Trends in Colorectal Cancer Screening of African Americans Aged 45-49

Abstract

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. African Americans have a higher incidence of and mortality from CRC compared to other ethnic groups. Screening tests have proven efficacy to reduce CRC incidence and mortality. The American College of Gastroenterology in 2008 and American Society for Gastrointestinal Endoscopy in 2014 recommended screening of African Americans beginning at age 45 years. This study assessed the rate of CRC screening test use in African Americans between the ages of 45-49 years from 2005 to 2015. Methods: Individuals between the ages of 45-49 years were identified in Cancer Control Supplement of National Health Interview Survey (NHIS) conducted in 2005, 2010 and 2015. The NHIS is a national in-person household survey conducted by the US Census Bureau on the civilian population. Respondent history of colonoscopy, stool testing, sigmoidoscopy, CT colonography and demographic information was analyzed using SAS version 9.4 (SAS Institute Inc, Cary, NC, USA). A P value <0.05 was considered significant. Results: A total of 7434 individuals were identified age 45-49 years with 1115 African Americans in this cohort. Only 210 African American respondents had at least one screening test for CRC (18.8%). Screening test use in 2015 was lower among African Americans (20.2%) than Whites (21.4%) (see Table 1). African Americans receiving screening tests were more likely to be above the poverty threshold (79.3% vs 70.9%; P<0.01), college educated (48.0% vs 21%; P<0.01), and insured (88.8% vs 80.2%; P<0.01). No gender differences were observed in African American screening test use.Table: Table. Rate of CRC Screening Test Use by Race and YearConclusion: Screening test use in African Americans is similar to Whites in the 45-49 age cohort suggesting limited implementation of early screening guidelines. Race and socioeconomic barriers to healthcare contribute to disparities in CRC screening test use. Poor adherence to CRC screening in African Americans in the setting of persistent differences in national recommendations emphasizes the need for ongoing public health advocacy, communication to primary care providers/patients and additional prospective research.