Earlier this year, Juanita Thomas, 63, went to the local motor vehicle department to register a car.
For Thomas, a retired housekeeper, mother, grandmother and great-grandmother from Omaha, Nebraska, cancer was the last thing on her mind that day. But while she was at the DMV, she was approached no fewer than three times by people offering her a free colorectal cancer screening kit.
Finally, she gave in.
“I took it home, put it down and looked at it for a few days before I used it,” Thomas tells TODAY.com. It wasn’t until her children mentioned “Black Panther” actor Chadwick Boseman, who died at age 43 of colon cancer, that Thomas was finally convinced to take the test.
The test, a fecal immunochemical test (FIT) that detects blood in stool, turned out to be easier to take than expected. Using a prepaid envelope, she sent it to a lab for analysis. Thomas found nothing abnormal in her sample, so she was shocked to get a call later to tell her that the lab had indeed found blood in her stool.
“I had no idea, absolutely no idea. I felt fine,” she said. “That’s why I kept refusing to take the test.”
Thomas then underwent a colonoscopy, accompanied by her daughter, which “took all the nerves out of her,” she says. During the procedure, doctors found and removed eight polyps from her colon and rectum. While most colon polyps are harmless, some can turn into cancer if left untreated, the Mayo Clinic says.
In Thomas’ case, the team found no cancer.
Looking back, Thomas says she’s glad the DMV people were so persistent, because the procedure revealed those polyps and reassured her that she didn’t have colon cancer. “I walked out of there feeling like a whole new person,” she says.
Thomas is just one of about 340 people who were tested for colon cancer through the Black Equity, Access and Testing for Cancer (BEAT) Cancer Project. She is one of 21 participants whose test results came back positive and six who underwent a follow-up colonoscopy.
The study aims to use the DMV — both the physical space and its data list — to provide free colorectal cancer screening to people in underserved communities.
“I’ve been researching cancer screening for the last 10 years, and … one thing that really bothers me is that cancer screening assistance is not equal for everyone,” Jungyoon Kim, Ph.D., assistant professor in the department of health services and administration at the University of Nebraska Medical Center and leader of the study, told TODAY.com.
One statistic in particular has always stuck with her: African-Americans are about 20 percent more likely to be diagnosed with colon cancer than other racial groups — and they are also 40 percent more likely to die from colon cancer, according to the American Cancer Society.
“It really surprised me,” she said. “I wondered if there was anything in my community I could do to reduce this.”
Partnering with an advisory committee of local groups, including Douglas County Treasurer John Ewing, the Great Plains Colon Cancer Task Force and Charles Drew Health Center, Kim decided to reach out to people who don’t always get the care they deserve — and decided to meet them at the DMV instead of a doctor’s office.
Although the DMV is a state agency, individual county treasurer’s offices provide DMV services, Ewing tells TODAY.com.
As a volunteer for local initiatives like Sunshine Kids and events for the Leukemia and Lymphoma Society, Ewing says the partnership just made sense — both as a way to improve access to colon cancer screenings and as part of a strategy to change the way people interact with offices like his.
“This is not a government like any other,” he said. “It’s more innovative. And it’s about asking how can we become better partners with the community.”
Researchers set up booths at the DMV and in the lobby of Ewing’s office building to talk to people and hand out FIT kits. Staff also use DMV driver’s license data to mail kits to eligible participants in certain age and racial groups in the area, Kim says. The data is surprisingly rich, covering about 90 percent of the area’s population, she says.
Thanks to funding from the Robert Wood Johnson Foundation, the test kit is completely free for participants. “You don’t even have to pay for postage because you can just use the prepaid envelope,” Kim says.
If follow-up care is needed, such as a colonoscopy, insurance should cover it, Bailey Cooper, board secretary of the Great Plains Colon Cancer Task Force and an oncology nurse at Nebraska Medicine Buffett Cancer Center, tells TODAY.com.
And for those without insurance, community health navigators are able to connect participants with low-cost or free care at the health center, Kim says. About 40 percent of Study participants reported not having a primary care physician, and 25 percent of them had no insurance, she said.
For example, if participants don’t have a “medical center” at the time they go through this process, staff can refer them to the Charles Drew Health Center, a federally qualified health center, Ewing says. (Ewing is also the health center’s board chair.)
Addressing health care disparities requires meeting people where they are.
Distributing test kits to the DMV is an “innovative and exciting” approach, Scherezade K. Mama, Dr.PH., assistant professor in the department of health disparities research at the University of Texas MD Anderson Cancer Center, told TODAY.com.
Mama (who is not involved in the BEAT Cancer study) and her colleagues have experience setting up outreach studies in Texas at tax preparation events and working with local pastors.
Transportation, distance and child care coverage are major concerns for the low-income and rural populations Mama works with, “so we meet them where they are or where they are already going rather than requiring additional travel,” Mama says.
Similarly, using the DMV as a space to meet those who might fall through the cracks of the traditional medical system “could have a big impact,” Mama says.
So far, the DMV seems to have been overlooked as a way to reach these people. “I’ve never heard of any incidents at the DMV before,” Mama says.
Ewing agrees: “I’ve never heard of anyone else doing it. But I want us to be different.”
It will be particularly interesting to see how many people actually take the tests and whether participants are more likely to respond to kits obtained in person or by mail, Mama says.
Indeed, the biggest challenge has been following up with people who test positive for FIT, Cooper says. “It’s sometimes very difficult to get a hold of someone, usually by phone,” she says. “There’s a real fear of what I’m going to find with further testing. I’d rather not know.”
Ewing adds: “We often bury our heads in the sand and think everything is fine or hope it will pass.”
People may not know that they should get screened for colon cancer at their age or that the cost of screening should be covered by insurance. Educating the public on these topics is another way that outreach projects like this one can help address racial disparities in the medical field, Ewing adds.
Even though more kits are mailed than distributed, “that personal touch and experience – having a face, a name and someone to talk to – can make all the difference,” Mama says.
Cooper has a similar hunch: “With the DMV approach, there’s a face-to-face interaction, a conversation,” she says. “But if you just see it online or on paper, it doesn’t really resonate with you.” Having someone directly in front of you to answer questions as they come up “can definitely be more effective (than sending by mail),” she adds.
Regardless of how the data ultimately turns out, this study “could give us more insight into where we’re getting the best return on investment,” Mama says, which could help guide future outreach efforts.
Even if the project only helps a few people, “it’s still someone”
The project initially began with a small pilot study in 2021, followed by the current clinical trial, which began dissemination in October 2023, Kim says.
The team is now preparing for a new round of outreach activities starting September 1, with an increased emphasis on social media advertising to drive participants to in-person sites.
“I would like to keep it going,” Cooper says. “We would like to work on this project for as long as possible, because even if it only helps a small number of people, it is still a great help.”
Although the task force provides free test kits every March for Colorectal Cancer Awareness Month, she said, this project would help them reach community members throughout the year.
Ewing also hopes the project can continue, but he sees potential for expansion into other areas of health. He thinks the DMV space could be used for colon cancer awareness for a few months, and then for breast cancer or stroke awareness.
After his colonoscopy, Thomas won’t need another one for three years, she said, and she encourages others to “definitely get the test. … It’s annoying. But in the long run, it’s worth it.”
But for now, she’s looking forward to enjoying the rest of her “polyp-free summer,” she says.
