S0287 Incarceration Is Associated With Poor Adherence to Colorectal Cancer Screening in African American Men

Abstract

INTRODUCTION: In the United States (US), African-American (AA) men are disproportionately affected by colorectal cancer (CRC). They have higher incidence and mortality rates compared to all other groups, and this is in part due to their lower rate of adherence to CRC screening. AA men are also heavily impacted by incarceration in the US, with almost a third expected to spend time in prison in their lifetime. Given the significance of incarceration on the socialization of AA men in the US, it is vital to understand its impact on adherence to CRC screening. We aimed to investigate the association between prior incarceration and adherence to CRC screening in average-risk AA men in the US. METHODS: This was a cross-sectional study involving AA men between the ages of 50 and 75 years in an urban center in the US. Those with a personal or family history of CRC were excluded. Surveys were administered to obtain information on demographics, experiences with incarceration, and CRC screening practices. Adherence to screening was defined as having had a colonoscopy within the past 10 years, a flexible sigmoidoscopy within the past 5 years, or a stool-based test within the past year. Logistic regression analyses were performed to examine the association between incarceration and adherence to screening. RESULTS: Among the 144 men included in the final analysis, median age was 59 years (interquartile range 8 years), 84% had health insurance coverage (n = 122), and 63% (n = 92) had at least a high school diploma (Table 1). Seventy-four men (51.4%) had been incarcerated in the past, including 52 of them who had been incarcerated two or more different times. Median age at first incarceration was 18 years (interquartile range, 8 years) and the median duration of imprisonment was 48 months (interquartile range, 112 months). Fifty percent of the study population (n = 72) was adherent to CRC screening. After adjusting for age and health insurance coverage, those who had been incarcerated more than once had a significantly lower likelihood of adherence to CRC screening [0 vs ≥2: OR 0.46 (95% CI 0.22–0.97); Ptrend = 0.04] (Table 2). CONCLUSION: Incarceration is associated with lower adherence to CRC screening in AA men. Targeted CRC-related education should be explored for AA men with a history of incarceration, and in the pre-release period for those in prisons. Further studies should assess for modifiable barriers to CRC screening in AA men with a history of incarceration.Table 1.: Characteristics of Study Population, by Adherence to Colorectal Cancer ScreeningTable 2.: Association between Incarceration and Adherence to Colorectal Cancer Screening