Screening In African Americans Research Articles

Are Contemporary Interventions Effectively Lowering Barriers to Colorectal Cancer Screening in African Americans?

Are Contemporary Interventions Effectively Lowering Barriers to Colorectal Cancer Screening in African Americans?

Is there evidence to start colorectal cancer screening in African Americans before the standard guideline age?

Is there evidence to start colorectal cancer screening in African Americans before the standard guideline age?

Databases for Gastrointestinal Clinical and Public Health Research: Have Database, Will Research

Databases for Gastrointestinal Clinical and Public Health Research: Have Database, Will Research

Assessing the effectiveness of a community health advisor plus screen to save educational intervention on stool-based testing adherence in an African American safety net clinic population: study protocol for a randomized pragmatic trial

BackgroundColorectal cancer (CRC) is the second most deadly cancer affecting US adults and is also one of the most treatable cancers when detected at an earlier clinical stage of disease through screening. CRC health disparities experienced by African Americans are due in part to the later stage of diagnosis, suggesting the importance of improving African Americans’ CRC screening participation. The national Screen to Save (S2S) initiative employs a community health educator to deliver CRC screening education which can be tailored for specific populations, and such approaches have increased CRC screening rates in disadvantaged and racial/ethnic minority populations.Methods/designIn this trial emphasizing stool-based CRC screening, focus groups informed the development of an adapted S2S video and brochure tailored for African Americans and identified preferred motivational text messages for a multicomponent community health advisor (CHA) intervention. A CHA hired from the community was trained to deliver a 6-week CRC educational intervention consisting of an initial face-to-face meeting followed by 5 weeks of calls and texts. Interested eligible persons are enrolled primarily through recruitment by two partnering community health centers (CHCs) and secondarily through various outreach channels and, after consenting and completing a baseline survey, are randomly assigned to one of two study arms. The CHCs are blinded to study arm assignment. Intervention arm participants receive the brochure and CHA intervention while participants assigned to the control group receive only the brochure. All participants receive a stool-based CRC screening test from their health center, and the primary outcome is the completion of the screening test at 12 months. Secondary objectives are to estimate the effect of the intervention on mediating factors, explore the effect of moderating factors, and perform a cost-effectiveness analysis of the CHA intervention.DiscussionThe TUNE-UP study will enhance understanding about CRC screening in African Americans obtaining primary health care through CHCs and is one of the very few studies to examine a CHA intervention in this context. A better understanding of the mechanisms by which the intervention affects patient beliefs and behaviors will help focus future research while the exploratory cost-effectiveness analysis will inform CHCs’ decision-making about implementing a CHA program to increase screening and reduce cancer health disparities.Trial registrationClinicalTrials.govNCT04304001. Registered on March 11, 2020.

Advancing Diversity, Equity, and Inclusion in Scientific Publishing

Advancing Diversity, Equity, and Inclusion in Scientific Publishing

Colorectal cancer screening in African Americans: are we following the guidelines?

The age at onset, incidence, and mortality rate of colorectal cancer varies among racial groups being highest in African Americans. This increased risk led to the recommendation to begin screening at the age of 45years. Whether the recommendation for screening of African Americans at an earlier age was implemented is unknown. We used data from the Cancer Control Supplement of National Health Interview Survey (NHIS) conducted in the years 2005, 2010, and 2015 to analyze demographic data and use of colorectal screening (colonoscopy, stool heme testing, sigmoidoscopy, computed tomographic colonography) among the US population between the ages of 45-49years. Data on colorectal screening was available from 6740 individuals; 16.5% were African Americans. Screening test use among African Americans in 2005, 2010, and 2015 was similar to use in Whites (i.e., 15.4% (95% CI 11.4-19.4), 28.4% (95% CI 19.3-30.4) and 20.2% (95% CI 14.8-25.5) vs. 16.9% (95% CI 15.1-18.6), 19.3% (95% CI 16.9-21.7), and 21.4% (95% CI 18.6-24.2) in 2005, 2010 and 2015, respectively. Observed screening test use rates may largely be accounted for by diagnostic exams. The recommendation for earlier colorectal screening of African Americans has not yet resulted in increased test utilization. These results emphasize the need for multidisciplinary actions to inform and implement public health policy.

Barriers Driving Racial Disparities in Colorectal Cancer Screening in African Americans.

