Racial Disparities and Barriers to Colorectal Cancer Screening in Rural Areas

Wilkins, Thad; Gillies, Ralph A.; Harbuck, Stacie; Garren, Jeonifer; Looney, Stephen W.; Schade, Robert R.

doi:10.3122/jabfm.2012.03.100307

Cited by 50 publications

(63 citation statements)

References 28 publications

(29 reference statements)

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“…Studies reported several types of patient fear: 1) fear of pain during colonoscopy; 2) fear of invasion during colonoscopy; 3) fear of bowel preparation; 4) fear of sedation or of hospital setting; and 5) fear of receiving a cancer diagnosis. 18–22, 24–25, 27–28,30–32 Fear of perceived “invasion” during colonoscopy was a common theme among African American males in particular. 18–21,24,27–28,30 Male respondents in focus groups and cognitive interviews described colonoscopy as “offensiveness,” “violating,” and “treading on my masculinity.” 18,24,27 Cancer-related fear stemmed from concerns about being diagnosed with cancer 19, 21, 25, 28,30 and of cancer treatment.…”

Section: Resultsmentioning

confidence: 99%

“…19, 21–22, 26, 28,30,31,33 African Americans were often not aware of their increased risk of CRC. 21, 30, 33 For example, in one survey of 76 African American participants, only 16% believed that African Americans had a higher risk of CRC than Whites, and only 53% believed that CRC was preventable.…”

Section: Resultsmentioning

confidence: 99%

“…We identified provider-level barriers to screening including lack of provider recommendation for colonoscopy, 21, 26, 28,30–31 insufficient patient counseling about screening, 19, 22, 28 poor knowledge of updated CRC screening guidelines in African Americans, 36 lack of provider recognition of barriers, 10, 25 and long wait times at the primary medical doctor’s office. 19 …”

Section: Resultsmentioning

confidence: 99%

“…In interviews of 635 rural participants, African Americans were significantly more likely than Whites to believe that insufficient provider contact time served as a barrier to screening. 22 …”

Section: Resultsmentioning

confidence: 99%

“…Our review identified system-level barriers for performing screening colonoscopy in African Americans, including the cost of colonoscopy, 21–22, 30, 34 inadequate health care insurance among many African Americans, 19, 22, 30 fewer specialist referrals, 21, 30 and fewer interactions with a primary care physician. 35 …”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Explaining persistent under-use of colonoscopic cancer screening in African Americans: A systematic review

Bromley¹,

May

Federer

et al. 2015

Preventive Medicine

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Introduction Although African Americans have the highest incidence and mortality from colorectal cancer (CRC), they are less likely than other racial groups to undergo CRC screening. Previous research has identified barriers to CRC screening among African Americans. However we lack a systematic review that synthesizes contributing factors and informs interventions to address persistent disparities. Methods We conducted a systematic review to evaluate barriers to colonoscopic CRC screening in African Americans. We developed a conceptual model to summarize the patient-, provider-, and system-level barriers and suggest strategies to address these barriers. Results Nineteen studies met inclusion criteria. Patient barriers to colonoscopy included fear, poor knowledge of CRC risk, and low perceived benefit of colonoscopy. Provider-level factors included failure to recommend screening and knowledge deficits about guidelines and barriers to screening. System barriers included financial obstacles, lack of insurance and access to care, and intermittent primary care visits. Conclusions There are modifiable barriers to colonoscopic CRC screening among African Americans. Future interventions should confront patient fear, patient and physician knowledge about barriers, and access to healthcare services. As the Affordable Care Act aims to improve uptake of preventive services, focused interventions to increase CRC screening in African Americans are essential and timely.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Explaining persistent under-use of colonoscopic cancer screening in African Americans: A systematic review

Bromley¹,

May

Federer

et al. 2015

Preventive Medicine

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Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened

