To improve outcomes for individuals at risk for colorectal cancer (CRC), it is imperative to raise awareness and provide education regarding screening recommendations, methods, and benefits under the Affordable Care Act (ACA). Cultural tailoring of interventions is recommended to increase screening rates for early detection in racial and ethnic minorities, according to research presented at the American Academy of Physician Associates (AAPA) national conference held May 20 to 24, 2023, in Nashville, Tennessee.

The authors note a lack of awareness among older adults within certain racial and ethnic groups regarding ACA benefits and the age to start CRC screening, and that with proper screening, the risk can be reduced.

Researchers wanted to understand the knowledge, attitudes, beliefs, and screening practices of residents in South Los Angeles County who are mostly of Latino/a/x and Black/African American descent. To study screening rates, researchers included adults living in a community setting in their cross-sectional study. The study included individuals aged 45 to 75 years who did not have a previous history of colon cancer or terminal illness.

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Of the 120 adults included in the study, 57% were female and 43% were male. Researchers noted that 52% of individuals identified as Latino/a/x, while 44% identified as Black/African American. The annual household income of 46% of individuals was <$10,000; however, 13% of individuals confirmed having health insurance. Findings indicate that 31% confirmed completing high school and receiving a diploma.

A 66-question survey was created for participants to complete, which included the following topics: knowledge, attitudes, and beliefs; screening; and medical insurance. Results of the survey indicated that it is more common for individuals who identify as Black or African American to be unfamiliar with the benefits of the ACA. Additionally, these participants may be less likely to believe that they are at risk for colorectal cancer when compared to the Latino/a/x population.

The Latino/a/x community members experience barriers when it comes to screening due to fear and a limited understanding of the testing process. Approximately 30% of the participants believe that undergoing CRC screening puts them at an avoidable risk.

Screening for CRC was considered up to date if an individual had a colonoscopy in the last 10 years or a home test within the last 3 years. However, even though participants recognized the benefits of screening, approximately one-third of the participants were not considered up to date for screening. Additionally, 40% of the participants who were not up to date had no plans of receiving a screening in the next year.

Table 1. Knowledge of ACA Benefits and Cancer Screening

Patient Response  Aware of ACA Benefits, %  Don’t know how to get a colon cancer test, %  
Black/African American
ACA, Affordable Care Act

Table 2. Perceived Age to Begin Colon Cancer Screening

What is the Appropriate Age to Start Colon Cancer Screening?
ParticipantsAge, yAnswered Positive, %
Black/African American  

The findings of this study can be used to create specific approaches for improving the health outcomes of these communities. Understanding people’s knowledge, beliefs, and screening habits regarding early cancer detection can impact their quality of life and lifespan; since cancer outcomes and health disparities are greatly influenced by race, ethnicity, and socioeconomic status.

Researchers noted that this study has potential limitations due to a small sample size of only 120 participants at one site and potential bias from utilizing snowball sampling.

According to researchers, “PA’s [Physician Associates] are perfectly positioned to address CRC health disparities by enhancing patient knowledge and addressing barriers related to CRC screening in at-risk communities.”

Visit Clinical Advisor’s meetings section for more coverage of AAPA 2023.


Vines-Douglas G, Kuo Y, Shrode K, Shaheen M, Millan R, Kibe L. Small pebbles make big ripples. Racial/ethnic differences related to colorectal cancer screening in adults from underserved communities: knowledge, attitudes and beliefs, screening. Presented at: AAPA national conference; May 20-24, 2023; Nashville, TN.