Colorectal cancer screening has been shown to decrease mortality from colorectal cancer. Screening disparities continue to exist among ethnic minorities, particularly for African Americans. We herein review the barriers of colorectal cancer screening in this population. At its foundation are patient barriers, which are further compounded by physician-related barriers and the idiosyncrasies of the healthcare system. Interventions to address the barriers include patient outreach, provider education, and healthcare legislation addressing financial barriers. Recent research has focused on factors predicting intentions to undergo colorectal cancer screening. Underlying all of the barriers is the systemic racism that affects and influences the healthcare system as much as all other institutions and contributes to inequities in the delivery of effective cancer prevention efforts. Perpetual disparities in CRC screening within the African American community are due to multifactorial barriers from the individual patient to provider and healthcare system and societal influences. An awareness of the behavioral and systemic factors that affect African Americans must underpin efforts to reach full equity in delivering CRC screening to this often medically underserved segment of our society.

Systematic Review of Interventions to Increase Stool Blood Colorectal Cancer Screening in African Americans.

African Americans experience colorectal cancer (CRC) related disparities compared to other racial groups in the United States. African Americans are frequently diagnosed with CRC at a later stage, screening is underutilized, and mortality rates are highest in this group. This systematic review focused on intervention studies using stool blood CRC screening among African Americans in primary care and community settings. Given wide accessibility, low cost, and ease of dissemination of stool-based CRC screening tests, this review aims to determine effective interventions to improve participation rates. This systematic review included intervention studies published between January 1, 2000 and March 16, 2019. After reviewing an initial search of 650 studies, 11 studies were eventually included in this review. The included studies were studies conducted in community and clinical settings, using both inreach and outreach strategies to increase CRC screening. For each study, an unadjusted odds ratio (OR) for the CRC screening intervention compared to the control arm was calculated based on the data in each study to report effectiveness. The eleven studies together recruited a total of 3334 participants. The five studies using two-arm experimental designs ranged in effectiveness with ORs ranging from 1.1 to 13.0 using interventions such as mailed reminders, patient navigation, and tailored educational materials. Effective strategies to increase stool blood testing included mailed stool blood tests augmented by patient navigation, tailored educational materials, and follow-up calls or mailings to increase trust in the patient-provider relationship. More studies are needed on stool blood testing interventions to determine effectiveness in this population.

837 – Pilot Study of Early Screening in African Americans in an Organized Colorectal Cancer Screening Program Based on Fecal Immunochemical Testing

837 – Pilot Study of Early Screening in African Americans in an Organized Colorectal Cancer Screening Program Based on Fecal Immunochemical Testing

Abstract IA10: Risk and appropriate screening of African-Americans for prostate cancer

Abstract In 2017 the US Preventive Services Task Force (USPSTF) reevaluated recommendation included support for screening men aged 55 to 69 years, but did not include African American men (AAM) because of lack of evidence. Their recommendation was based on evidence from a European study. However, in 2015 we reported (Powell et al., CEBP) that prostate cancer (PCa) survival among AAM was significantly worse than European American men (EAM) before PSA screening, but after the advent of PSA testing, 1995 to 2005, PCa survival was found to be similar among AAM compared to EAM. Another study reported that screening should begin for AAM at least nine years before EAM testing. Therefore AAM should begin PSA screening at approximately age 45 years. These studies were not included in the most recent USPSTF analysis. Even though survival is currently similar among AAM and EAM, the risk of PCa diagnosis has been reported to be 60% greater among AAM than other ethnicities and the mortality rate reported as 2 to 3 times greater among AAM than other ethnicities by SEER (Surveillance Epidemiology and End Results) analysis from 1973 to 2014. Our team at Wayne State University/Karmanos Cancer Institute has reported that PCa grows faster among AAM than among EAM based on our autopsy study, clinical data, and SEER data (CEBP, 2010). PCa starts at the same time among these groups but reaches distant disease at a 3 times greater proportion among AAM and at a younger age than EAM. This may account for much of the disproportionate mortality rate, but there are other factors that may contribute as well to such racial disparity of treatment. There is growing genetic and biologic evidence to support the disproportionate growth rate findings. Wallace et al. (Cancer Res 2008) reported that genes that facilitate PCa cell movement from the prostate gland to bone and are expressed in metastatic PCa tissue were greater among AAM than EAM. In 2013 we reported that genes associated with PCa are differentially expressed in AAM and EAM (Powell et al., CEBP). Functional driver genes more expressed among AAM were mostly proinflammatory cytokines, and those more expressed among EAM were lipid metabolism genes and ERG. It has been reported that proinflammatory genes are associated with aggressive PCa and activate transcription factors that activate the androgen receptor and cause PCa proliferation. They have other functions such as angiogenesis and being indirectly responsible for downregulation of cell adhesion molecules. They also play a role in several biologic pathways contributing to advanced disease. Further studies are needed such as validation of our data, comparison to other genetic panels, and identifying methods to personalize or individualize these genetic findings. Citation Format: Isaac J. Powell. Risk and appropriate screening of African-Americans for prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr IA10.

