Investing in Diagnostic Equity: A Community-Driven Colorectal Cancer Initiative

Colorectal cancer takes a disproportionate toll on Black Americans, who are less likely to be screened for the illness—and are significantly more likely to die from it—than whites.

Julius Wilder, MD, PhD, a gastroenterology associate professor, medical sociologist and equity leader at Duke University School of Medicine, is trying to change this. He has launched a project aimed at increasing colorectal cancer screening rates among African Americans living in Durham, North Carolina.

Dr. Wilder, along with team members and UC San Francisco medical resident Bharti Selvan (a former Duke medical student), is raising community awareness about colorectal cancer risk factors and screening options, while also educating trainees about the disproportionate burden of colorectal cancer and other race-dependent disparities in health outcomes. The project is funded through the ABIM Foundation’s Building Trust through DEI and Diagnostic Excellence in Internal Medicine Training grant program.

Through a partnership with the Community Health Coalition, the project team has distributed fecal immunochemical test (FIT) kits at four health fairs and educated community members about colorectal risk and screening options; they are planning for 10 more events. The project team has also given presentations to internal medicine residents and medical students about colorectal cancer and health equity and engaged a community organizer to teach residents about community engagement. In addition, they are developing a health equity curriculum for internal medicine residents that will be adaptable to various health disparities.

“We see a clear need for two things that this project addresses,” Dr. Wilder said. “First, we need to engage diverse communities about colon cancer screening, and we must do this in the community, going beyond the need for them to come to us. The second broad issue focuses on the education of our residents about health equity and how community engagement is a means of addressing social drivers of health inequities. We achieve this through our core lectures and the curriculum we are designing for the medical residents.”

Dr. Wilder is seeking both to improve community health—tracking the number of FIT kits distributed, colonoscopy referrals, and colonoscopies completed—and trainees’ understanding of the complex factors at play in seeking to understand and address disparities in the communities they serve.