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Review of Barriers to Colorectal Cancer Screening in Hard-to-Reach Populations
The coronavirus disease 2019 (COVID-19) pandemic has changed the way Americans experience every facet of life. Most concerningly, access to preventive health care is more limited than ever before — at a time when it is of paramount importance. A pause in elective procedures, including cancer screening, is leading to sharp declines in important and proven preventive health care assessments.1 These effects may exacerbate existing barriers to care,2 especially for individuals who live in rural areas with limited access to medical resources.3
Logistical hurdles and long-distance travel mean that many patients in rural areas lack access to preventive care, early detection, and treatment.4 This becomes especially problematic when we consider diseases that are managed best with routine screenings and early detection, including colorectal cancer (CRC), which is one of the most preventable and treatable cancers if caught early.5-9 Despite its slow-progressing nature,7,10 CRC is the second deadliest cancer in the United States.11 As the COVID-19 pandemic has evolved, concern that the estimated number of CRC-related deaths could grow over the next decade due to delays in screening brought on by the outbreak has risen.1,12
The Alaska Native people, who represent a medically underserved population in the nation, have the highest CRC incidence (89 per 100,000) and mortality (40 per 100,000) in the US.13 The Alaska Tribal Health System provides medical care to Alaska Native people through community-based clinics and regional hospitals, only 2 of which are connected to the road system. Reaching the other clinics requires travel by small plane, which is highly weather dependent. These factors make access to traditional CRC screening methods including colonoscopy difficult and can cause people to skip screening altogether. Thanks to the collective efforts of providers and public health experts across the state, CRC screening rates in the Alaska Native population have improved substantially; however, they remain lower than national rates.14,15
In 2020, COVID-19 caused a 3-month closure of endoscopy services across the Alaska Tribal Health System. Even as clinics begin to reopen with new safety measures in place, clinic staff are finding that patients are reluctant to come into the hospital for screening for fear of being exposed to the virus. Amid the ongoing COVID-19 pandemic, efforts to leverage existing screening tools may help providers to accommodate patients from their own homes.
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