Abstract C15: Increasing cancer prevention education and cancer screening in African Americans through a cancer health ministry

Abstract Objectives: 1. To assess church's ability to increase screening and awareness for different cancers 2. To describe how one church was able to create cancer screening opportunities for their community Background: It has been documented that faith-based health programs are capable of producing positive results in health education and cancer prevention. With a little more than half of the African American population reporting church attendance at least once a week, church health ministries are capable of having a strong impact on cancer prevention. While many churches have wellness ministries, the presence of a cancer ministry is often overlooked. Having a cancer ministry can help increase participation in cancer prevention, cancer awareness, and screening in the African American community. Introduction: Fallbrook Church is a local African American church in the northern part of Houston, Texas. The church boast a membership of over 7,000 and holds two worships services every week. Although Fallbrook has an established wellness ministry, a motivated survivor wanted to start a cancer ministry based on her own experience with diagnosis and treatment. The member reached out to the Faith Health and Family Collaborative at MD Anderson Cancer Center for support in developing a cancer ministry. Methods: The National Outreach Network Community Health Educator met with the Combat Ready Cancer Ministry to plan events and identify community partners who could assist with screening and education. After meeting with the group and sharing different resources that were available from MD Anderson Cancer Center and other community partners, the ministry was able to not only focus on being a support group for members who were diagnosed with cancer, but also schedule four prevention and education events for the 2017 calendar year. Results: The first event focused on oral cancer. The event featured a local dentistry office that was able to perform oral exams and educate participants on oral cancer. The event was attended by 42 participants. The second event focused on colorectal cancer and featured the National Cancer Institute's Screen to Save initiative. This event featured a presentation from the NON CHE at MD Anderson Cancer Center, a walk-through adventure colon, and an opportunity to receive a free FOBT kit for early detection of colorectal cancer. The event had more than 200 attendees and 25 people participated in the City of Houston's Colorectal Cancer Awareness Program to receive free FOBT kits. Their third event focused on prostate cancer, a cancer that affects more African American men than any other ethnic group. This event featured education from a local urologist and an opportunity to get a free PSA test for prostate cancer detection. Seventy-two men attended the event and 86% of the men received free PSA screenings. The group's fourth event is scheduled for November and will focus on providing onsite mammograms for members of the church. The cancer ministry partnered with The Rose (local mammography and diagnostic imaging center). This partner will perform onsite mammograms, and for every two insured participants The Rose will provide one free mammogram. Discussion: Cancer health disparities continue to be an issue in the United States. The African American church has proven to be a great tool to help reach many of our underserved communities. Creating a ministry that focuses on cancer and connecting the ministry to resources provides the opportunity to increase education, awareness, and screening for many of the cancers that affect African Americans more than other ethnic groups. Citation Format: Terrence R. Adams. Increasing cancer prevention education and cancer screening in African Americans through a cancer health ministry [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C15.

Abstract C67: Addressing racial disparity in colorectal cancer screening with CT colonography: Experience in an African-American cohort

