Disparities In Colorectal Cancer Screening Research Articles

Persistent Disparities in Colorectal Cancer Screening: A Tell-Tale Sign for Implementing New Guidelines in Younger Adults.

In May 2021, the U.S. Preventive Services Task Force began recommending initiating colorectal cancer screening at age 45 (vs. 50) years. We estimated prevalence of colorectal cancer screening (by colonoscopy, sigmoidoscopy, CT colonography, or stool-based tests) in adults ages 50 to 75 years using data from the National Health Interview Survey in 2000, 2003, 2005, 2008, 2010, 2013, 2015, and 2018. For each survey year, we estimated prevalence by age, race/ethnicity, educational attainment, family income, and health insurance. We also compared increases in prevalence of screening from 2000 to 2018 in 5-year age groups (50-54, 55-59, 60-64, 65-69, and 70-75 years). Overall, prevalence of colorectal cancer screening increased from 36.7% in 2000 to 66.1% in 2018. Screening prevalence in 2018 was lowest for age 50 to 54 years (47.6%), Hispanics (56.5%), Asians (57.1%), and participants with less than a high school degree (53.6%), from low-income families (56.6%), or without insurance (39.7%). Increases in prevalence over time differed by five-year age group. For example, prevalence increased from 28.2% in 2000 to 47.6% in 2018 (+19.4%; 95% CI, 13.1-25.6) for age 50 to 54 years but from 46.4% to 78.0% (+31.6%; 95% CI, 25.4%-37.7%) for age 70 to 75 years. This pattern was consistent across race/ethnicity, educational attainment, family income, and health insurance. Prevalence of colorectal cancer screening remains low in adults ages 50 to 54 years. As new guidelines are implemented, care must be taken to ensure screening benefits are realized equally by all population groups, particularly newly eligible adults ages 45 to 49 years. See related commentary by Brawley, p. 1671.

Colorectal Cancer Screening with Mailed Fecal Immunochemical Tests and Telephone Outreach at a Community Health Center during the COVID-19 Pandemic

Colorectal cancer (CRC) is a common cause of cancer death and disproportionately affects non-Hispanic Black patients. Routine screening with the fecal immunochemical test (FIT) decreases CRC incidence and mortality, and previous literature suggests pairing FIT with live outreach. Screening delays due to the COVID-19 pandemic will likely increase CRC incidence and mortality, especially in underserved communities. We implemented a quality improvement (QI) project at an urban community health center (CHC) in which FIT was paired with live telephone outreach. The intervention increased CRC screening at the CHC by five percentage points. Fecal immunochemical test completion rates significantly increased with successful contact (24.6% for at least one vs. 3.0% for none, p < .0001) and ordering a FIT kit during a patient interaction (28.4% vs. 15.7%, p < .001). This intervention addressed disparities in CRC screening, and the report may have general implications for addressing systemic racism in preventive medicine.

Cancer detection, diagnosis, and treatment for adults with disabilities

About 15% of the global population-more than 1 billion people-have a disability. People with early-onset disability are now living into middle and older ages and are therefore at risk for adult cancer. Overall, disabled people are more disadvantaged in social determinants of health and are more likely to have risk factors associated with cancer than people without disabilities. People with disabilities often experience disparities in breast and cervical cancer screening compared with people who do not have disabilities, and patterns in colorectal cancer screening disparities are inconsistent. The minimal evidence that exists relating to the timeliness of cancer diagnosis, treatment, and outcomes for people with disabilities suggests differential treatment and higher cancer-related mortality than for people without disabilities. Worldwide, disabled people face barriers to obtaining cancer care, including inaccessible medical diagnostic equipment, ineffective communication accommodations, and potentially biased attitudes among clinicians. Ensuring equitable cancer care for people with disabilities will therefore require eliminating not only physical but also attitude-based barriers to their care.

