title: Increasing colorectal cancer screening among African Americans, linking risk perception to interventions targeting patients, communities and clinicians.
abstract: Colorectal cancer (CRC) screening remains significantly underutilized by African Americans despite their increased risk compared to whites. The purpose of this article is to review recent research on patterns of screening, perceptions of CRC screening methods and outcomes of seven intervention trials specifically designed to increase screening among African Americans in light of the recommendation of the American College of Gastroenterologists to make colonoscopy the screening method of choice for this population. This review shows that progress has been made in understanding the complexity of perceived barriers to CRC screening among African Americans. Interventions that used community-based education targeting individuals and clinically based education targeting clinicians showed modest increases in screening rates. Targeting entire communities did not show significant results. However, because intervention studies use not only different types of interventions but different screening outcome measures, results are not easily comparable. While there is growing evidence that interventions can increase the use of fecal occult blood test (FOBT), it is not yet known if similar interventions can increase rates of screening colonoscopy. Clinicians, patients and policymakers also need to consider the array of social, cultural and financial issues associated with CRC screening in African-American communities.
authors.affiliation: Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA. stephanie.ward@tuhs.temple.edu
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Ward
authors.forename: Karen
authors.initials: K
authors.lastname: Lin
authors.forename: Brian
authors.initials: B
authors.lastname: Meyer
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Bass
authors.forename: Lalitha
authors.initials: L
authors.lastname: Parameswaran
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Gordon
authors.forename: Sheryl Burt
authors.initials: SB
authors.lastname: Ruzek
mesh_terms: D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D004502:Education, Medical, Continuing; D005762:Gastroenterology / Q000193:education; D006266:Health Education; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D009780:Occult Blood; D010342:Patient Acceptance of Health Care; D010465:Perception; D012306:Risk