Abstract Purpose: Incidence and mortality from colorectal cancer (CRC) are higher among minorities, including African Americans, compared with non-Hispanic whites, and CRC screening rates for African Americans lag behind non-Hispanic whites. The purpose of this investigation was to evaluate computed tomographic (CT) colonography performance and outcome measures in an African-American cohort. Materials and Methods: Institutional review board-approved and HIPAA-compliant study. Informed consent was waived. Retrospective evaluation of the African-American cohort from the Atlanta Veterans Affairs Medical Center CT colonography screening program. Colonoscopy referral rates and histologic diagnoses were evaluated. Results: CT colonography studies (n = 2,490; mean age 59.5 years [range 50-80]; 85.5% male), were performed between 2007 and 2016. The per-patient positive rate of CT colonography was 9.8% for polyps 6-9 mm, 5.4% for polyps 10-29 mm, and 1.3% for masses > 30 mm. Based on CT colonography findings and patient preference, 13.9% of patients were referred to optical colonoscopy and 2.9% were referred to CT colonography follow-up. Of patients recommended to undergo colonoscopy, 80.6% completed the procedure and colonic pathology was confirmed in 83.2% thereof. Histologic diagnoses were 221 tubular adenomas (161 6-9 mm; 60 > 10 mm), 60 tubulovillous adenomas/villous adenomas (14 6-9 mm; 46 > 10 mm), 31 hyperplastic polyps (26 6-9 mm; 5 > 10 mm), 17 adenocarcinomas (all > 10 mm), 10 adenomas with high-grade dysplasia (all > 10 mm), and 3 serrated polyps (1 6-9 mm; 2 > 10 mm). The per-patient positivity rate for patients who had optical colonoscopy (n = 279) was 71.3% for adenoma, 9.7% for hyperplastic polyp, and 6.1% for adenocarcinoma. Conclusions: CT colonography is an effective screening modality for African-American adults and could potentially improve rates of colorectal screening in African-Americans. Citation Format: Todd Fibus, Courtney C. Moreno, Elizabeth A. Krupinski, David H. Kim, Perry J. Pickhardt. Addressing racial disparity in colorectal cancer screening with CT colonography: Experience in an African-American cohort [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C67.

Decision-making and socioeconomic disparities in colonoscopy screening in African Americans.

Socioeconomic status (SES) disparities in colorectal cancer screening are persistent. Lower education and income are both associated with lower screening rates. Both cognitive (e.g., perceived barriers) and affective (e.g., disgust, fear) decision-making constructs are known determinants of colorectal cancer screening behavior. This study tests the hypotheses that SES may be related to decision-making constructs and that this SES-decision-making construct relation may contribute to explaining the SES-screening behavior disparity. Surveys assessing perceived benefits and barriers to screening, self-efficacy, positive and negative affective associations with colonoscopy, fear of colonoscopy, colorectal cancer knowledge, past screening behavior, and demographics including education and income were completed by 2,015 African American participants ages 50 and older. Both univariable and multivariable relations of SES to decision-making constructs were examined, as were univariable and multivariable models of the indirect effect of SES on screening via decision-making constructs. Socioeconomic status was related to both screening compliance and the decision-making constructs. Bootstrap modeling of the indirect effect showed that the total effect of the SES-screening behavior relation included an indirect effect via social cognitive decision-making constructs. These findings suggest that cognitive and affective decision-making constructs account for at least some of the SES disparities in colorectal cancer screening behavior. As such, more research is needed to explore the intra individual-level influences of disparities in colorectal cancer screening. In addition, work is needed to develop effective intervention approaches to address the relation of SES to decision-making constructs. (PsycINFO Database Record

Supplemental Material for Decision-Making and Socioeconomic Disparities in Colonoscopy Screening in African Americans

Supplemental Material for Decision-Making and Socioeconomic Disparities in Colonoscopy Screening in African Americans

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

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.

Early Experience in Lung Cancer Screening in African Americans

Early Experience in Lung Cancer Screening in African Americans

Improving Internal Medicine Residentsʼ Colorectal Cancer (CRC) Screening Knowledge via Smart Phone Application: A Novel Approach

Introduction: Colo-Rectal cancer is the third most common type of cancer and the second leading cause of cancer death in the United States. The incidence and mortality of CRC have declined in the last decade, but still there is a room for improvement. About one in three adults in US is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge as shown by previous studies. we conducted this IRB approved study [UT IRB# 201713] to improve the residents CRC screening knowledge via smart phone application. Methods: A questionnaire was designed based on CRC screening guidelines of ACS, ACG and USPSTF. The questionnaire was emailed via SurveyMonkey link to all the residents of internal medicine department. The responses were analyzed after 4 weeks. Then a smart phone application was designed and was published on Play Store and App Store for android users and I phone users respectively. All the residents were introduced to the application. The survey was repeated and the responses were compared with the previous one. Pearson Chi square test and the fisher exact test was applied to look for statistical significance.Table: Number of Responders Correctly Identifying Appropriate Exams for CRC Screening.Table: Number of Responders Correctly Identifying Appropriate Exams for CRC Screening.Table: Number of Responders Correctly Identifying Appropriate Exams for CRC Screening.Results: 50 residents completed the first survey and 41 completed the second survey after publication of the application. There was no significant difference in knowledge by the residency years at baseline and knowledge improved equally across all the residency years. Survey was divided into seven domains to test various aspects of CRC screening knowledge. Some of the areas which showed statistically significant improvement (P value <0.05) included age to start CRC screening in African Americans, ordering preventive tests first, identification of CRC screening tests, identification of preventive and detection methods, positive tests to be followed by colonoscopy, follow up after colonoscopy findings and CRC surveillance in diseases. Conclusion: In this modern era of smart phones and gadgets, developing a smartphone based application or educational tool is a novel idea and can help in improving the knowledge of residents about colorectal cancer screening as shown by our study. Such smart phone based educational tool can be a part of residents' orientation before the start of residency to emphasize further on CRC screening.

