Reluctance to Screening Colonoscopy in Arab Americans

Abstract

Purpose: Explore compliance of Arab-Americans to colorectal cancer (CRC) screening and identify the barriers to non-compliance in order to increase adherence to screening. Methods: Observational community based study through a survey filled by Arab-American Friday prayer attendees ≥ 50 years in three mosques in Dearborn, MI. Demographics and screening history was obtained. country of origin, age, health insurance, annual income, length of time in the United States, education level, and the ability of the primary care physician (PCP) to communicate in Arabic was also inquired. The responses were compared using a student t-test between respondents who have had CRC screening with colonoscopy and those who have not had any screening tests. A p value of 0.05 or was considered statistically significant. Results: Total number surveyed was 130. Average age of participants is 64 years. There were 99(76%) males and 31(24%) females. More than 50% were Lebanese and 28% were from Yemen. Only 7% did not receive any schooling. Majority had health insurance (89%), and 86% had a primary care physician of which 79% of the PCPs spoke Arabic. Half of the participants had colonoscopy mostly for screening purposes. Fifty-Eight (45%) participants did not have CRC screening. Most of the participating females (72.4%) had colonoscopy compared to 46.8% of the males (P value = 0.016). The mean length of stay in the U.S. was 39.16 years in the colonoscopy group compared to 30.77 years in the non-screening group (P value= 0.006). Participants who had colonoscopy had a PCP (58%), while 77.8% of those who did not have CRC screening did not have a PCP (P value=0.005). Participants with a non-Arabic speaking PCP had more colonoscopy rates (77.3%) compared to participants with an Arabic speaking PCP (50%) (P value=0.027). Most of the Lebanese participants had colonoscopy (71.9%) compared to 25.7% of the surveyed Yemeni (P value=0.00). Factors that did not reach statistical significance were Residency/citizenship status, level of Education, Annual Income and Age. Discomfort, unawareness about CRC screening, Fear of intimidation, misconception that the procedure is unnecessary and non-recommendation by PCP were among the most common barriers. Language and financial barriers were remotely reported. Approximately 85% of the participants would agree to undergo CRC screening if the above reasons were eliminated. Conclusion: Our results confirm the reluctance to screening colonoscopy in Arab-Americans. A new pattern of barriers is being seen. Female gender and having a non-arabic speaking PCP is beneficial. We suggest better education to this population group about the benefit and ease of screening. Addressing this alone could increase adherence to screening for this population.