Disparities in Colon Cancer Screening – A Population Study

Abstract

Purpose: The screening rates for colorectal cancer are lower in certain racial and ethnic subgroups. We analyzed colorectal screening adherence across 6 geographically distinct multiracial communities in Chicago, Ill. We evaluated various barriers to colorectal screening. Methods: In 2002–2003, a comprehensive household health survey was conducted in six community areas with 1,700 households in English and Spanish. As a part of the survey, individuals over the age of 50 were asked whether they had ever had colorectal cancer screening with either an endoscopic exam or blood stool test. Results: The proportion of participants over the age of 50 who reported ever having a blood stool test, or endoscopic test ranged from 42% to 70%, and 36 to 54% across the 6 communities. The community with the highest screening proportion for an endoscopic test (54%) was predominantly white with the lowest poverty level. The communities with the lowest screening proportion for an endoscopic test had the highest poverty levels and were composed of predominantly, blacks and Hispanics. Within the 6 communities, Mexicans (33%) were less likely to report screening with a blood stool test compared with whites (65%) (P < 0.0001). They were also less likely to report ever having a sigmoidsocopy/colonoscopy. Participants whose home was primarily Spanish speaking reported a lower adherence to occult blood screening (31%), and endoscopic screening (38%) compared with homes where English was the primary language (66%) (P < 0.0001). Having a regular primary care physician, getting medical care other than when sick, and having any doctor visits in the past 12 months were all associated with adherence with colorectal cancer screening (P < 0.05). Conclusion: Adherence to colorectal cancer screening varies widely between different communities. Community level analysis of screening adherence would assist the shaping of culturally meaningful prevention efforts.