Source matters: a survey of cost variation for fecal immunochemical tests in primary care

BackgroundColorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Mailed fecal immunochemical tests (FIT) are an effective way to increase CRC screening rates, but is still underutilized. In particular, cost of FIT has not been explored in relation to practice characteristics, FIT selection, and screening outreach approaches.MethodsWe administered a cross-sectional survey drawing from prior validated measures to 252 primary care practices to assess characteristics and context that could affect the implementation of direct mail fecal testing programs, including the cost, source of test, and types of FIT used. We analyzed the range of costs for the tests, and identified practice and test procurement factors. We examined the distributions of practice characteristics for FIT use and costs answers using the non-parametric Wilcoxon rank-sum test. We used Pearson’s chi-squared test of association and interpreted a low p-value (e.g. < 0.05) as evidence of association between a given practice characteristic and knowing the cost of FIT or fecal occult blood test (FOBT).ResultsAmong the 84 viable practice survey responses, more than 10 different types of FIT/FOBTs were in use; 76% of practices used one of the five most common FIT types. Only 40 practices (48%) provided information on FIT costs. Thirteen (32%) of these practices received the tests for free while 27 (68%) paid for their tests; median reported cost of a FIT was $3.04, with a range from $0.83 to $6.41 per test. Costs were not statistically significantly different by FIT type. However, practices who received FITs from manufacturer’s vendors were more likely to know the cost (p = 0.0002) and, if known, report a higher cost (p = 0.0002).ConclusionsOur findings indicate that most practices without lab or health system supplied FITs are spending more to procure tests. Cost of FIT may impact the willingness of practices to distribute FITs through population outreach strategies, such as mailed FIT. Differences in the ability to obtain FIT tests in a cost-effective manner could have consequences for implementation of outreach programs that address colorectal cancer screening disparities in primary care practices.

Decreasing colorectal cancer screening disparities: A culturally tailored patient navigation program for Hispanic patients.

Colorectal cancer (CRC) is the second leading cause of cancer-related death in Hispanic patients. Screening colonoscopy has been shown to reduce the incidence and mortality of CRC. However, utilization among Hispanic patients and other minority groups is low. The objective of this study was to evaluate colonoscopy utilization among Hispanic patients with a culturally tailored patient navigation program (CTPNP) in place. A CTPNP was designed to meet the needs of the authors' Hispanic patient population and their health care system characteristics. A CTPNP protocol was created, and a Spanish-speaking navigator/coordinator was hired. Enrolled patients received a Spanish-language introductory letter, an initial phone call for patient education, and follow-up calls to ensure that all potential barriers to colonoscopy were overcome. Colonoscopy completion (CC), colonoscopy cancellation (CN), and colonoscopy no-show (NS) rates were recorded and compared with historical rates in Rhode Island. Over a 28-month period, 773 patients were referred to the CTPNP, and 698 (53% female and 47% male) were enrolled in the program. The overall CC rate was 85% (n=592) with no difference between males and females. The CN rate was 9% (n=62), and the NS rate was 6% (n=44). The most common reasons for CN and NS were cost and an inability to contact the patient after referral. Within the CC group, 43% (n=254) of patients underwent polypectomy, and 1.3% (n=8) required colectomy. Ninety percent (n=530) of the CC group reported that they would not have completed colonoscopy without the CTPNP. Implementation of a CTPNP is an effective intervention to improve the CC rate and eliminate the historical gender gap in utilization among Hispanic patients.

Adaptation of colorectal cancer screening tailored navigation content for American Indian communities and early results using the intervention

BackgroundAmerican Indians (AI) experience major colorectal cancer (CRC) screening disparities with commensurate inequity in CRC mortality and other outcomes. The purpose of this report is to describe the methods and early results of adapting a previously successful intervention for the AI community.MethodsThe educational content and delivery strategy of the parent intervention were adapted for AIs guided by an adaptation framework and cultural consultations with the community and clinicians. As part of the environmental scanning, we identified the need to substantively revise our data entry, collection, and tracking system and develop a REDCap database for this purpose. In this study, we staggered the implementation of the intervention in each facility to inform the process from one clinic to the next, and assess both the clinical outcomes of the tailored intervention and the implementation processes across two clinic settings, Facilities A and B.ResultsThe REDCap database is an indispensable asset, and without it we would not have been able to obtain reliable aggregate screening data while improvements to facility electronic health records are in progress. Approximately 8% (n = 678) of screening-eligible patients have been exposed to the navigator intervention. Of those exposed to the navigator intervention, 37% completed screening.ConclusionsWith the small numbers of patients exposed so far to the intervention, it would be premature to draw any broad conclusions yet about intervention effects. However, early screening completion rates are substantial advances on existing rates, and we have demonstrated that a tailored navigator intervention for facilitating CRC screening was readily adapted with provider and community input for application to AIs. A REDCap database for tracking of CRC screening by navigators using tablets or laptops on- or offline is easy to use and allows for generation of aggregate, anonymized screening data.Trial registration.There was no health intervention meeting the criteria of a clinical trial. The University of Arizona Institutional Review Board granted exemption from obtaining informed consent from patients undergoing CRC screening after administration of the tailored navigation intervention as usual care.