Aziz,

Wagner,

Agyekum

et al. 2023

JAMA Netw Open

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ImportanceDespite recommendations for universal screening, adherence to colorectal cancer screening in the US is approximately 60%. Liquid biopsy tests are in development for cancer early detection, but it is unclear whether they are cost-effective for colorectal cancer screening.ObjectiveTo estimate the cost-effectiveness of liquid biopsy for colorectal cancer screening in the US.Design, Setting, and ParticipantsIn this economic evaluation, a Markov model was developed to compare no screening and 5 colorectal cancer screening strategies: colonoscopy, liquid biopsy, liquid biopsy following nonadherence to colonoscopy, stool DNA, and fecal immunochemical test. Adherence to first-line screening with colonoscopy, stool DNA, or fecal immunochemical test was assumed to be 60.6%, and adherence for liquid biopsy was assumed to be 100%. For colonoscopy, stool DNA, and fecal immunochemical test, patients who did not adhere to testing were not offered other screening. In colonoscopy–liquid biopsy hybrid, liquid biopsy was second-line screening for those who deferred colonoscopy. Scenario analyses were performed to include the possibility of polyp detection for liquid biopsy.ExposuresNo screening, colonoscopy, fecal immunochemical test, stool DNA, liquid biopsy, and colonoscopy–liquid biopsy hybrid screening.Main Outcomes and MeasuresModel outcomes included life expectancy, total cost, and incremental cost-effectiveness ratios. A strategy was considered cost-effective if it had an incremental cost-effectiveness ratio less than the US willingness-to-pay threshold of $100 000 per life-year gained.ResultsThis study used a simulated cohort of patients aged 45 years with average risk of colorectal cancer. In the base case, colonoscopy was the preferred, or cost-effective, strategy with an incremental cost-effectiveness ratio of $28 071 per life-year gained. Colonoscopy–liquid biopsy hybrid had the greatest gain in life-years gained but had an incremental cost-effectiveness ratio of $377 538. Colonoscopy–liquid biopsy hybrid had a greater gain in life-years if liquid biopsy could detect polyps but remained too costly.Conclusions and RelevanceIn this economic evaluation of liquid biopsy for colorectal cancer screening, colonoscopy was a cost-effective strategy for colorectal cancer screening in the general population, and the inclusion of liquid biopsy as a first- or second-line screening strategy was not cost-effective at its current cost and screening performance. Liquid biopsy tests for colorectal cancer screening may become cost-effective if their cost is substantially lowered.

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Disparities in colorectal cancer screening among breast and prostate cancer survivors

Dash

Parikh

et al. 2021

Cancer Medicine

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Background Colorectal cancer (CRC) screening is recommended as an integral part of cancer survivorship care. We compared the rates of CRC screening among breast and prostate cancer survivors by primary cancer type, patient, and geographic characteristics in a community‐based health‐care system with a mix of large and small metro urban areas. Materials and Methods Data for this retrospective study were abstracted from medical records of a multi‐specialty practice serving about 250,000 individuals in southern Maryland. Breast (N = 1056) and prostate (N = 891) cancer patients diagnosed prior to 2015 were followed up till June 2018. Screening colonoscopy within the last 10 years was considered to be guideline concordant. Multivariate logistic regression was used to determine the prevalence odds ratios of being concordant on CRC screening by age, gender, race, metro area type, obesity, diabetes, and hypertension. Results Overall 51% of survivors had undergone a screening colonoscopy. However, there was a difference in CRC screening rate between prostate (54%) and breast (44%) cancer survivors. Older age (≥65 years), being a breast cancer survivor compared to prostate cancer, and living in a large compared to small metropolitan area were associated with a lower probability of receiving CRC screening. Having hypertension was associated with higher likelihood of being current on colonoscopy screening guidelines among survivors; but diabetes and obesity were not associated with CRC screening. Conclusions Low levels of CRC screening utilization were found among breast and prostate cancer survivors in a single center in Southern Maryland. Gender, comorbidities, and residential factors were associated with receipt of CRC screening.

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Racial Disparities and Barriers to Colorectal Cancer Screening in Rural Areas

Cited by 50 publications

References 28 publications

Explaining persistent under-use of colonoscopic cancer screening in African Americans: A systematic review

Explaining persistent under-use of colonoscopic cancer screening in African Americans: A systematic review

Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened

Disparities in colorectal cancer screening among breast and prostate cancer survivors

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