Addressing the disparity in access to colon cancer screenings in Minnesota

CATHY WURZER: This may have escaped your attention. And let's face it, you probably might not want to hear it, but it's important that you do. March is Colon Cancer Awareness Month. According to the State Department of Health, colon cancer is one of the leading causes of cancer related deaths in Minnesota. And like most cancers, the chances of survival are much higher when you catch it early.

But white Minnesotans are more likely to get screened than people from other racial and ethnic groups. We wanted to talk about the barriers that get in the way of early detection, so we called Francisco Ramirez, who works on this issue as a community and education supervisor for M Health Fairview. Francisco is on the line. Good to hear your voice.

FRANCISCO RAMIREZ: Thank you so much. And on behalf of M Health Fairview, very grateful for this opportunity. Thank you.

CATHY WURZER: I'm glad you have the time. Thank you. See, the disparity in colon cancer screenings is stark. I think people might be surprised about that. What could some of the reasons be behind that?

FRANCISCO RAMIREZ: Yeah. And then like you were saying, unfortunately, colorectal cancer is the third leading cause of cancer deaths in Minnesota for both men and women. And unfortunately, some people in our diverse communities in our communities of color, like American-Indians, African-American, and Latinos, are more affected than other groups. This is extremely important to us because in our community advancement department, one of our main goals is to partner, to build trust with our communities to advance in health equity, and improve health.

CATHY WURZER: I'm wondering in terms of some of the barriers. Do you find, is there a lack of cultural competency on the part of some providers perhaps and language barriers? Is there shame also associated with colon cancer?

FRANCISCO RAMIREZ: Yeah, definitely. And there are like-- we have since 10 years ago, because we started this program back in 2014, we know that there are some risk factors for colorectal cancer, like there are some that we can change and there are some that we cannot change. They were like saying, to put a little bit of humor, then 45 are the new 50. I don't know if this makes sense or not. But being older is a risk factor and also family history.

But there are other factors in our communities, risk factors like people in our communities of color, there are so many times and they have higher rates of obesity, diabetes. And also, they face like lack of access to the healthcare system, or they don't trust the health system. And then these risk factors are there. And that's why we see we still have a big gap between the patients that go and do the screenings and those that they are not.

CATHY WURZER: So as you say, there are risk factors, physical risk factors, as you say, familial. There's some genetic risk factors and then some of-- these other barriers that go into issues with getting the screenings. I'm wondering, looking now at the barriers to screening now, how can healthcare providers help remove some of them?

FRANCISCO RAMIREZ: Yeah. And I think like what we have been doing is kind of like our team at M Health Fairview, we have been working really hard to building strong relationships with our communities and education, providing like colorectal cancer prevention, outreach, and support to our diverse communities. But not only when they go to the clinic for their physical, because many of our community members they don't even go yearly to do the physical check out. Then we strongly believe that those relationships with community partners with like different agencies, we work closely with MDH, with Sage, with CUHCC and with different community clinics across the state.

Then I think one of the main steps is to keep building trust with that community and go and keep educating community where they are, where they feel safe, but not only for once a year. This has to be consistent to see these positive outcomes.

CATHY WURZER: As you're getting this trust developed and built, I'm wondering how your success rates. Are you-- I think this is the 10th year of your screening program. Are you getting more people in the door for screenings? And what are you finding?

FRANCISCO RAMIREZ: Yeah. I go pretty much everywhere. So far, since 2014, M Health Fairview-- and thanks to our amazing providers, providers and nurses and also to the leadership that we have, and they support and they believe that prevention is life, we have been able to provide 345 free colonoscopies. And then thousands of people like get educated.

Then for us, for me, personally, prevention is key. Education is a great need in our communities. And I think like this is crucial to have healthier communities. Then we go to different places like during the week, over the weekend. We share a flyer that we have in different languages, like Somali, Hmong, English, and in Spanish. We are like even like trying to create other languages as well because it's needed in the state and we are.

But also, we kind of like try to kind of like share this everywhere with community clinics and with our patients from different places.

CATHY WURZER: Do you think you've saved lives, Francisco?

FRANCISCO RAMIREZ: Yes, definitely. According to the CDC with the gold standard test is a colonoscopy. But what I say to the community, the best test is the one that you want to do, the one that you are ready to do. But screening save lives. And that's why we are like here.

Like we still have a gap in Minnesota. According to the Minnesota community measurement, about 52% of non-English speaking patients in Minnesota have an up-to-date colorectal cancer screening compared to 72% of English speaking patients. And there is more work to do. There is more work to do. But we strongly believe that working and building trust with our communities is crucial to have a better health outcomes.

CATHY WURZER: Have you been successful in terms of finding potential early cancers?

FRANCISCO RAMIREZ: Well, thanks to these screenings, we have been able to find many patients with polyps. Those numbers in the data that we have, every year-- I will give you an estimate number, but it's about 30 or 40% of those patients that go through the colonoscopy that providers found polyps. And thanks to the colonoscopy, those polyps are removed.

If they don't remove those polyps, the risk to is going up to maybe have a cancer. Then definitely, we have been success successful, because every time that a patient goes to the colonoscopy, they find polyps, they remove those polyps. And they say we need to follow up with you in three years or five years. That's a life that we say already there, because the patient, there are so many times patients come from different countries. And there are so many times, and they say, I never hear that I have to do this screening in my country.

And then there is still too much and more education that we have to provide. But in a cultural competence way than we approach to the patient and we explain in different language to the community, going step by step about why is this so important to do.

CATHY WURZER: By the way, I've got about 30 seconds left how can folks who may be eligible for a free screening, get one, learn more?

FRANCISCO RAMIREZ: Yes. And anyone in our beautiful state of Minnesota who is between 45 up to 75, if they live in Minnesota and if they don't have medical insurance or underinsurance, they qualify for these free colonoscopy, anyone in the community. And the best way to see if they qualify is to call in to ask to the 651-279-5668, 279-5668.

CATHY WURZER: Area code 651. We'll put that on our website, Francisco. Thank you for your time.

FRANCISCO RAMIREZ: Thank you so much for the invite.

CATHY WURZER: Francisco Ramirez is community education and outreach supervisor for M Health Fairview. By the way, we should mention to you that M Health Fairview is a financial supporter of MPR News.