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.
Written by: Peter M Crosta