Colorectal Cancer Screening Rates Differ Among Racial Groups
June 02, 2017
White people are more likely than blacks and Hispanics to undergo
screening for colorectal cancer, according to a study published in the
June 23 issue of Archives of Internal Medicine.
Anthony F. Jerant, M.D. (University of California Davis School of
Medicine, Sacramento) and colleagues point to barriers related to
socioeconomic status, health care access, and language as reasons for
this racial discrepancy. Differences between whites and Asians,
however, are most likely due to other factors.
Compared to screening rates for other types of cancer, colorectal
cancer screening rates historically have been lower. The clear
disparities in screening rates between non-Hispanic whites and racial
and ethnic minorities in the United States, "May contribute to
the higher colorectal cancer incidence and mortality rates observed in
racial/ethnic minorities relative to non-Hispanic whites," according to
the authors.
To further analyze the factors related to these racial disparities,
Jerant and colleagues studied survey data collected from 22,973 adults
age 50 and older. The national surveys, conducted between 2000
and 2005, asked questions pertaining to demographics, colorectal cancer
screening behaviors, and additional items related to social and health
care.
The survey revealed that 54.1% of respondents received either a
colorectal cancer screening by means of colonoscopy or fecal occult
blood testing (FOBT). The racial breakdown for receiving such tests was:
33.8% of Asians
48.2% of blacks
36.7% of Hispanics
57.2% of whites
Notably, the differences between blacks, Hispanic, and whites
disappeared when the researchers statistically adjusted for factors
related to demographics, socioeconomic variables, language spoken at
home, health care access and self-rated health. The authors write that,
"Beyond socioeconomic factors, which disproportionately affect
minorities, these findings suggest the effect of access and, for
Hispanics, language-appropriate care on colorectal cancer screening
uptake."
The disparity between whites and Asians remained significant, however,
after adjusting for these factors. "Although this study does not permit
firm conclusions regarding the reason for this finding, the implication
is that unmeasured cultural factors may contribute to the
Asian/non-Hispanic white disparity in colorectal cancer screening,"
explain Jerant and colleagues. "Less acculturated Asian individuals in
the United States may have core health beliefs and values that differ
from those in the 'Western' health model, leading them to decline FOBT
or endoscopy offered in the absence of worrisome symptoms. They may
also be less likely to be offered colorectal cancer screening."
The authors believe that these findings can help design programs that
can target different minority groups to improve their screening rates.
For Asians, the suggestion is culturally targeted interventions for
patients and physicians, and for black patients, the authors mention
enhancing access to health care. For Hispanic patients, conclude the
authors, maximizing access and offering language-appropriate care may
improve their screening rate.
Determinants of Racial/Ethnic Colorectal Cancer Screening
Disparities
Anthony F. Jerant, MD; Joshua J. Fenton, MD, MPH; Peter
Franks, MD
Archives of Internal Medicine (2008). 168[12]:
pp. 1317
- 1324.
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: Peter M Crosta