title: Perceived medical discrimination and cancer screening behaviors of racial and ethnic minority adults.
abstract: BACKGROUND
  Discrimination has been shown as a major causal factor in health disparities, yet little is known about the relationship between perceived medical discrimination (versus general discrimination outside of medical settings) and cancer screening behaviors. We examined whether perceived medical discrimination is associated with lower screening rates for colorectal and breast cancers among racial and ethnic minority adult Californians.
  
  
  METHODS
  Pooled cross-sectional data from 2003 and 2005 California Health Interview Survey were examined for cancer screening trends among African American, American Indian/Alaskan Native, Asian, and Latino adult respondents reporting perceived medical discrimination compared with those not reporting discrimination (n = 11,245). Outcome measures were dichotomous screening variables for colorectal cancer among respondents ages 50 to 75 years and breast cancer among women ages 40 to 75 years.
  
  
  RESULTS
  Women perceiving medical discrimination were less likely to be screened for colorectal [odds ratio (OR), 0.66; 95% confidence interval (95% CI), 0.64-0.69] or breast cancer (OR, 0.52; 95% CI, 0.51-0.54) compared with women not perceiving discrimination. Although men who perceived medical discrimination were no less likely to be screened for colorectal cancer than those who did not (OR, 1.02; 95% CI, 0.97-1.07), significantly lower screening rates were found among men who perceived discrimination and reported having a usual source of health care (OR, 0.30; 95% CI, 0.28-0.32).
  
  
  CONCLUSIONS
  These findings of a significant association between perceived racial or ethnic-based medical discrimination and cancer screening behaviors have serious implications for cancer health disparities. Gender differences in patterns for screening and perceived medical discrimination warrant further investigation.
authors.affiliation: Stanford University Center for Biomedical Ethics, Palo Alto, California, USA. lcrawley@stanford.edu
authors.forename: LaVera M
authors.initials: LM
authors.lastname: Crawley
authors.forename: David K
authors.initials: DK
authors.lastname: Ahn
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Winkleby
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000208:ethnology*; D002140:California / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups; D011287:Prejudice; D044469:Racial Groups; D012307:Risk Factors; D011795:Surveys and Questionnaires