Social networks as predictors of colorectal cancer screening in African Americans.

BackgroundEarly detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. Colorectal cancer mortality rates are higher in African Americans than in whites, while screening rates are somewhat lower. Individual social networks can reduce emotional and/or logistical barriers to health-promoting but distasteful procedures such as CRC screening. The aim of this study was to examine social network interactions, and their impact on CRC screening among African Americans. We hypothesized a positive association between social network index (SNI) scores and CRC screening.MethodsIn a community intervention trial with four arms, we previously demonstrated the efficacy of a small group educational intervention to promote CRC screening among African Americans. This intervention outperformed a one-on-one educational intervention, a reduced out-of-pocket expense intervention, and a control condition. In the present analysis, we compared the SNI scores for participants in the small group intervention cohort with a comparison group comprised of the other three cohorts. Social networks were assessed using the Social Network Index developed by Cohen.ResultsSmall group participants had a significantly higher network diversity score (Mean difference 0.71; 95% CI, 0.12–1.31; p=0.0017) than the comparison group. In the second component of the SNI score – the number of people talked to over a two week period – the small group intervention cohort also scored significantly higher than the comparison group. (Mean difference, 9.29; 95% CI, 3.963–14.6266; p=0.0004).ConclusionsThe findings suggest that social interaction and support was at least partially responsible for the relatively high post-intervention screening rate in the small group intervention participants. Education in small groups could foster strong social networks. Strong and positive network diversity and a large number of people in social networks may enhance CRC screening rates among African Americans.

Colorectal Cancer in African Americans: An Update.

This review is an update to the American College of Gastroenterology (ACG) Committee on Minority Affairs and Cultural Diversity's paper on colorectal cancer (CRC) in African Americans published in 2005. Over the past 10 years, the incidence and mortality rates of CRC in the United States has steadily declined. However, reductions have been strikingly much slower among African Americans who continue to have the highest rate of mortality and lowest survival when compared with all other racial groups. The reasons for the health disparities are multifactorial and encompass physician and patient barriers. Patient factors that contribute to disparities include poor knowledge of benefits of CRC screening, limited access to health care, insurance status along with fear and anxiety. Physician factors include lack of knowledge of screening guidelines along with disparate recommendations for screening. Earlier screening has been recommended as an effective strategy to decrease observed disparities; currently the ACG and American Society of Gastrointestinal Endoscopists recommend CRC screening in African Americans to begin at age 45. Despite the decline in CRC deaths in all racial and ethnic groups, there still exists a significant burden of CRC in African Americans, thus other strategies including educational outreach for health care providers and patients and the utilization of patient navigation systems emphasizing the importance of screening are necessary. These strategies have been piloted in both local communities and Statewide resulting in notable significant decreases in observed disparities.

Colorectal cancer screening in African Americans: practice patterns in the United States. Are we doing enough?

Background: Colorectal cancer (CRC) is a common form of malignancy and a leading cause of death in the United States. Screening decreases CRC incidence and mortality. African Americans are at an increased risk of developing CRC, and recommendations are to initiate screening at the age of 45. This study aims to assess the rate of screening for colorectal cancer in African Americans between the ages of 45–49.Methods: African Americans between the ages of 45–49 were identified in the Explorys national database. Patients who completed a colonoscopy, sigmoidoscopy or fecal occult blood test were identified and stratified by sex and insurance status. A P value < 0.05 was considered significant.Results: A total of 181 200 African Americans were identified as eligible for screening. Only 31 480 patients (17.4%) received at least one screening procedure for CRC. The majority of patients (66.7%) were screened via colonoscopy. African American females were more likely to complete a screening test (17.8% vs 16.7%; P < 0.01). The majority of patients (66.0%) who completed a screening test had private insurance.Conclusion: Race, gender and barriers to medical care contribute to disparities in CRC screening rates. Among African Americans, CRC screening remains suboptimal. Tailored public health initiatives, medical record alerts and improved communication between providers and patients are fundamental to addressing issues that impact poor adherence to CRC screening in African Americans.