Colorectal Cancer Screening Barriers

Colorectal cancer is a chronic disease that starts as a polyp, a tumor type growth that begins in the inner lining of the colon or rectum and extends toward the middle layers (ACS, 2013). Most polyps’ formation is not cancerous, except for a special type of polyp called adenomas. Although prevention is primary in public health and health promotion measures; but primary prevention is not always realistic, thus, early detection and removal of polyps are the best alternatives to any other therapeutic measures (ACS, 2013). It is estimated that 95% of colorectal cancers are adenocarcinomas, an epithelial cancerous tissue with a glandular origin within the colon or rectum lining (ACS, 2013). Nonetheless, there are other rare forms of colon and rectum tumors.

Early screening for colorectal cancer is necessary for the intervention process for the condition. However, when there are many barriers affecting efficient early screening and detection of colorectal cancer (CRC) within the target population, it entangles an already complicated issue. Some of the barriers to early screening expands to social, cultural, and political issues. For instance, among the American Indian (AI) and Alaska Natives (AN), the epidemiological and public health efforts for the prevention and control or reduction of the incidence or prevalence of CRC is enormously hindered (James et al., 2013). In all area of the disease control and prevention aspects, detection of the risk factors or early detection of the symptoms is effective steps in reducing the mortality rate associated with the condition.

James et al., (2013) conducted a community-based participatory study on the barriers that hinder early detections of CRC. The study, primarily investigated and advanced insight on the barriers associated with early detection and screening of colorectal cancers among the AI and AN male population (James et al., 2013). The study findings, further advanced cohesive preventative and control measures for the Indian Health Service (IHS) department with effective public health programs, infrastructures and infostructures (James et al., 2013). These tools are necessary to amend the societal and health disparity within the target community.

The study employed a qualitative approach via a questionnaire and community-based meeting settings (James et al., 2013). The research questions that were included in each setting included information about knowledge of CRC, sources of CRC awareness programs, perception of CRC (negative perceptions), physicians’ impact, traditional or cultural influences or perceptions, and the participant or indigenous expectations for medical or health interventions (James et al., 2013). Each of the discussion categories focused on its impact as a barrier for early screening in detecting colorectal cancer. Interestingly, the study indicated that the AI men had similar concerns about the disease as any other groups or races or ethnic groups (James et al., 2013).

The study also emphasized factors or concerns that were specific to the AI and AN communities. The concerns included personal privacy, embarrassment, cultural healing practices, and self-contained or community-sustainable or localized and convenient clinics within the tribes. Concerns about privacy and embarrassment perception stemmed from cultural values regarding the knowledge and social evaluation threats attributable to the health condition within the cultural settings. In addition, part of the implications of the study for policy development and program planning deals with AI’s lack of trust in Western medicine. The issue of trust or lack thereof resulted from cumulative perceptions or effects or prejudgments indicative of prior medical/health malpractices subjected towards the AI and AN tribes.

Perhaps, integration of traditional or cultural formative research within the western-structured intervention is a necessary approach capable of producing effective early screening turnout and intervention process among the target AI and AN population. More importantly, limitation of outsourcing of specialized services such as colonoscopy, and maintaining specialized infrastructures/inforstructures within the reach of IHS departments and the tribes will encourage and promote early CRC screening turnout (James et al., 2013). Furthermore, the AI community-based consensus suggested that screening programs must address the needs/unmet needs of the target population in order to achieve a sustainable and feasible culturally relevant programs for the prevention and control of CRC among the AI/AN population.


American Cancer Society. (ACS). (2013). Colorectal cancer overview. Retrieved from http://www.

James, S., Filippi, M., Pacheco, C., Cully, L., Perdue, D., et al. (2013). Barriers to colorectal cancer screening among American Indian men aged 50 or older, Kansas and Missouri, 2006–2008. Preventing Chronic Disease, 10, 130067. Doi pcd10.130 067