Abstract PO-025: Implementing evidence-based interventions (EBI) to increase uptake of fecal immunochemical test (FIT) colorectal cancer (CRC) screening in Vulnerable Populations

Abstract Purpose: We partnered with a local Federally Qualified Health Center (FQHC) to test implementation of evidence-based interventions (EBI) promoting Fecal Immunochemical Test (FIT) CRC screening in an environment in which colonoscopy has been the prevailing screening strategy. We report on implementation adaptations and preliminary results. Background: Sociocultural and medical concerns are barriers to colonoscopy uptake in some populations. An additional barrier to CRC screening is system level capacity for colonoscopy that results in a back log of cases and long wait times. With Covid-19, the additional backlog in overdue CRC screening has underscored the need to expand FIT testing capacity to address screening needs and to pre-empt further racial/ethnic and SES disparities in CRC outcomes. This trial tests the unique and additive value of multiple EBIs for increasing CRC screening (primarily through FIT testing, but also colonoscopy when indicated) while evaluating the success of implementing these approaches. EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and assistance from community health workers. Methods: Participants (3500), ages 45-75, were identified from a large FQHC in New Haven, CT and determined to be overdue for CRC screening. Participants were randomly assigned to one of the four arms of the study: 1) Provider reminder (overdue for CRC screening) only; 2) Provider Reminder + SDOH short message and one-size-fits all link to resources; 3) Provider Reminder + SDOH short message and offer for individualized navigation (trained navigators from local community) to address SDOH and other barriers; 4) Provider Reminder + offer to participate in a CRC educational program as phase 2 of the NCI's Screen to Save program (not an EBI). Preliminary data on uptake of CRC screening will be presented. Results: With input from stakeholders, we have: 1) lowered age eligibility from 50 to 45 to align with new guidelines; 2) expanded the target population to 2 additional satellite clinics, more than doubling the proposed study enrollment; 3) incorporated design changes in the patient reminders. The collaboration between research team and clinician stakeholders has been critical in minimizing disruptions to clinical workflow while assuring fidelity to the evidence-based interventions. Preliminary outcomes (within one month of intervention) on uptake of intervention across the 4 arms of the study, i.e., referral for CRC screening and test completion will be presented. Conclusion: The unique challenges of this urban community of primarily African American/Black, Hispanic/Latinx and/or low socioeconomic status individuals stem from the disproportionate burden of SDOH barriers. Findings will inform primary care setting implementation of EBIs to address the anticipated increase in disparities in CRC screening, exacerbated by COVID-19 changes in health care access and utilization, as well as the increased demand associated with the change in guidelines. Citation Format: Beth A. Jones, Sakinah C. Suttiratana, Sally A. DeGiovanni, Levita Y. Robinson, Michael J. Couturie, Denise Stevens, Monique K. Stefanou, Jose DeJesus, Eduardo Reyes, Jonathan Colon, Maryanne Cosgrove, Steven J. Parra. Implementing evidence-based interventions (EBI) to increase uptake of fecal immunochemical test (FIT) colorectal cancer (CRC) screening in Vulnerable Populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-025.

Factors Affecting Colorectal Cancer Screening Among African-Born Immigrants in the United States: A Cross-Sectional Study

Objectives: Early detection of colorectal cancer through periodic screening has proved to be effective in reducing the incidence rate and mortality from colorectal cancer. Available records indicate racial and ethnic disparities in colorectal cancer screening in the United States. In this paper, a retrospective cross-sectional study to examine how family income, health insurance status, language of interview, length of stay in the US, perceived health status, level of education, and having a usual place for medical care affect colorectal cancer screening among African-born immigrants in the United States is presented.

