Barriers to Colorectal Cancer Screening in Latino and Vietnamese Americans

Judith M. E. Walsh, MD, MPH; Celia P. Kaplan, PH, MA; Bang Nguyen, PH; Ginny Gildengorin, PhD; Stephen J. McPhee, MD; Eliseo J. Pérez-Stable, MD

Disclosures

J Gen Intern Med. 2004;19(2) 

In This Article

Abstract and Introduction

Objective: To identify current colorectal cancer (CRC) screening practices and barriers to screening in the Latino, Vietnamese, and non-Latino white populations.
Methods: We conducted a telephone survey of Latino, non-Latino white, and Vietnamese individuals living in San Jose, California. We asked about demographics, CRC screening practices, intentions to be screened, and barriers and facilitators to screening.
Results: Seven hundred and seventy-five individuals (40 % white, 29.2 % Latino, and 30.8 % Vietnamese) completed the survey (Response Rate 50 %). Overall, 23 % of respondents reported receipt of fecal occult blood test (FOBT) in the past year, 28 % reported sigmoidoscopy (SIG) in the past 5 years, and 27 % reported colonoscopy (COL) in the past 10 years. Screening rates were generally lower in Latinos and Vietnamese. Vietnamese were less likely than whites to have had SIG in the past 5 years (odds ratio [OR], 0.26; 95 % confidence interval [CI], 0.09 to 0.72), but ethnicity was not an independent predictor of FOBT or COL. Only 22 % of Vietnamese would find endoscopic tests uncomfortable compared with 79 % of whites (P < .05). While 21 % of Latinos would find performing an FOBT embarrassing, only 8 % of whites and 3 % of Vietnamese felt this way (P < .05). Vietnamese were more likely than whites to plan to have SIG in the next 5 years (OR, 2.24; 95 % CI, 1.15 to 4.38), but ethnicity was not associated with planning to have FOBT or COL.
Conclusions: Rates of CRC screening are lower in ethnic minority populations than in whites. Differences in attitudes and perceived barriers suggest that culturally tailored interventions to increase CRC screening will be useful in these populations.

Colorectal cancer is the third most common form of cancer in the U.S. and has the third highest mortality rate, and screening clearly reduces mortality.[1,2,3] In a recent systematic assessment of the value of clinical preventive services, which are recommended for average risk individuals by the U.S. Preventive Services Task Force, preventive services were ranked based on burden of disease prevented by the service and cost effectiveness. Screening for colorectal cancer was one of the highest ranked services (score of 7+ on a scale of 2 to 10) with the lowest delivery rate (<50 % nationally) and it was concluded that it should be a national priority to increase rates of colorectal cancer screening.[4]

The United States Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer for all persons older than age 50 years but does not recommend a preferred screening strategy.[5] Potential strategies include fecal occult blood testing (FOBT) annually with sigmoidoscopy every 5 years or colonoscopy every 10 years.[6,7] Despite this recommendation, these screening guidelines have not been widely implemented by physicians. In 2001, only 23.5 % of eligible patients had undergone FOBT within the preceding year, and only 38.7 % of eligible patients had undergone sigmoidoscopy or colonoscopy in the preceding 5 years; these rates have not significantly improved since 1999.[8]

Rates of cancer screening often tend to be even lower among ethnic populations in the United States,[9,10,11] and the Latino and Vietnamese populations are no exception. The Latino population in the United States is the second largest population in the US.[12] The Vietnamese are one of the fastest growing Asian Pacific ethnic groups in the United States, and it is estimated that by 2030 the Vietnamese population will be the largest Asian Pacific ethnic group in the United States.[13] Colorectal cancer screening rates have previously been shown to be lower in the Latino and Vietnamese populations than in non-Latino whites.[14,15] Since the time of these studies, colorectal cancer screening has been widely endorsed, and therefore some changes in rates of screening might be expected. The aim of this study was to identify current colorectal cancer screening practices and barriers and facilitators to colorectal cancer screening in the Latino, Vietnamese, and non-Latino white populations.

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