title: Colorectal cancer screening among African Americans: the importance of physician recommendation.
abstract: BACKGROUND
  African Americans have higher colorectal cancer incidence and mortality rates than whites. They are also more likely to be diagnosed with late-stage disease and less likely to survive for at least five years after diagnosis. Lack of adherence to colorectal cancer screening recommendations has previously been found to be associated with lower income, lower educational level, and racial/ethnic minority status.
  
  
  METHODS
  One hundred-fifty African-American patients (aged 50-79 years) of an inner city hospital, were surveyed by mail and telephone in early 2002. Seventy-six patients completed the survey, and data from 74 surveys were analyzed.
  
  
  RESULTS
  Approximately one-half (55%) of the respondents reported having received a fecal occult blood test (FOBT) in the last 12 months, sigmoidoscopy in the last five years, or colonoscopy in the last 10 years. Thirty-nine percent of the survey participants reported never having received a physician recommendation for FOBT, 60% reported never having received a recommendation for sigmoidoscopy, and 57% reported never having received a recommendation for colonoscopy. Previous physician recommendation was strongly associated (p < 0.001) with levels of FOBT, sigmoidoscopy, and colonoscopy use.
  
  
  CONCLUSIONS
  Future studies should examine factors that influence primary care physicians' decision-making about ordering colorectal cancer screening tests, as well as patients' decision-making regarding adherence to physician recommendations.
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. vtaylor@fhcrc.org
authors.forename: Vicky
authors.initials: V
authors.lastname: Taylor
authors.forename: Daniel
authors.initials: D
authors.lastname: Lessler
authors.forename: Kathy
authors.initials: K
authors.lastname: Mertens
authors.forename: Shin-Ping
authors.initials: SP
authors.lastname: Tu
authors.forename: Alton
authors.initials: A
authors.lastname: Hart
authors.forename: Nadine
authors.initials: N
authors.lastname: Chan
authors.forename: Jianfen
authors.initials: J
authors.lastname: Shu
authors.forename: Beti
authors.initials: B
authors.lastname: Thompson
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D044383:Black People; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D020380:Needs Assessment; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014861:Washington / Q000453:epidemiology