Barriers to Colorectal Cancer Screening Between Arab American and Southeast Asian Americans

Abstract

Introduction: To define and compare the characteristics and barriers to colorectal cancer screening (CRCS) in 2 ethnic populations who did not receive CRCS in metropolitan Detroit, MI, area. Methods: After announcing the study in 4 community centers in Detroit metropolitan area, individuals identified themselves as Arab Americans (ArAs) and Southeast Asian Americans (SEAAs) completed the study survey. Information obtained were country of origin, age, health insurance status, length of time in the United States, education level, CRCS history, family history of colorectal cancer, access to a primary care physician (PCP), the ability of their PCP to communicate in their native language, and barriers to CRCS. The results were compared between both populations. Results: A total of 171 individuals participated in the study. There were 41 SEAAs, representing 24% of the study population and 130 ArAs (76%). A larger percent of the SEAAs did not have CRCS compared to ArAs (70.7% vs. 45.4%; p=0.005). Compared to unscreened SEAAs, unscreened ArAs are older and have been living for a longer duration in the United States (Table 1). They were also more likely to have received a high school degree or higher and more likely to earn $20,000 or more annually. Although both unscreened ArAs and SEAAs have PCPs, a higher proportion of ArAs have PCPs that can communicate in their native language (97.8% vs. 63.6%; p<0.001). ArAs were found to be less aware about CRCS and have a lower tolerability to screening tests compared to SEAAs (Table 2). In addition, more ArAs did not think that CRCS is necessary (52.5% vs. 20.7%; p=0.004). Other factors including embarrassment, language barriers, and scheduling issues were not significantly different between both groups. Overall, ArAs were more willing to undergo CRCS if the above barriers were eliminated (86.4% vs 31%; p<0.001).Table 1: Characteristics of Unscreened Arab Americans and Southeast Asian AmericansTable 2: Comparison of Barriers to CRCS Between Arab Americans and Southeast Asian AmericansConclusion: ArA are more likely to undergo CRCS if barriers are eliminated when compared to SEAA. This effect may be as a result of living in the United States for longer period of time and integration with the American culture. Although SEAAs are more likely to have high school education or more, they are less likely to undergo CRCS. Increasing medical provider participation and educational and outreach programs to minorities can be used to increase CRCS in both ArA and SEAA populations.