Colorectal Cancer Screening in Black Men: Recommendations for Best Practices

Abstract

Screening for colorectal cancer has been demonstrated to reduce colorectal cancer mortality. Blacks have a higher mortality from this malignancy, particularly men, yet screening rates in this population are often found to be lower than in whites. A modest literature demonstrates effective interventions that can increase screening rates in blacks; however, results are not consistent and ongoing work is required. Most work has not addressed specific barriers to screening in black men. Given the lack of studies on black men only, this study evaluated the state of research in the black population using a PubMed search. The authors provide commentary that proposes increased (1) state and local government support for collaborative programs with healthcare organizations, including patient navigation; (2) augmented community-organizing efforts to generate more attention to the need for colorectal cancer screening in the black community, with a focus on black men; and (3) federal research funding to promote investigation into new interventions and evaluation of existing ones. Specific recommendations for black men include lowering the screening age to 45 years, increasing access to health care, the use of patient navigators, and improved reporting and monitoring of colorectal cancer screening rates.

Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis

“…Heterogeneity of the findings made it challenging to determine which intervention was most effective and should be considered for future studies focused on African-American men as recommended by Kwaan and Jones-Webb [ 90 ]. Due to the diversity of settings, geographic regions, interventions employed, and outcomes measured, factors other than the intervention may have influenced CRC screening uptake.…”

Colorectal cancer disparities and African Americans: is it time to narrow the gap?

“…However, the U.S. Preventive Services Task Force still recommends screening at 50 due to the lack of evidence supporting the effectiveness of earlier screening in African Americans. 5 The effectiveness of screening is also heavily dependent on compliance and follow-up of patients with health care providers. One of the reasons for poor follow-up from African American patients is the invasiveness of a colonoscopy.…”

“…15 Despite noninvasive tests, there is still an issue of non-compliance; African Americans are 10% less likely to follow-up after a positive screening test than Caucasians. 5 Programs like the Screening Colonoscopies for People Everywhere in South Carolina (SCOPE SC), done on Caucasian and African American noninsured patients, reported an 85% completion rate in patients when health navigators were trained in educating patients on bowel preparations and referral details regarding CRC screening. 11 Similar programs also provide additional assistance with scheduling appointments, sending reminders, and rescheduling canceled appointments.…”

“…Interventions that make the communication between patients and their primary care providers (PCPs) more effective can also reduce African Americans' mistrust of healthcare providers and increase compliance. 5 The use health navigators or educators, 5,12 as mentioned earlier, can be an invaluable tool to ensure patients follow-up with their required screening. There have also been technologybased interventions that aim to increase awareness and compliance and to educate the African American community about CRC through methods like phone calls, text messages, emails, websites, mobile apps, and targeted-entertainment education aids, which show promise but still provide a challenge to patients at risk who are often older, not technologically savvy, or lack the devices to access these kinds of communication.…”

Gastrointestinal Cancers: Racial and Ethnicity Differences

“…Additionally, there might be other factors that are more speci c to individual types of gastrointestinal cancers. For example, esophageal adenocarcinoma is more frequent among non-Hispanic whites (NHW); esophageal squamous cell carcinoma and colorectal cancer are more frequent among African Americans and the reasons might be multifactorial, including socioeconomic and lack of health care access, treatment, and prevention [4][5][6][7][8][9]. Also, a lower rate of surgery among Hispanics for esophageal cancer was associated with a decreased survival rate when compared to whites, even when adjusted for relevant socioeconomic and tumor factors [10].…”