Telehealth and racial disparities in colorectal cancer screening: A pilot study of how virtual clinician characteristics influence screening intentions.

Racial disparities in colorectal cancer (CRC) can be addressed through increased adherence to screening guidelines. In real-life encounters, patients may be more willing to follow screening recommendations delivered by a race concordant clinician. The growth of telehealth to deliver care provides an opportunity to explore whether these effects translate to a virtual setting. The primary purpose of this pilot study is to explore the relationships between virtual clinician (VC) characteristics and CRC screening intentions after engagement with a telehealth intervention leveraging technology to deliver tailored CRC prevention messaging. Using a posttest-only design with three factors (VC race-matching, VC gender, intervention type), participants (N = 2267) were randomised to one of eight intervention treatments. Participants self-reported perceptions and behavioral intentions. The benefits of matching participants with a racially similar VC trended positive but did not reach statistical significance. Specifically, race-matching positively influenced screening intentions for Black participants but not for Whites (b = 0.29, p = 0.10). Importantly, perceptions of credibility, attractiveness, and message relevance significantly influenced screening intentions and the relationship with race-matching. To reduce racial CRC screening disparities, investments are needed to identify patient-focused interventions to address structural barriers to screening. This study suggests that telehealth interventions that match Black patients with a Black VC can enhance perceptions of credibility and message relevance, which may then improve screening intentions. Future research is needed to examine how to increase VC credibility and attractiveness, as well as message relevance without race-matching.

Filipinos’ attitudes, barriers, and enablers on colorectal cancer screening: Insights from a qualitative research study

BackgroundFilipinos have lower colorectal cancer (CRC) screening rates and worse outcomes versus non-Hispanic Whites. As Filipinos are understudied on how they perceive CRC screening, we conducted focus groups examining their attitudes, enablers, and barriers to screening. MethodsIn August and September 2021, we recruited Filipinos aged 40–75 years to participate in an online focus group. Filipinos who received care at an academic medical center or were members of Filipino community organizations in Los Angeles, CA, were sent emails inviting them to participate. We used a semi-structured interview guide for the focus groups and audio recordings were transcribed and analyzed using an inductive coding approach. Codes were generated from the qualitative data, sorted, classified into themes and subthemes, and illustrated with verbatim quotes. ResultsWe conducted four online focus groups with 16 Filipinos. As for enablers for CRC screening, participants mentioned the importance having a doctor's recommendation. Participants reported the following barriers: potential out-of-pocket costs (the Philippines healthcare system is largely cash-based); fatalistic beliefs; reactive approach to health; lack of awareness in the community on CRC screening. Suggested solutions for improving CRC screening uptake in the community included: providing information on screening benefits, what to expect from each test (e.g., steps involved, accuracy), and financial considerations; participation by Filipino celebrities and doctors in media campaigns. ConclusionOur study highlights Filipinos’ perceptions on CRC screening. These data can support investigators, health systems, public health agencies, and community organizations in developing culturally tailored, sustainable interventions to address CRC screening disparities among Filipinos.

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Disparities in Colorectal Cancer Screening in Latinos and Non-Hispanic Whites

