fee scale, but they are less widely available and critically dependent on federal funding to sustain partnerships.”

What will it take to get cancer screening utilization rates up?

“This is a deeply rooted systemic issue with many barriers requiring many solutions,” Ewing said. “But we must continue to publish studies that highlight the inequities in cancer disparities and push for equitable health policy at the state and federal levels.” Building authentic research partnerships to meet the needs of the underserved is also a step in the right direction, she noted.

Bewa, a COPH PhD student, FPRC research assistant and one of the study’s co-investigators, concurs.

“It’s important to ensure that communities are educated and aware of their cancer risk as well as the screening options and resources available to them that address barriers,” said Bewa. “Overall, a health equity lens is needed to address colorectal cancer screening barriers and disparities. We hope [our study results] will be used by policymakers to address the cancer burden in Florida.”

Story by Donna Campisano, USF College of Public Health