Abstract A93: Contextualizing early detection: Lessons from lay definitions of colorectal cancer early detection.
Authors: Hunleth Jean M. , Mueller Nancy , James Aimee 
Published: August 2014

Purpose of study: Practitioners and researchers often promote “early detection” as a key message in colorectal cancer (CRC) screening programs and as a strategy to reduce disparities in CRC mortality. To better understand the experience of CRC for individuals who face substantial health and income inequalities, this qualitatively research examines the meanings and understandings of “early detection” that may be overlooked by quantitative approaches. This study suggests that early detection messages are contextualized and interpreted within lived experiences.

Procedures: Six focus groups and 21 open-ended interviews were conducted during 2006 and 2007 to examine understandings of CRC screening and detection. The study took place at an urban community health center in a U.S. Midwestern city and focused on adults age 45 years and older. Most participants were female, African American, unemployed, and had no more than a high school education. Nearly half were without any type of health insurance. Transcripts were analyzed by two coders, who used an inductive data analysis approach.

Summary of Data: Four key findings were identified throughout the transcripts. First, participants made sense of CRC through comparisons to a range of diseases experienced in their families and communities and seen in public health campaigns. Second, they utilized statements about early and late detection of cancer to make sense of past personal and family experiences with cancer. Most participants had experienced multiple deaths of family and friends to cancer and were drawing on early detection messages to grapple with their sadness, guilt, and blame over why loved ones had died. Third, CRC screening and detection were viewed within the context of possible treatments and treatment outcomes. Ideas about treatment accessibility and effectiveness heavily influenced participants' approaches to accessing screenings. Finally, rather than an avoidance of health-seeking behavior, participants demonstrated and discussed their persistence in attempting to achieve diagnoses and treatment with limited resources.

Conclusion: The study findings suggest that frequently invoked constructs in preventive health, such as early detection and the treatability of cancer in its earliest stages, take on much more complex meanings than researchers, practitioners, and clinicians may expect. Examining these meanings offers a starting point for understanding and redressing CRC disparities in populations that have experienced significant inequities in access to quality healthcare, which have sometimes endured over generations. Researchers should consider social contexts and deeper meanings when developing communications that emphasize early detection and when using measures that ask individuals about early detection beliefs and behaviors.

Citation Format: Jean M. Hunleth, Nancy Mueller, Aimee James. Contextualizing early detection: Lessons from lay definitions of colorectal cancer early detection. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A93.