Colorectal cancer is the second leading cause of cancer deaths in Latinos in the U.S., but it is unclear, from previous research, whether Latinos have differing rates of colorectal cancer screening methods from those of non-Hispanic Whites. This study used electronic health records from 686 community health centers across 21 states in the Accelerating Data Value Across a National Community Health Center of the National Patient-Centered Clinical Research Network. Records from English-preferring Latinos, Spanish-preferring Latinos, and non-Hispanic Whites aged 50-75 years were included. A total of 5 outcomes were compared between 2012 and 2017 to provide a comprehensive view of colorectal cancer screening: (1) any colorectal cancer screening, (2) stool-based screening, (3) annual rates of stool testing, (4) any referral for lower gastrointestinal endoscopy, and (5) endoscopy referral among patients with a positive stool-based screening. In this study (N=204,243), Spanish-preferring Latinos had higher odds of any colorectal cancer screening (OR=1.44, 95% CI=1.23, 1.68) and stool-based testing (OR=1.82, 95% CI=1.55, 2.13) than non-Hispanic Whites. English- and Spanish-preferring Latinos had lower odds of having ever had a referral for endoscopy in the study period than non-Hispanic Whites (English: OR=0.23, 95% CI=0.15, 0.34; Spanish: OR=0.55, 95% CI=0.40, 0.74), even with a positive stool-based screening (English: OR=0.14, 95% CI=0.06, 0.33; Spanish: OR=0.33, 95% CI=0.19, 0.57). In a multistate network of community health centers, Latino patients aged >50 years were more likely to receive stool-based screening tests for colorectal cancer than non-Hispanic Whites but were less likely to receive endoscopy referrals than non-Hispanic Whites, even when experiencing a positive stool-based screening test. Initiatives to improve Latino colorectal cancer outcomes should encourage indicated referrals for lower gastrointestinal endoscopy.

S3257 Addressing Disparities in Colorectal Cancer Screening

Introduction: Colorectal cancer (CRC) screening rates are significantly lower in low-income, minority populations nationally. Health system data from a large academic medical center revealed a 3% lower CRC screening rate amongst black patients and a 14% lower rate of CRC screening in the resident patient panels, which contain a greater percentage of high-risk, low-income patients. This novel resident-led quality improvement (QI) work identified causes for disparities in CRC screening, then implemented a resident-driven population health based protocol. Methods: Analysis was conducted across two academic primary care clinics at a single institution. Residents conducted chart reviews and targeted interviews of key stakeholders in the CRC screening process, including patients, physicians, and staff. An EMR-based dashboard was used to collect demographic data and CRC screening rates for colonoscopy and FIT tests for the patient panels for the year 2020. A population health protocol was then developed and implemented by residents during dedicated outpatient blocks. Results: Twenty-two structured interviews revealed scheduling algorithms, limited time during clinical encounters and patient and provider knowledge deficits as the top contributors to low CRC screening rates. Data generated from a central database revealed colonoscopy compliance rates to be 76% for attending panels versus 62% for resident panels, and compliance for FIT to be on average 15% higher than colonoscopies. An established navigator program for improving CRC screening was only effective in 30% of patients. Based on these results, a population health protocol was developed for residents to outreach patients with lapsed CRC screening outside the office visit and streamline referrals to the navigator program for high-risk patients. Thus far, 18 residents have implemented the protocol and 266 patients have been outreached. Conclusion: Multiple factors lead to disparities in CRC screening including intricacies within the health system but also experience in practice. Interventions are being studied to counteract such factors and improve disparities that disproportionately impact minority patients. This QI initiative demonstrates that a resident-led intervention outside the clinical visit can reach a significant number of high-risk patients. In the next phase of data collection, we will examine the impact of our protocol on the number of additional colonoscopies and FIT tests completed.

S3246 The Impact of COVID-19 on Colorectal Screening Adherence at a Large Institution

Introduction: Colorectal cancer (CRC) is the second-leading cause of death in the US. Despite the National Colorectal Roundtable goal of achieving 80% adherence, CRC screening remains underutilized, especially in the underinsured populations. Screening programs have been heavily disrupted during the COVID-19 pandemic. We aimed to quantify the impact of this disruption on the already existing disparities in CRC screening especially as it pertains to those ethnic groups underserved in medicine. Methods: Data for this project was abstracted from a health system electronic health record (EHR). Patients were identified 1 year before and after COVID-19 precautions began, using March 1, 2020 as the inflection point. For each year, the primary inclusion criterion was an ordered colonoscopy. The outcome of interest was colonoscopy receipt. Self-reported race was obtained from the EHR. Differences by year and race were assessed using Chi-square analysis. Results: A cohort of 816 patients between age 45 and 75 for who a colonoscopy was ordered were selected from EHR at a single large institution. 538 patients were in the Pre-COVID group, and 278 were in the post-COVID group (Table). Of these two groups 47.9% (n = 258) had colonoscopy performed – a 59% reduction. In the Post-COVID group, this was 37.7% (n = 105). This reduction in colonoscopies performed persisted across all race groups. For White patients, it was 55%, Asian Americans had a 57% reduction, and African Americans had a 66% reduction. Conclusion: The true impact of COVID-19 on colorectal cancer is yet to be uncovered as future mortality estimates from CRC are ongoing. Due to widespread closure of endoscopy centers and delay in screening, we believe that the pandemic worsened the screening disparities most prevalent among minority populations. Our retrospective analysis over the last two years points to the drastic reduction of screening for all races, and especially for African Americans. As life gradually returns to normal, it would be interesting to see how the past year has impacted the incidence and prevalence of CRC.Figure 1.: Difference in colonoscopies performed per ethnic group before and during COVID-19 pandemic.

