BACKGROUND The “Southern Black Belt,” a term used for > 100 years to describe a subregion of the southern U.S., includes counties with high concentrations of African Americans and high levels of poverty and unemployment, and relatively high rates of preventable cancers. METHODS The authors analyzed data from a state‐based telephone survey of adults age ≥ 18 years to compare the cancer screening patterns of African‐American and white men and women in nonmetropolitan counties of this region, and to compare those rates with those of persons in other southern counties and elsewhere in the U.S. The primary study groups were comprised of 2165–5888 women and 1198 men in this region interviewed through the Behavioral Risk Factor Surveillance System. The respondents lived in predominantly rural counties in 11 southern states with sizeable African‐American populations (≥ 24.5% of county residents). The main outcome measures were recent use of the Papanicolau (Pap) test, mammography, test for fecal occult blood in the stool (FOBT), and flexible sigmoidoscopy or colonoscopy. RESULTS Between 1998–2000, 66.3% (95% confidence interval [95% CI] ± 2.7%) of 1817 African‐American women in the region age ≥ 40 years had received a mammogram within the past 2 years, compared with 69.3% (95% CI ± 1.8%) of 3922 white women (P = 0.066). The proportion of African‐American and white women who had received a Pap test within the past 3 years was similar (85.7% [95% CI ± 1.9%] vs. 83.4% [95% CI ± 1.5%]; P = 0.068]. In 1997 and 1999, 29.3% of African‐American women in these counties reported ever receiving an FOBT, compared with 36.9% in non‐Black Belt counties and 42.5% in the remainder of the U.S. Among white women, 37.7% in Black Belt counties, 44.0% in non‐Black Belt counties, and 45.3% in the remainder of the U.S. ever received an FOBT. Overall, similar patterns were noted among both men and women with regard to ever‐use of FOBT, flexible sigmoidoscopy, or colonoscopy. Screening rates appeared to vary less by race than by region. CONCLUSIONS The results of the current study underscore the need for continued efforts to ensure that adults in the nonmetropolitan South receive educational messages, outreach, and provider recommendations concerning the importance of routine cancer screening. Cancer 2002;95:2211–22. Published 2002 by the American Cancer Society. DOI 10.1002/cncr.10933

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Background: Because total prostate-specific antigen (PSA) and, more recently, the percent free PSA are used to screen men for prostate cancer, population-based, age-and racespecific distributions are needed of both PSA tests among American men to estimate the effect of lowering the PSA threshold or widespread introduction of the free PSA test as an additional screening test. Methods: We did PSA assays on serum samples from men of ages 40 years and older (n = 1,320) who participated in the 2001-2002 National Health and Nutrition Examination Survey. Results: About 6.1% (95% confidence interval, 4.7-7.7%), corresponding to an estimated 3.4 million (range, 2.7-4.3 million) men nationwide, ages 40 years and older, had a total PSA of >4.0 ng/mL. Among men ages 50 to 69 years old, the age group for which PSA testing is most prevalent, 5.4% or an estimated 900,000 to 2 million men had a total PSA of >4.0 ng/mL. An equal number had a total PSA between 2.5 and 4.0 ng/mL and a percent free PSA of <25%. Approximately 27% of men in this age group, corresponding to a range of 5.7 to 8.1 million men, had a total PSA <2.5 ng/mL and a percent free PSA of <25%. Conclusion: The effect of lowering the total PSA threshold or introducing another screening test is significant. Provision of the number of U.S. men with certain total PSA and percent free PSA values may help guide prostate cancer public health policy and screening practices. (Cancer Epidemiol Biomarkers Prev