Colorectal cancer screening in African Americans: practice patterns in the United States. Are we doing enough?

Abstract

Background: Colorectal cancer (CRC) is a common form of malignancy and a leading cause of death in the United States. Screening decreases CRC incidence and mortality. African Americans are at an increased risk of developing CRC, and recommendations are to initiate screening at the age of 45. This study aims to assess the rate of screening for colorectal cancer in African Americans between the ages of 45–49.Methods: African Americans between the ages of 45–49 were identified in the Explorys national database. Patients who completed a colonoscopy, sigmoidoscopy or fecal occult blood test were identified and stratified by sex and insurance status. A P value < 0.05 was considered significant.Results: A total of 181 200 African Americans were identified as eligible for screening. Only 31 480 patients (17.4%) received at least one screening procedure for CRC. The majority of patients (66.7%) were screened via colonoscopy. African American females were more likely to complete a screening test (17.8% vs 16.7%; P < 0.01). The majority of patients (66.0%) who completed a screening test had private insurance.Conclusion: Race, gender and barriers to medical care contribute to disparities in CRC screening rates. Among African Americans, CRC screening remains suboptimal. Tailored public health initiatives, medical record alerts and improved communication between providers and patients are fundamental to addressing issues that impact poor adherence to CRC screening in African Americans.

Screening for colorectal cancer in Tianhe, Guangzhou: results of combining fecal immunochemical tests and risk factors for selecting patients requiring colonoscopy

“…These features may enable colonoscopy to be a reliable tool for the early detection of CRC and also allow prevention of the progression of other lesions to CRC. Many Western countries include colonoscopy in their CRC screening programs [ 13 , 14 ]. Although the program was widely advertised before the start of screening, our reported colonoscopy compliance rate was unsatisfactory.…”

Latina and Black/African American Women’s Perspectives on Cancer Screening and Cancer Screening Reminders

“…While there is a myriad of research pointing to sub-optimal cancer screening and cancer-related mortality rates in Latinas and Black/African American women [7, 14, 18], there is very little qualitative data available on what could be done to improve cancer screening uptake and perhaps ultimately improve mortality rates in these populations. The voices heard from these focus groups do not generate easy answers for the amelioration of these disparities.…”

“…And yet, a number of barriers to cancer screening have been identified, including cost, fear, trust, time and lack of knowledge [10–13]. These barriers have been highlighted as a major contributor to the lower cancer screening rates for Latinas and Black/African American women [14–16], and higher mortality rates for certain cancers, including breast and colon, among Black/African American women [17] and cervical among Latinas [18]. …”

Colorectal Cancer Screening in Black Men: Recommendations for Best Practices

“…12 A study using claims data on more than 180,000 blacks showed only 17.4% in those ages 45À49 years had been screened. 13 In a South Carolina Federally Qualified Health Center (FQHC) CRC screening program, in which 71% of 665 participants were black, and 29% were male, the adenoma detection rate among those aged 45À49 years was 26%. 14 However, the diagnostic and therapeutic yield of CRC screening in this age group is understudied.…”