Removing barriers to cancer testing

People older than 50 have all kinds of reasons for not getting tested for colorectal cancer.

They’re scared the test will find something deadly. They’re squeamish about the procedure itself. They lack insurance, or – if they’re on Medicaid – they can’t find a practitioner who’ll accept it. They face language barriers and doctors too busy to explain the tests, or they don’t understand that the disease is preventable.

A project by the local health district and two clinics serving northeast Spokane aims to identify people due for screening along with the real-life barriers they’re facing – and then help remove the barriers so more people get tested. The project, which started last month, taps into the growing cadre of trained “community health workers” to reach residents.

“It’s so easy to prevent and detect early on, and there really is, unfortunately, a lot of people falling through the cracks and not getting the screening,” said Malia Ethredge, a patient benefit coordinator at the Spokane Falls Family Clinic. The Riverstone Family Health Clinic, which also serves many low-income residents in northeast Spokane, also is participating.

“You don’t go to the doctor and go, ‘Gee, doc, I really want to get my colon checked,’ ” Ethredge said.

Ethredge was among the first people trained through the state Department of Health to become a community health worker. The DOH implemented the training program in 2011 in response to the Affordable Care Act, which calls for greater participation of community members who can help provide health education and outreach in homes, community centers, clinics, shelters and elsewhere.

Because they’re trained to help remove economic, cultural or other barriers on the ground level, community health workers seemed like a good fit to improve the colorectal-cancer screening rate among residents in northeast Spokane, said Donna Oliver, who runs the Spokane Regional Health District’s breast, cervical and colon health program.

Among cancers, colorectal cancer is highly preventable, Oliver said. It usually takes 10 to 15 years for the polyps detected during cancer screening to develop into cancer.

Remove the polyps, and you prevent cancer. It’s a smart investment, Oliver said, that can save lives and money – early detection makes treatment easier and cheaper.

But only about 40 percent of people with colorectal cancer are diagnosed at that early stage, according to the American Cancer Society, because many people don’t get tested. Colorectal cancer is expected to cause nearly 52,000 deaths this year. More than 90 percent of people diagnosed with it are 50 or older.

Colonoscopies may get more press as an over-50 rite of passage. But there’s a simpler and less-expensive take-home version of a colorectal-cancer test – and doing either one of the tests is much better than doing neither, Oliver said.

A colonoscopy allows a doctor to see the length of the colon, or large intestine, using a long, flexible tube with a video camera at one end. The tube is inserted into the rectum and snaked through the intestine as the doctor looks for polyps, which can usually be removed during the procedure. In general, a patient with a clean colonoscopy doesn’t need another test for 10 years, Oliver said.

Take-home stool-sample tests are relatively inexpensive. The patient brushes a sample of their stool on a card, then mails it to a lab or clinic, which will test it for blood. If blood shows up on a take-home test, that could indicate polyps or a tumor, and the patient is referred for a colonoscopy.

Educating residents about the tests and how to get them is part of the mission of the project in northeast Spokane. Using nearly $23,000 in grant money from the American Cancer Center and Walmart, the project will last until April.

It’ll rely heavily on community health workers to spread the word and help residents connect with care. They can be volunteers or paid workers who work in a medical center or from their kitchen table. They might find translators for non-English speakers or practitioners who take Medicaid for low-income people.

During their training, the workers learn organizational, communication and documentation skills, Oliver said. They talk about cultural competency and “roles and boundaries” – when to refer someone to talk to someone else, for instance.

For Margaret Braun, 57, the training was a natural fit. As the part-time pastoral-care coordinator – “i.e., church secretary” – at Living Hope church, she’s learned to connect people with resources, whether it’s a women’s group or treatment for substance abuse.

She applies those skills at home at Heritage Heights apartments, a 62-unit affordable-housing building for seniors. Full of ideas about how to improve her fellow residents’ quality of life, she was offered a small grant through the Comprehensive Health Education Foundation to enact them. She recruits speakers on heart disease, diabetes and nutrition. She found a translator for social events that bring together Slavic-speaking residents and English speakers.

Beyond the community health worker training, she’s had no formal education in public health. But she’s a “connection maker,” she said, and she’ll put those skills to use for the colorectal-screening project.

Her training – a combination of in-person and online classes – included the basics about colorectal cancer. She also learned how to address people’s economic or logistical hurdles when it comes to getting care.

For those who’ve lived on small incomes their whole lives, going to the doctor never became a habit – they don’t seek care when they need it even when they finally get insurance. Among her oldest neighbors, especially, she said, there’s a generational hurdle: “You didn’t ask questions. You just took the doctor’s word and did what you were told.”

Just the word cancer is scary, much less the thought of colorectal cancer, Braun said.

But there are people in her building “who’ve survived far worse cancers than that. … There’s no reason to die from colorectal cancer.”