Earlier this year, Juanita Thomas, 63, went to her local Department of Motor Vehicles to register her car.
Cancer was the last thing on Thomas’ mind that day, a retired housekeeper, mother, grandmother and great-grandmother who lives in Omaha, Nebraska. But while at the DMV, she was offered free insurance three times. Colorectal cancer Screening kit.
Finally she relented.
“I brought it home and sat looking at it for a few days before I used it,” Thomas told TODAY.com, until her kids mentioned “Black Panther” actor Chadwick Boseman. Died of colon cancer at age 43Thomas finally decided to take the test.
The kit includes: Stool immunochemical testing Obtaining the FIT, which detects blood in stool, was easier than she expected. She used a prepaid envelope to mail it off to a lab for analysis. After finding nothing abnormal in her sample, Thomas was shocked to get a call later saying the lab had, in fact, detected blood. Blood in the stool.
“I had no idea. I felt fine,” she said, “so I kept refusing to get tested.”
Thomas then had a colonoscopy with her daughter, and “the nerves went away,” she said. During the exam, doctors found and removed eight polyps from her colon and rectum. Most colon polyps are harmless, but if left untreated, they can progress to cancer. Mayo Clinic says.
In Thomas’ case, the team found no cancer.
Looking back, Thomas says she’s glad the DMV staff persisted, because the test found a polyp and gave her peace of mind that it wasn’t colon cancer. “I came out of the test feeling like a different person,” she says.
Thomas is one of about 340 people. Have you been tested for colon cancer? BEAT Cancer ProjectShe was one of 21 participants who tested positive and one of six who underwent a follow-up colonoscopy.
The study aims to utilize the DMV (both its physical space and data directory) to provide free colorectal cancer screening to people in underserved areas.
“I’ve been researching cancer screening for the past 10 years, and what really bothers me is that subsidies for cancer screening aren’t being offered equally to everyone,” study leader Dr. Jeongyoon Kim, an assistant professor in the Department of Health Services and Administration at the University of Nebraska Medical Center, told TODAY.com.
One statistic that stood out to her was that black Americans are about 20% more likely to be diagnosed with colorectal cancer than other racial groups, and 40% more likely to be diagnosed with colorectal cancer. More likely to die from colon cancer Also, American Cancer Society.
“That was a real eye-opener for me,” she said. “I wondered if there was anything I could do to reduce this in my community.”
Kim partnered with an advisory board of local organizations, including Douglas County Treasurer John Ewing, the Great Plains Colorectal Cancer Task Force and the Charles Drew Health Center, to reach people who don’t always get proper care, meeting them at the DMV instead of a doctor’s office.
Although the DMV is a state agency, each county treasurer’s office provides DMV services, Ewing told TODAY.com.
Ewing, who has volunteered at community events including Sunshine Kids and the Leukemia & Lymphoma Society, said the partnership made sense both as a way to improve access to colorectal cancer screenings and as part of a strategy to change the way clinics like his interact with people.
“This isn’t government as usual,” he said, “it’s more innovative, and we’re looking at how we can be better partners with the local community.”
Research staff set up booths in the lobbies of the DMV and Ewing office buildings to talk to people and hand out FIT kits. They also used DMV driver’s license data to mail kits to eligible participants in certain age and racial groups in the area, Kim explains. The data is surprisingly rich, covering about 90% of the area’s population, she says.
Thanks to funding from the Robert Wood Johnson Foundation, the test kits will be provided completely free to participants. “You don’t even have to pay for postage because you can use prepaid envelopes,” Kim said.
If follow-up care is required, ColonoscopyInsurance should be able to cover it, board chair Bailey Cooper said. Great Plains Colorectal Cancer Task Force “I was so happy,” the oncology nurse practitioner at Nebraska Medicine Buffett Cancer Center told TODAY.com.
For those who don’t have insurance, community health navigators can connect participants to low-cost or free care at health centers, Kim explains. Many of those surveyed did not have a primary care doctor, and 25% reported being uninsured, she said.
For example, if there’s no “medical home” while participants are going through the process, staff might direct people to Charles Drew Health Center, a federally qualified medical center, Ewing said. (Ewing is also president of the medical center’s board of directors.)
Correcting health care disparities means facing people’s current situations
Distributing test kits at the DMV is an “innovative and exciting” approach, Dr. Sherezadeh K. Mama, assistant professor in the department of health disparities research at The University of Texas MD Anderson Cancer Center, told TODAY.com.
Mom (not involved with the BEAT Cancer study) and her colleagues have experience launching research outreach at tax preparation events in Texas and working with local pastors.
Transportation, distance, and access to child care are major concerns for the low-income and rural residents Mama serves, “so we meet them where they are or where they’re already headed, rather than asking them to make additional trips,” Mama explains.
Similarly, using the DMV as a place to meet with people who might fall through the cracks of the mainstream health care system “could have a big impact,” Mama said.
But until now, the DMV seems to have been overlooked as a place to reach out to such people. “I’ve never heard of anything happening at the DMV,” Mama said.
Ewing agrees: “I haven’t heard of anyone else doing it, but we want to do something different.”
It will be particularly interesting to see how many people actually get tested and whether participants are more likely to respond to kits they receive in person or by mail, Mama says.
In fact, Cooper says the biggest challenge is following up with people who have a positive FIT result. “It can be really hard to get in touch with someone, usually by phone,” she explains. “There’s a very real fear of, ‘What will we find out if we do more testing? It’s better not to know.'”
Ewing added: “A lot of times we just bury our heads in the sand and think everything’s going to be OK or hope the problem will go away.”
People may simply not know This is the age at which you should be screened for colorectal cancer. Or they say the cost of testing should be covered by insurance. Educating the public about these issues is another way outreach projects like this one help address racial disparities in health care, Ewing adds.
While kits may be mailed out more than distributed, “the personal contact and experience of having a face and a name and someone you can actually talk to makes a big difference,” Mum said.
Cooper has a similar hunch. “The DMV approach is to have face-to-face interaction, to have a conversation,” she says, “but just seeing it online or in print doesn’t resonate as well.” Having someone in person to answer your questions when they come up is “definitely more effective” than mailing it, she adds.
Regardless of what the data ultimately comes out as, the study “can potentially give us more information about where we can be most cost-effective,” Mama said, which could help guide future outreach efforts.
Even if the project only helps a few people, “it still helps somebody.”
The project will begin with a small pilot study in 2021, followed by Current Clinical TrialsThe outreach efforts began in October 2023, Kim said.
The team is currently preparing for its next outreach effort, which begins on September 1, and will also focus on social media advertising to drive participants to in-person venues.
“I’d love it if this could continue,” Cooper said. “We want to keep doing this as long as we can, because even if it only helps a few people, it helps somebody.”
The task force provides free testing kits each March during Colorectal Cancer Awareness Month, but this project will help them get testing kits to local residents year-round, she said.
Ewing said he hopes the project continues, but may expand to other health topics. Perhaps the DMV space could be used for colorectal cancer awareness for a few months, then breast cancer or other topics. Stroke Awarenesshe says.
Thomas says you don’t need to get tested again for three years after having a colonoscopy, and encourages others to “definitely get tested. It may be a hassle, but it’s worth it in the long run.”
But for now, she says she’s looking forward to enjoying the rest of her “polyp-free summer.”
