Timely colorectal cancer screening in African Americans

Abstract

African Americans have low rates of colorectal cancer (CRC) screening, and little is known about factors influencing their participation. This study sought to identify variables within the biopsychosocial (BPS) model's three factor groups (biological, psychosocial/behavioral, social) that predicted timely colorectal cancer (CRC) screening ('screening') in African American (AA) men and women aged ≥ 40 in Maryland. A secondary analysis of data from 580 AAs in the 2002 Maryland Cancer Survey (MCS) examined whether biological (age, gender, CRC family history), psychosocial/behavioral (mammogram and prostate specific antigen [PSA] screening history, body mass index, activity level, fruit/vegetable consumption, alcohol, smoking, cancer concern, cancer perceived risk, perception of familial cancer), and social (education, employment, insurance, access to healthcare provider [HCP], and HCP recommendation of fecal occult blood test and/or sigmoidoscopy/colonoscopy) factors predicted screening. Research question 1 examined individuals without CRC family history (N=473) using simultaneous, hierarchical block, and stepwise entry logistic regression analyses of individual and grouped variables. Recommendation of fecal occult blood test (OR 11.90, 95% CI: 6.84, 20.71) and sigmoidoscopy/colonscopy (OR 7.06, 95% CI 4.11, 12.14), moderate/vigorous activity (OR 1.70, 95% CI: 1.02, 2.82), and history of PSA screening (OR 2.81, 95% CI 1.01, 7.81) predicted screening, as did the social factor group. Research question 2 examined individuals with CRC family history (N=86) using the same models. Recommendation of sigmoidoscopy/colonscopy (OR 24.3, 95% CI 5.30, 111.34) and vigorous activity (OR 5.21, 95% CI: 1.09, 24.88) predicted screening, as did the social factor group. The study hypothesis proposing that CRC family history predicted screening when controlling for age, education, and insurance was not supported. Results suggest that HCP recommendation was the most important predictor of screening. The small sample of people with CRC family history and sample characteristics (e.g., insurance) that differed from Maryland demographics limit generalizability. Other potentially important variables (e.g., fatalism) were not in the MCS dataset and therefore could not be examined. Prospective research should examine additional possible predictors of screening, and socioeconomic and other variables that limit access to HCPs. Variables that influence HCPs' recommendations for screening and individuals' adherence to recommendations are also important to investigate.