MSK psychologist Rosario Costas-Muñiz, PhD, focuses on cancer prevention and treatment in the Latino community, including colorectal cancer. She estimates that 90% of the people she cares for speak Spanish as their first language.
Colorectal cancer is a leading cause of cancer deaths among people within the Latino/Hispanic community.
But Rosario Costas-Muñiz, PhD, of Memorial Sloan Kettering Cancer Center (MSK), wants people to know the good news about screening tests for colorectal cancer, which can help prevent the disease and are often easier than people think.
Dr. Costas-Muñiz is Director of the Latino Comprehensive Psychological Oncology Program. As a psychologist at MSK, her work focuses on cancer prevention and treatment in the Latino community, and she estimates that 90% of the people she cares for at MSK speak Spanish as their first language.
She was raised in Puerto Rico, and her research delves deeply into many Latino groups, including people from the Caribbean, those of Mexican ancestry, and other Hispanic populations.
“My passion about screening for colorectal cancer in the Latino community is also deeply personal,” she says. “My father was diagnosed with advanced colorectal cancer when he was 50. He died two years later, when I was a teenager.
“One of the things that inspires me,” she continues, “is asking, ‘If he was screened earlier, would he be with us now?’ That really drives my work.”
Dr. Costas-Muñiz’s research has uncovered some of the biggest barriers Latinos face in seeking to protect themselves against colorectal cancer — and she has tips to help.
How does colorectal cancer affect the Latino community?
Colorectal cancer is the second most common cancer among Latino/Hispanic men and also the second leading cause of cancer death. Colorectal cancer is the third most common cancer among Latina/Hispanic women and the third leading cause of cancer death, according to the American Cancer Society.
Who should have colorectal cancer screening?
MSK and major doctors’ groups advise people at average risk to begin screening for colorectal cancer at age 45.
The American Cancer society reports that rates of colorectal screening at 45 years of age and older are significantly lower in Hispanic adults (49%) than among non-Hispanic whites (58%).
Learn more about colorectal screening
Common Barriers to Colorectal Screening in the Latino Community
Lack of Insurance and Access to Healthcare Providers
“Our research shows that the main barrier to more Latinos being screened for colorectal cancer is concern about insurance,” says Dr. Costas-Muñiz. “For some people, that means no insurance or being concerned that the insurance they have won’t cover the cost.”
Dr. Costas-Muñiz suggests that people get in touch with their local health authorities and call providers and hospitals to ask if they offer free or reduced-rate colorectal screening.
“In New York state, for example, there are lots of opportunities for free screenings in different clinics, including MSK’s Ralph Lauren Center in Harlem,” she says. “The HHC system (Health and Hospitals Corporation), which operates hospitals and clinics across the New York area, also offers many free colorectal screening opportunities.”
Another source of information and resources is the New York Citywide Colorectal Cancer Control Coalition (C5), a group of health professionals with expertise in colorectal cancer prevention that advises and collaborates with the NYC Department of Health to increase access to colorectal screenings. MSK doctors are members of this group.
RESOURCES:
- Cancer Screening at The Ralph Lauren Center
- New York State Cancer Services Program offers free or low-cost screening: https://www.health.ny.gov/diseases/cancer/services/community_resources/
- Community members can call 311 or 1-866-442-CANCER (2262) to find out about low-cost or free screening.
- The C5 webpage includes more resources in Spanish: https://www.nyc.gov/site/doh/health/health-topics/colon-cancer.page#facts
Lack of Doctor Engagement
Dr. Costas-Muñiz points out that “many people in the Latino community do not have a primary care physician to encourage them to get screened for colorectal cancer, or they only see a doctor when they are really sick, not for preventive care.” Even if they do have a primary healthcare provider, she says, “it may be in a setting with lots of patients and no time to ask questions, or there may be language barriers.”
The result, according to her research, is that a crucial opportunity to encourage colorectal screening is lost. “For many patients, including Latinos, it is not enough to be told: ‘It’s time for your screening.’ They need to understand what a screening is, what their options are, where to get it, and what the logistical details are, such as taking a day off work for a colonoscopy.”
TIP: Dr. Costas-Muñiz recommends that people bring a list of questions to their healthcare providers, to make sure their concerns are addressed.
QUESTIONS TO ASK ABOUT COLORECTAL SCREENING
- Am I at risk for colorectal cancer?
- When do you recommend that I start getting tested?
- How often do I need to get tested?
- What are the different types of screening tests for colorectal cancer?
- Which screening test do you recommend for me? Why?
- What happens during the test? How do I prepare?
- Does the test have any risks or side effects?
- How long will it take to get the results?
- What can I do to reduce my risk of colorectal cancer?
- What is the cost?
- Do I have to take time off from work? (for working people)
- Do I have to bring someone with me to the test?
- What is the recovery time?
- Does the clinic offer language interpretation or a translator?
- Do you have the preparation and other materials in Spanish?
Language and Work Issues
Dr. Costas-Muñiz encourages Latinos to advocate for Spanish-language services. Families can serve an important role too. “That could mean scheduling doctor appointments for a mother and daughter on the same day,” she notes, “so the daughter can be there and even translate for the mother if needed.”
Dr. Costas-Muñiz points out that for many Latinos, missing a day of work to undergo a colonoscopy can present a dilemma. “They may work a job where they are paid by the day and are reluctant to lose income,” she says. “But I tell them that colonoscopies can prevent much larger, more invasive healthcare issues later. And at-home tests are a convenient option to make sure people get screened.”
What are the different types of colorectal screening?
- Stool-based tests examine a sample of a person’s stool (poop) to look for signs of cancer or growths inside the colon that can turn into cancer. These tests include one commonly known by its brand name, Cologuard.
Many people appreciate that these tests can be used at home and don’t require any preparation. If the test reveals signs of cancer, then a colonoscopy is recommended to confirm.
- A colonoscopy looks directly inside the colon and rectum. A thin, flexible tube is inserted into the colon. The tube contains a camera to look for polyps (growths of tissue) that can grow into cancer. If discovered, polyps can be easily removed by the doctor during the colonoscopy. A similar procedure called a sigmoidoscopy looks at a shorter section of the colon.
TIP: colonoscopy or sigmoidoscopy is the only type of colorectal screening that can prevent cancer by removing polyps.
Learn more about how at-home screening compares to colonoscopies
Colorectal Cancer Among People Under 45
The number of older people diagnosed with colorectal cancer is going down — and so is the death rate — because of more screening and advances in treatment, many of them pioneered at MSK.
However, there has been a disturbing rise in recent years of colorectal cancer among people younger than 45, including younger people in the Latino community. These younger people are often not diagnosed until the cancer is advanced, making it harder to treat.
MSK established the Center for Young Onset Colorectal and Gastrointestinal Cancers, the first center in the world devoted to the specific needs of people under 45 who are diagnosed with colorectal cancer.
Symptoms of Colon Cancer
Colon cancer sometimes has few, if any, symptoms. However, it’s important for people at any age to talk with a healthcare provider if they experience troubling symptoms that last longer than a few days, including:
- Rectal bleeding or blood in your stool
- A change in your bowel habits, such as diarrhea, constipation, or narrow stool that lasts longer than expected
- Unexplained abdominal pain or cramping
- A persistent urge to have a bowel movement that doesn’t go away after you have one
- Unexplained weakness and fatigue
- Unintended weight loss
- A diagnosis of anemia
- Women who have bloating that doesn’t go away or happens with unexplained weight loss