Putting an End to Health Disparities in Colon cancer

Taking the lead on health disparities: Bergen Medical Associates educating patients on colon cancer risks, screenings

Dr. Crystal Broussard, gastroenterologist at Bergen Medical Associates, examines the racial and ethnic disparities associated with colon cancer’s diagnosis and treatment

Colon cancer is the third most common cancer diagnosed in America, according to data from the Centers for Disease Control and Prevention. The disease is preventable and potentially curable when caught early, and colonoscopies serve as highly effective screening tools.

But Americans aren’t equally reaping the benefits of educational outreach, screenings, early diagnosis and quality treatment, studies show.

For example, the American Cancer Society said that of the more than 100,000 new cases of colon cancer that will be diagnosed this year, “racial and ethnic minorities are more likely to develop (colon) cancer and die from it as compared to the general population of the United States.” In fact, “African Americans are about 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups,” the ACS continued.

This situation is well understood by Crystal Broussard, MD, a gastroenterologist who is African American and has worked at Bergen Medical Associates, which has six offices throughout Bergen County, for the past 23 years. Dr. Broussard treats a range of conditions within the GI tract, including gastroesophageal reflux disease (GERD), abdominal pain, irritable bowel syndrome (IBS), Inflammatory Bowel Disease (IBD), gallbladder disease, pancreatitis and peptic ulcer disease. “While we do a lot of colon cancer screening, we’re also instrumental in diagnosing cancer of the esophagus, stomach, liver and biliary tree and will then refer these patients to our surgical and oncological colleagues,” she said.

While the causes of these cancers can lie in any combination of genetic, environmental and dietary factors and many cases can be successfully treated if caught early, Dr. Broussard said that the past three years have provided an eye-opening look into the ethnic and racial disparities that exist in health care. Additional research and personal inquiry have made her even more informed about these disparities in the diagnosis and treatment of colon cancer in particular.

“The pandemic helped expose the glaring inequities in health care with respect to people of color and those of lower socioeconomic status, with that population experiencing higher levels of morbidity and mortality relative to COVID,” she noted. “The incidence of cases, hospitalizations and death were absolutely higher among African Americans, Hispanics and Indigenous Americans compared to other populations.”

In the following interview, Dr. Broussard discusses the causes of health disparities in colon cancer, its impact, and her hope for tackling this disturbing reality in the future.

What is a “health disparity” and what factors contribute to it?

Dr. Broussard: A disparity refers to any noticeable or measurable difference between a group or population that’s unequal or unfair. A health disparity refers to a higher burden of illness, injury, disability or mortality that’s experienced by a particular population (including race/ethnicity, gender, disability, geography or sexual identity/orientation) which is potentially preventable and/or can be treated. Among the many factors that contribute to this are social determinants of health — for example, people of a lower socioeconomic status often have less access to quality health care, less insurance and less utilization of services. Many have less knowledge or access to nutritious foods and may also have underlying health issues such as obesity, high blood pressure, diabetes and other conditions that can compromise their health and put them at higher risk.

How have health disparities manifested themselves in the case of colon cancer? 

Dr. Broussard: Although the incidence of and mortality from colon cancer have decreased in the past 10 years, disparities still exist, especially among African Americans, Indigenous Americans and native Alaskans. African Americans in particular, have the highest incidence of and mortality from colon cancer and tend to be diagnosed at later stages than other racial/ethnic groups. They’re also more likely to be diagnosed at a younger age (under 50) than other groups, which initially led the American College of Gastroenterology to recommend in 2005 that African Americans begin screening for colon cancer at age 45. However, more recently, it’s now recommended that CRC screening begin at age 45 for all patients of average risk a due to a higher incidence of colon cancer being diagnosed among all people under age 50.

Are there also health disparities when it comes to screening for colon cancer?

Dr. Broussard: There are definite disparities in colon cancer screening among the African American population. Reasons for this can include less health literacy and knowledge about screening, fear of the procedure, and a lack of trust in physicians due to historical atrocities experienced by this population in the name of science (e.g., the Tuskegee Syphilis Experiment), all of which can result in a lower number of screenings among this population. For some, there’s also a lack of access to quality health care. While Obamacare has most certainly helped, not everyone can take advantage of the insurance programs offered. Unfortunately, there are barriers at the physician level too, as studies show that African Americans are less likely to be recommended for screening by physicians, and, when diagnosed, are less likely to be referred for consultative services. They’re also less likely to receive surgery for early-stage colon cancer or chemotherapy in later stages than other groups, so there’s bias in the system.

How do you believe the issue of health disparity can or should be addressed?

Dr. Broussard: As a gastroenterologist who’s also an African American, I want to educate all of my patients, have them see that I’m at risk just like they are, and provide access to information that will allow them to make informed decisions about their health. While a lot of progress has been made and colon cancer screening has improved overall, there’s still work to be done. Culturally sensitive educational outreach may help to bridge the gap. People need to know the risks and signs of colon cancer and must be proactive by being their own health advocate. At the same time, physicians need to provide all patients with the opportunity to be screened and cared for equitably, as it will enhance outcomes across the board.

How is Bergen Medical Associates supporting this mission and what is your hope for the future? 

Dr. Broussard: Health systems that provide equal access to screening will reduce the incidence of colon cancer, and Bergen Medical Associates is highly proactive in this arena by openly sharing a wealth of information on colon cancer screening with all patients. We’re committed to doing our part to ensure that all patients are well-versed in colon cancer risk factors and the importance of screening so that they can make educated decisions about their health care. Ultimately, I believe that both health care providers and patients have a responsibility to act and advocate for what is equitable in the realm of health care. Health equity is a national priority and I look forward to the day when we can reduce and hopefully eliminate this disparity in our society.

For More Information

With offices in Emerson, Paramus (2), Ridgewood, Northvale and Montvale, Bergen Medical Associates offers primary care and 12 areas of specialized care. Patients enjoy the “one-stop shopping” approach where so many medical services are provided under one umbrella. The multispecialty group fosters an environment of collaboration among the physicians, which results in a seamless continuum of care for patients. For more information, contact us today or call 201-967-8221.