Influence of family history and preventive health behaviors on colorectal cancer screening in African Americans

Abstract

BACKGROUND. African Americans (AAs) have low rates of colorectal cancer (CRC) screening. To the authors' knowledge, factors that influence their participation, especially individuals with a family history of CRC (“family history”), are not well understood. METHODS. A secondary analysis of the 2002 Maryland Cancer Survey data examined predictors of risk‐appropriate, timely CRC screening (“screening”) in AAs with a family history and in individuals without a family history. Predictors that were evaluated included age, sex, family history, mammogram or prostate‐specific antigen (PSA) screening, body mass index, activity, fruit/vegetable consumption, alcohol, smoking, perceived risk of cancer, education, employment, insurance, access to a healthcare provider, and healthcare provider recommendation of fecal occult blood test (FOBT) and/or sigmoidoscopy/colonoscopy. RESULTS. In individuals without a family history of CRC (N = 492), recommendation for FOBT (odds ratio [OR] of 11.90; 95% confidence interval [95% CI], 6.84–20.71) and sigmoidoscopy/colonscopy (OR of 7.06; 95% CI, 4.11–12.14), moderate/vigorous activity (OR of 1.74; 95% CI, 1.06–2.28), and PSA screening history (OR of 2.68; 95% CI, 1.01–7.81) were found to be predictive of screening. In individuals with a family history (N = 88), recommendation for sigmoidoscopy/colonscopy (OR of 24.3; 95%, CI 5.30–111.34) and vigorous activity (OR of 5.21; 95% CI, 1.09–24.88) were found to be predictive of screening. However, family history did not predict screening when the analysis was controlled for age, education, and insurance. AAs who had a family history were less likely to screen compared with their white counterparts (N = 293) and compared with AAs who were at average risk for CRC (P < .05). CONCLUSIONS. Regardless of family history, healthcare provider recommendation and activity level were important predictors of screening. Lower screening rates were observed in AAs who had a family history compared with individuals who did not. The authors believe that, for AAs who have a family history, further examination of barriers and facilitators to CRC screening within the cultural context is warranted. Cancer 2008. © 2008 American Cancer Society.

Gender and Physician differences in the Physician-Patient Discussion Prior to Open Access Colonoscopy

“…Physician recommendation in our population was the number one reason for undergoing open access colonoscopy. This corresponds to previous studies citing physician recommendation as an important factor influencing a patient decision to undergo CRC screening [10][11][12][13][14][15][16]. To improve future open access colonoscopy patient education and thus increase patient adherence, we must ensure patient reception of an open access colonoscopy handout that would explain the value of open access colonoscopy in preventing CRC, the actual procedure and address frequently asked questions.…”

Disparities in colorectal cancer in African-Americans vs Whites: Before and after diagnosis

“…Family history did not predict screening in African Americans when the analysis was controlled for age, education, and insurance. African Americans who have a family history are less likely to screen compared with their white counterparts and compared with African Americans who are at average risk for colorectal cancer (P < 0.05) [29] . Tailored intervention increased screening via FOBT in a statistically significant manner in the Caucasian but not in the non-Caucasian population of first degree relatives of people affected with colorectal cancer [30] .…”

Ethnic differences and predictors of colonoscopy, prostate-specific antigen, and mammography screening participation in the multiethnic cohort

“…Interactions between ethnicity and these factors have emerged as areas of interest [13,22–25]. The purpose of the current study was to examine how ethnicity and other factors influence colonoscopy, PSA, and mammography screening among participants of the Multiethnic Cohort (MEC).…”