S257 Persistent Racial and Ethnic Disparities in Colorectal Cancer Screening: A Tell-Tale Sign for New Guidelines

Introduction: Colorectal cancer (CRC) screening can reduce CRC incidence and mortality; however, screening participation is low in minority populations. The U.S. Preventive Services Task Force recently recommended lowering the age to initiate CRC screening from 50 to 45 years, raising concerns that implementing new guidelines will exacerbate well-known race/ethnicity disparities in screening. To address this gap, we examined temporal trends in CRC screening by age and race/ethnicity in a population-based sample. Methods: We estimated the proportion of adults (age 50-75 years) up-to-date with CRC screening using population-based data from the National Health Interview Survey. We examined temporal trends in screening during the period 2000-2018, overall and by age (50-54, 55-59, 60-64, 65-69, and 70-75 years) and race/ethnicity (White, Hispanic, Black, Asian). In parallel, we examined trends in colonoscopy use in adults age 45-49 years. Results: In adults age 50-75 years, the overall proportion up-to-date with CRC screening increased from 36.7% in 2000 to 66.1% in 2018. By 2018, screening rates were 68.7%, 64.4%, 56.5%, and 57.1% in Whites, Blacks, Hispanics, and Asians, respectively (Figure 1). The increase was significant in all race and ethnicity groups, but Hispanics and Asians remained less likely to undergo screening compared to Whites and Blacks (all P < 0.01). CRC screening was lowest among newly eligible individuals age 50-54 years. Differences in screening by race/ethnicity were concentrated in this youngest age group but disappeared over time in older groups. For example, screening rates were 51.0%, 50.0%, 35.5%, and 32.2% for adults age 50-54 years (Figure 1) and 78.4%. 78.1%, 78.1%, and 69.0% for adults 70-75 years (Figure 1F) in Whites, Blacks, Hispanics, and Asians, respectively. Hispanics and Asian Adults age 50-54 years were less likely to be screened compared to Whites and Blacks from 2000 to 2018 (all P < 0.01). In adults age 45-49 years, colonoscopy use increased from 6.5% in 2000 to 17.7% in 2018 and was lowest among Hispanics and Asians. Conclusion: CRC screening has increased over 2000 to 2018 in all racial, ethnicity and age groups. Uptake remains low in certain segments, particularly newly eligible Hispanic and Asian adults age 50-54 years. Disparities observed in adults age 50-54 years may occur in adults age 45-49 years as new recommendations are implemented. Care must be taken to ensure the benefits of CRC screening are realized equitably by all race/ethnicity and age groups.Figure 1.: Proportion of adults up-to-date with colorectal cancer screening by age and race/ethnicity group.

S3244 Colorectal Cancer Screening Disparities Worsened During the COVID-19 Pandemic

S3244 Colorectal Cancer Screening Disparities Worsened During the COVID-19 Pandemic

S3247 Colorectal Cancer Screening Disparities

S3247 Colorectal Cancer Screening Disparities

Healthcare provider cultural competency and receptivity to colorectal cancer screening among African Americans

