Among African Americans, colorectal cancer is the third most common cause of cancer-related death. With the proper screening, it has a 90 percent cure rate, yet screening rates are much lower among this group than other ethnic groups.

Many researchers have tried to figure out why, but most have only looked at African Americans as one group, and therefore haven’t explored the differences in what keeps African American men and women from getting this potentially life-saving test.

“Most studies have looked at African Americans as a whole and have outlined differences that might exist in different segments of the population,” said Sarah Bauerle Bass, an associate professor of public health in the College of Health Professions and Social Work.

In a study published this month in the Journal of Cancer Education’s online edition, lead author Bass and a team of researchers looked at data collected from focus groups of 23 African American men and women over the course of six months. While women generally reported being more aware of the need for screening and more amenable to the procedure, men reported several barriers that kept them from getting tested, including less trust in the health care system, apprehension to being put to sleep for the procedure, and in some cases, a perceived sexual connotation of having a colonoscopy.

Bass said that because African American men are at a much greater risk of colon cancer than other groups, it’s important to understand what’s keeping them from being tested, so that an educational program can target those specific barriers.

“None of the existing research on colorectal cancer screening rates among this group has broken it down this way,” she said. “It provides us with information that can help us develop educational materials or public information campaigns that are tailored to specific characteristics and differences in thinking.”

Among those that had previously been screened, both men and women reported how important and useful the procedure is, and were more aware of the dietary risks for colorectal cancer, including high-fat foods and red meat.

Still, despite having some fears of the procedure, both men and women who had never been screened reported that they would rather have a colonoscopy than a fecal occult blood test, which had long been used as an alternative screening method for those who were wary of the colonoscopy, especially in African American communities.

“The participants that had previously been screened were more aware of the importance of early detection and prevention,” said Bass. “That suggests that if we can just get patients past those fears and get them tested, they’ll be more aware of the benefits. Hopefully, that will translate into fewer cases and fewer deaths.”

In the next phase of her research, Bass and fellow researchers developed a series of decision making aids based on these preliminary findings, to see if these tailored messages would be effective in improving screening rates.

“Deaths from colorectal cancer are highest among African Americans, yet are extremely easy to prevent with screening,” said Bass. “To that end, it is vitally important that we develop a campaign that will address the specific needs and concerns of this population.”

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Other researchers on this paper include Thomas F. Gordon, Sheryl Burt Ruzek, Caitlin Wolak, and Dominique Ruggieri in the department of Public Health at the College of Health Professions and Social Work; and Stephanie Ward, Anuradha Paranjape, Karen Lin and Brian Meyer in the section of General Internal Medicine at the School of Medicine. This research was funded by a grant from the National Institutes of Health.

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