Abstract
In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative to nL-White people in Virginia, but preventable with equitable screening access and timely diagnostic follow-up. However, structural barriers, such as fractured referral systems and extended time between medical visits, remain. Because Federally Qualified Health Centers (FQHCs) care for a large proportion of racial and ethnic minorities, and underserved communities, regardless of ability to pay, they are ideal partners to tackle structural barriers to cancer screenings. We piloted a quality improvement initiative at five FQHCs in southcentral Virginia to identify and address structural, race-related barriers to CRC, as well as CCa screening and diagnostic follow-up using evidence-based approaches. Uniquely, FQHCs were paired with local community organizations in a didactic partnership, to elevate the community’s voice while together, increase support, acceptance, uptake, and intervention sustainability. We report on project development, and share preliminary data within the context of project goals, namely, to increase cancer screenings by 5–10%, improve knowledge and diagnostic follow-up processes, and build longitudinal partnerships.
Highlights
With 56% of colorectal cancers (CRC) diagnosed at later stages, it is no surprise that Virginia (VA) remains one of three enduring CRC mortality hotspots in the UnitedStates [1]
Working jointly, the Federally Qualified Health Centers (FQHCs) and their community partner assessed their own practices, processes, resources, and perceived barriers pertaining to these cancer screenings, and selected an evidence-based intervention (EBI) to jointly implement towards increasing screening rates
Though the HRSA-reported CRC and cervical cancer (CCa) screening rates for the five participating FQHCs (38% and 50%) did not significantly differ from the same screening rates for non-participating FQHCs (40% and 47%), rates for all FQHCs were well below the state (70% and 91%), and the Healthy People 2030 screening goals (74% and 84%)
Summary
With 56% of colorectal cancers (CRC) diagnosed at later stages, it is no surprise that Virginia (VA) remains one of three enduring CRC mortality hotspots in the UnitedStates [1]. Cervical cancer (CCa) in VA is not much different: 48% of CCa cases statewide are diagnosed at later stages, and CCa incidence and mortality in VA is greater in those who identify as Black and/or Latinx/e compared to other races [3]. Prevention and early detection of these cancers is possible through screenings that detect and/or remove pre-cancerous lesions (Papanicolaou (Pap) for CCa, and stool-based (i.e., FIT or FOBT) or visual (structural) exams (i.e., colonoscopy, flexible sigmoidoscopy) for CRC). These elevated rates of late-stage diagnoses and death are unacceptable.
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