A new study indicates that African-Americans with a
family history of colorectal cancer are
less likely to be screened than African-Americans at
average risk for the disease. There is also some
evidence to indicate that African-Americans with a family
history are less likely to be screened than
their white counterparts. The study is published in the
July 15 issue of Cancer, a peer-reviewed
journal of the American Cancer Society.
African-Americans have the highest colorectal cancer
incidence and death rates of all racial
groups in the United States. The reason for this is thought
to be multifactorial but remains poorly
understood. Overall, African-Americans have low rates of
colorectal cancer screening compared to
most other racial groups. Early detection is especially
important for those with family histories of CRC
who are at higher risk of developing the disease. Factors
associated with CRC screening are not well
understood for African-Americans, both those with and
without family histories of CRC.
To investigate the factors associated with
risk-appropriate CRC screening, Kathleen Griffith of
the Johns Hopkins
School of Nursing and colleagues at the University of
Maryland Baltimore analyzed
data from the 2002 Maryland Cancer Survey, a telephone
survey of more than 5,000 Maryland
residents performed under the Maryland Cigarette
Restitution Fund Program to identify predictors of
screening among African-Americans.
The researchers' analyses revealed that for
African-Americans, regardless of family history, a
health care provider's recommendation for colorectal cancer
screening was strongly correlated with a
higher likelihood of screening. Furthermore, individuals
who were more physically active were also
more likely to have been screened for colorectal cancer.
Surprisingly, though, having a family history
of colorectal cancer did not predict a higher likelihood of
screening. In fact, the researchers found
that African-Americans with a family history were less
likely to have received risk-appropriate
screening than those without a family history. Family
history of colorectal cancer is often associated
with increased rates of screening in whites.
The authors say it is difficult to explain why a
perception of increased risk, which is
significantly higher in African-Americans with a family
history of CRC than in those without, did not
translate into screening. Their findings suggest that other
unknown or unmeasured factors may play a
role in screening decisions. Additional studies to
determine what those factors might be could lead to
culturally tailored interventions designed to increase
screening rates, which in turn could ultimately
improve early detection and reduce colorectal cancer deaths
in African-Americans. "This study
suggests that African-Americans would benefit from a
primary care approach that evaluates their
risk factors for colorectal cancer and provides
corresponding recommendations for appropriate
screening tests," the authors write.
Regular colorectal cancer screening is one of the most
powerful weapons in preventing
colorectal cancer. It can, in many cases, prevent
colorectal cancer altogether. Experts estimate
adherence to national screening guidelines could prevent up
to eight in 10 deaths from the disease.
The American Cancer Society recommends that people at
average risk begin screening for colorectal
cancer at age 50. Colorectal cancer is the third most
common cancer diagnosed in both men and women
in the United States, as well as the third leading cause of
cancer-related death among both men and
women in the United States.
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