Pathways to Health: A surreal image representing colorectal cancer screening in American Indian communities, blending tradition and modern healthcare.

Are We Missing the Mark on Colorectal Cancer Screening? Insights from Northern Plains American Indian Communities

Theo Raines in Health & Wellness December 2025 • 5 min read.

"A closer look at screening practices reveals gaps in guideline adherence, highlighting the need for culturally tailored education and improved access to care."

Colorectal cancer (CRC) is a major health concern, and its impact varies significantly among different populations. American Indian and Alaska Native (AI/AN) communities, in particular, face unique challenges related to CRC, including differences in incidence, mortality, age of onset, and stage of diagnosis. Effective screening is crucial for reducing CRC incidence and mortality, but ensuring that these communities receive appropriate and timely screening requires a deep understanding of the local healthcare landscape.

A key factor in promoting CRC screening is the knowledge and practices of healthcare providers. Providers need to be up-to-date on the latest screening guidelines and equipped to address the specific needs and concerns of their patients. However, studies have shown that adherence to recommended screening practices can be inconsistent, particularly in underserved communities.

To address these challenges, the Improving Northern Plains American Indian Colorectal Cancer Screening (INPACS) study was initiated. This project aimed to gain insights into the CRC screening practices of healthcare providers serving Northern Plains AI/AN communities. By understanding the influences on provider behavior, the study sought to inform strategies for improving screening rates and ultimately reducing the burden of CRC in these vulnerable populations.

The Persistent Use of Outdated Screening Methods: Why It Matters

Pathways to Health: A surreal image representing colorectal cancer screening in American Indian communities, blending tradition and modern healthcare.

The INPACS study revealed a concerning trend: a significant proportion of healthcare providers in the Northern Plains AI/AN communities were still using digital rectal examination (DRE) specimens for fecal occult blood tests (FOBT). Specifically, nearly two-thirds (64.7%) of providers reported performing in-office guaiac-based FOBTs using DRE specimens. This practice is problematic because guidelines recommend against using DRE stool specimens for CRC screening.

The reasons behind the continued use of DRE specimens for FOBT are complex and multifaceted. Several factors may contribute to this practice:

Lack of Awareness: Some providers may not be fully aware of the updated CRC screening guidelines that discourage the use of DRE specimens.
Habit and Training: DRE stool specimens were a common method for FOBT in the past, and some providers may still be using this approach out of habit or due to their initial training.
Patient Expectations: Some providers may feel pressure to perform DRE stool specimens for FOBT because patients expect it or because they believe it is better than no screening at all.
System-Level Factors: Pressure to meet screening targets and a lack of clear communication from healthcare administrators may also contribute to the continued use of this outdated practice.

Regardless of the reasons, the continued use of DRE specimens for FOBT is a concern because it may lead to false reassurance and delay more appropriate screening. Studies have shown that this method has a low sensitivity for detecting CRC and advanced adenomas, meaning that it is likely to miss many cases. This can give patients and providers a false sense of security, potentially delaying diagnosis and treatment.

Moving Forward: Improving CRC Screening in Northern Plains AI/AN Communities

The findings from the INPACS study highlight the need for targeted interventions to improve CRC screening practices in Northern Plains AI/AN communities. These interventions should focus on:

<ul> <li>Provider Education: Ensuring that healthcare providers are up-to-date on the latest CRC screening guidelines and understand the limitations of using DRE specimens for FOBT.</li> <li>Community Engagement: Engaging with community members to raise awareness about CRC screening and address any concerns or misconceptions.</li> <li>System-Level Changes: Implementing clinic policies that promote recommended screening practices and providing support for providers to adopt these practices.</li> <li>Addressing Barriers to Access: Identifying and addressing barriers to CRC screening, such as lack of insurance, transportation, or access to endoscopy services.</li> </ul>

By addressing these challenges, we can work towards improving CRC screening rates and reducing the burden of this disease in Northern Plains AI/AN communities.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5888/pcd13.160267, Alternate LINK

Title: Influences And Practices In Colorectal Cancer Screening Among Health Care Providers Serving Northern Plains American Indians, 2011–2012

Subject: Public Health, Environmental and Occupational Health

Journal: Preventing Chronic Disease

Publisher: Centers for Disease Control and Prevention (CDC)

Authors: Melanie Nadeau, Anne Walaszek, David G. Perdue, Kristine L. Rhodes, Donald Haverkamp, Jean Forster

Published: 2016-12-15

Everything You Need To Know

What specific outdated screening method was identified as a concern in Northern Plains AI/AN communities, and why is it problematic?

The INPACS study revealed that a significant number of healthcare providers serving Northern Plains AI/AN communities were still utilizing digital rectal examination (DRE) specimens for fecal occult blood tests (FOBT). This is problematic because current guidelines advise against using DRE stool specimens for colorectal cancer screening due to its low sensitivity in detecting colorectal cancer and advanced adenomas, potentially leading to false reassurance and delayed diagnosis.

What are the reasons behind healthcare providers continuing to use digital rectal examination (DRE) specimens for fecal occult blood tests (FOBT) in colorectal cancer screening?

Several factors contribute to the continued use of DRE specimens for FOBT. These include a potential lack of awareness of updated CRC screening guidelines, habit and training from past practices, patient expectations, and system-level factors like pressure to meet screening targets and a lack of clear communication from healthcare administrators. Addressing these factors requires multifaceted interventions including education, policy changes, and improved communication strategies.

According to the INPACS study, what are the potential implications of using digital rectal examination (DRE) stool specimens for fecal occult blood tests (FOBT) for patients?

The persistent use of digital rectal examination (DRE) stool specimens for fecal occult blood tests (FOBT), as highlighted by the INPACS study, can lead to a false sense of security. Because this method has a low sensitivity for detecting colorectal cancer and advanced adenomas, many cases may be missed, delaying diagnosis and treatment. This delay can have severe implications, as colorectal cancer outcomes are significantly improved with early detection and intervention.

How can culturally tailored education improve colorectal cancer screening practices based on the insights from the INPACS study?

The INPACS study underscores the necessity for culturally tailored education to enhance CRC screening practices. This involves not only updating providers on current guidelines and evidence-based practices but also addressing the unique cultural beliefs, values, and healthcare access barriers within Northern Plains AI/AN communities. Culturally sensitive approaches can build trust, improve patient engagement, and ultimately lead to better screening rates and health outcomes. Furthermore, attention should be given to system-level factors like ensuring clear communication among healthcare staff to meet goals.

Aside from addressing outdated screening methods, what other steps can be taken to improve colorectal cancer screening and reduce disparities in Northern Plains AI/AN communities?

Beyond the specific findings of the INPACS study regarding the use of digital rectal examination (DRE) stool specimens for fecal occult blood tests (FOBT), broader considerations include addressing disparities in CRC incidence and mortality rates within Northern Plains AI/AN communities. Improving access to colonoscopy, offering alternative screening methods like fecal immunochemical test (FIT), and implementing patient navigation programs can further enhance screening rates and reduce the overall burden of CRC in these vulnerable populations. Furthermore, the latest CRC screening guidelines from organizations like the American Cancer Society should be promoted.