ABSTRACT African Americans suffer disproportionately from colorectal cancer (CRC), due in part to disparities in CRC screening. Better understanding culturally relevant psychosocial factors that impact CRC screening is therefore critical. This study examined how African Americans’ perceived cultural competency of their physician is associated with receptivity to take-home stool-based CRC screening. CRC screening deficient African Americans (N = 457) completed a patient-focused measure of perceived cultural competency and watched a brief video about CRC risks, prevention, and screening. Receptivity to stool-based CRC screening was measured using Theory of Planned Behavior (TPB) constructs . Participants were also given an opportunity to receive a no-cost at-home Fecal Immunochemical Test (FIT) kit, and we measured acceptance of this offer as a behavioral outcome (yes-no). Results showed that perceived cultural competency was associated with higher receptive attitudes, more favorable norms, greater perceived behavioral control towards stool-based screening, and also greater intentions to engage in FIT Kit screening (p < 0.001). We also found significant indirect effects of perceived cultural competency on FIT kit uptake through intention-mediated pathways. This study provides crucial evidence that participants’ perceived cultural competency may play an important role in preventive health behavior among racial minorities, including CRC screening uptake among African Americans.

Justice beliefs buffer against perceived barriers to colorectal cancer screening among African Americans

Objectives African Americans develop and die from colorectal cancer (CRC) more than any other racial group in the United States. Perceived barriers to screening (e.g. embarrassment and financial costs) likely exacerbate these disparities. Identifying psychological factors that can reduce the impact of perceived barriers and encourage CRC screening is therefore critical. This study explored whether believing the world is fairer for oneself than in general (personal justice ascendancy) would moderate the impact that perceived barriers have on receptivity to CRC screening. Method Four-hundred fifty-seven screening eligible African Americans completed measures of beliefs about justice for self and others, as well as perceived barriers to CRC screening. Participants also completed theory of planned behaviour (TPB) measures of screening receptivity (attitudes, norms, perceived behavioural control and intentions). Results Perceived barriers and justice beliefs interacted to predict perceived behavioural control over screening. Perceived barriers were associated with less perceived behavioural control only when personal justice beliefs were low. In turn, perceived behavioural control predicted stronger intentions to obtain CRC screening. Conclusions Interactive effects with perceived barriers highlight that strong personal justice beliefs play an important role in CRC screening and could aid in addressing CRC screening disparities among African Americans.

National disparities in colorectal cancer screening in patients with comorbid conditions: an analysis of the Behavioral Risk Factor Surveillance System.

Each year, approximately 53,200 people die in the U.S. from colorectal cancer (CRC), indicating a need to increase screening efforts. Some studies have suggested mammography use is higher in patients with comorbid conditions, a reflection of increased follow up. Another study found that patients with obesity were less likely to be screened for CRC than nonobese patients. However, no study has assessed the impact of multiple comorbidities on CRC screening. To analyze CRC screening rates in patients with comorbidities compared with healthy patients, and to assess whether the number of comorbid diagnoses impacted screening rates. A cross sectional analysis of patients who received CRC screening was performed using the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS). Respondents were classified as having had CRC screening if they answered "yes" to either of the following: "Have you ever had a blood stool test?" or "Have you ever had a sigmoidoscopy/colonoscopy?" Respondents younger than age 50 were excluded. A weighted multivariate logistic regression model was constructed to determine adjusted risk ratios (ARR). Confidence intervals (CI) were reported at 95%. We identified 279,784 respondents who met inclusion criteria. Of those, 79.7% (sample n=222,879; population N=46,304,360) of respondents had received CRC screening. Patients with diabetes, hypertension, skin cancer, chronic obstructive pulmonary disease (COPD), arthritis, depression, and chronic kidney disease were significantly more likely to be screened than those without comorbidities. There was no statistically significant difference in screening rates between patients with and without cardiovascular disease. Compared with patients with zero comorbidities, those with one were significantly more likely to receive screening (ARR, 1.11; CI, 1.09-1.12) as were those with two to four (ARR, 1.2; CI, 1.18-1.22). Patients with five or more comorbidities were significantly less likely to be screened than those with two to four (ARR, 1.12; CI, 1.1-1.14). Patients with one or more comorbidities were more likely to be screened than those without comorbidities, but those with five or more conditions were less likely to be screened than patients with two to four conditions. This indicates that physicians may be more fatigued and less likely to recommend CRC screening to patients with many comorbidities compared with patients diagnosed with only a few conditions. The results of this study add to the literature by identifying an interaction between the number of comorbidities and likelihood of being screened for CRC.