Background African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population. Materials and methods In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998–January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions. Results Our final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89–31.82, p = 0.0002) and 2.84 (95% CI 1.23–6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510). Conclusions Additional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.

Purpose: Rural areas of the U.S. experience disproportionate colorectal cancer (CRC) death compared to urban areas. The authors aimed to analyze differences in CRC survival between rural and urban Utah men and investigate potential prognostic factors for survival among these men. Methods: A cohort of Utah men diagnosed with CRC between 1997 and 2013 was identified from the Utah Cancer Registry. Survival and prognostic factors were analyzed via five-year CRC survival and Cox proportional hazards models, stratified by rural/urban residence. Results: Among 4,660 men diagnosed with CRC, 15.3% were living in rural Utah. Compared with urban men, rural CRC patients were diagnosed at older ages and in different anatomic subsites; more were overweight, and current smokers. Differences in stage and treatment were not apparent between rural and urban CRC patients. Compared with urban counterparts, rural men experienced a lower CRC survival (Hazard Ratio 0.55, 95% CI=0.53, 0.58 vs 0.58, 95% CI=0.56, 0.59). Race and cancer treatment influenced CRC survival among men living in both urban and rural areas.

African-American men have the lowest 5-year survival rate for colorectal cancer (CRC) of any ethnic/racial group in the country, which may be due in part to poor screening rates. Evidenced-based interventions are needed to increase CRC screening (CRCS) uptake among this population, as screening is associated with increased survival. Using Rayyan QCRI, a systematic review was employed to synthesize the evidence from published studies evaluating interventions to increase CRCS uptake among African-American men. Potential studies were retrieved from MEDLINE, CINAHL, EMBASE, and Cochrane CENTRAL resulting in 960 initial results. Articles published before 1998 were excluded, as well as studies that were not explicitly about CRCS uptake, were not in English, did not take place in the U.S., and/or did not include African-American men. Only primary analyses and evaluations of CRCS uptake interventions, as opposed to interventions considering behaviors related to but not directly indicative of CRCS uptake, were considered. After an abstract screening and full-text review was conducted by two blinded team members, 41 publications ranging from 2000 – 2018 made up the final sample. These studies were then coded for study setting, geographic region, theory, intervention type, and limitations. The majority of studies were conducted in either a medical center or church in the southern U.S. Nearly half of the studies did not report a theoretical foundation, yet in those which did, the Health Belief Model, Preventative Health Model, and the Stages of Change Model were the most common. Reflecting recent screening guidelines endorsed by the American Cancer Society, studies had age ranges starting as early as age 45. The most common interventions of 122 types utilized were telephone education (18%), mailed/electronically-sent educational materials (14%), mailed or administered in person CRCS stool-based kits (12%), and patient navigation (11%), and printed materials given to individuals in person (11%). The most effective intervention types were patient navigation and free stool kits, but were limited due to sustainability cost. Such a finding indicates a need for more research to uncover effective interventions that are not cost-prohibitive. Print education materials that were culturally-tailored specifically for African-Americans often performed as well as control interventions (e.g., those utilizing the Centers for Disease Control and Prevention’s Screen for Life Campaign materials). Furthermore, given most of the interventions took place in the south, studies in other regions of the country may uncover different CRC screening uptake patterns, as there may be regional variation in intervention effectiveness among African-American men. A major weakness our review revealed was that only 2 of the 41 studies (5%) solely focused on African-American men, warranting the needed for intervention samples comprised exclusively of African-American men to eliminate CRC screening uptake inequities. Citation Format: Colin Riley, Charles R Rogers, Matthew Huntington, Margaret Foster, Kenneth M Boucher, Kola Okuyemi. Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C124.