Racial and ethnic minorities

  Population considerations:

  • Earlier and more severe diagnoses. On average, racial and ethnic minorities, particularly African Americans, are diagnosed with colorectal cancer at younger ages compared to whites. Furthermore, a higher proportion of African Americans are diagnosed before the age of 50 compared to any other racial, and ethnic minority group (Ward, 2008). Racial and ethnic minorities often have later stages of cancer at the time it is diagnosed (Natale-Pereira, 2008; Ward, 2008).
  • Lack of provider recommendations. African Americans often rely heavily on health care provider recommendations for making medical decisions (Ward, 2008). However, health care providers have been less likely to recommend screening to minority patients (Shokar, 2008). Likewise, racial and ethnic minorities are significantly less likely to report receiving a doctor’s recommendation for colorectal cancer screening (Shokar, 2008).
  • Distrust of the medical system. Some racial and ethnic minorities perceive health care providers’ failure to offer colorectal cancer screening or recommendations for less effective screening methods as subtle forms of racial discrimination. (Ward, 2008).
  • Attitudes toward screening. Some racial and ethnic minority populations may not believe in the need for colorectal cancer screening. African Americans who have not been screened report that they would get screened only if symptoms such as blood in the stool were present (Ward, 2008). Similarly, Latinos tend to use home remedies to treat illness rather than practice preventive health care, such as screenings. They are likely to only seek medical attention when they feel sick (Natale-Pereira, 2008).
  • Lack of awareness. Many African Americans do not believe they are at higher risk for colorectal cancer than whites (Natale-Pereira, 2008; Ward, 2008). In fact, they often believe they are at low risk of developing cancer (Ward, 2008). On the other hand, many racial and ethnic minorities who perceive themselves to be at risk are not aware that they can do anything about it (Ward, 2008). In the Latino community, colorectal cancer is not discussed because it is thought to be private since it affects a private part of the body (Natale-Pereira, 2008).
  • Misconceptions. Racial and ethnic minorities often have misconceptions about colorectal cancer. Particularly in African American communities, few believe that colorectal cancer can be prevented (Ward, 2008). Many also believe that there are no options for treatment, that surgery can spread the cancer and that people cannot detect cancer early enough to make a difference (Hamlyn 2007). 
  • Lack of access to healthcare. Racial and ethnic minorities often express difficulties with accessing screening services as a barrier to getting screened. They also express issues with provider referrals and transportation (Natale-Pereira, 2008; Ward, 2008). Sometimes people without personal vehicles have to take two or three buses at one time to access health care services (Natale-Periera, 2008).
  • Lack of time. Racial and ethnic minorities have expressed a lack of time for screening. Many racial and ethnic minorities have to work hourly jobs, and taking time off from work to get screened is difficult. They worry about the pay that they will not receive during that time, or worse, the possibility of losing their jobs (Natale-Pereira, 2008).
  • Inadequate or no health insurance.  Lack of health insurance is a major reason why racial and ethnic minorities do not seek screening for colorectal cancer. They are afraid of how much treatment will cost if they get sick. Without health insurance, the cost of screening becomes an issue as well (Ward, 2008). Racial and ethic minorities often choose not to be screened since the cost of the test and treatment is beyond their means (Natale-Periera, 2008).
  • Language barriers. Particularly in Latino communities, health care providers usually do not speak their language and interpreters and translators are not always available when needed. Screening instructions and messages about colorectal cancer and other diseases that is provided to the public through mass media campaigns are usually in English, so it is difficult for non-English speakers to understand the messages (Natale-Pereira, 2008).
  • Fear. Some racial and ethnic minorities, particularly African Americans, are very passive when dealing with medical issues and often avoid getting care because of fear that something might be wrong such as an abnormality. Some fear that screening procedures are embarrassing or painful (Natale-Pereira, 2008; Ward, 2008).
  • Unhealthy diet. The diets of African Americans are frequently high in fat, cholesterol and sodium. African Americans tend to eat more animal fat and less fiber in the form of fruits and vegetables than do other Americans (Hamlyn, 2007). Evidence suggests that diets high in fat and alcohol and low in calcium and folate are linked to higher rates of colorectal cancer (Hamlyn, 2007).
  • Alcohol and tobacco use. According to the Centers for Disease Control and Prevention, the use of tobacco and alcohol products is slightly higher in African Americans compared to the white population (Hamlyn, 2007). Using alcohol and tobacco increases one’s risk for colorectal cancers (Hamlyn, 2007).
  • Other priorities. Colorectal cancer screening is a low priority for Latinos compared to other health concerns they face. For example, heart disease, diabetes and asthma are often viewed as higher priorities. These conditions are more visible in the community and are most likely to receive attention from community members (Natale-Pereira, 2008).

  Strategies to address these considerations:

  • Improve provider communication. Since African Americans often rely heavily on provider recommendations for making medical decisions, it is important to increase physician communication about colorectal cancer screening and prevention (Ward, 2008). Provider training could help improve communication with racial and ethnic minorities. Providers should learn to speak openly with patients to identify their fears and concerns. They should also tailor messages to patient’s specific fears and concerns, address myths and misconceptions about colonoscopy and provide general education about colon cancer and treatment options (Green, 2008). In addition, providers should learn how to explain testing procedures clearly (Natale-Pereira, 2008).
  • Increase cultural awareness. To develop a trusting and therapeutic relationship with their patients, health care providers need to have an awareness of cultural differences and cultural sensitivity in racial and ethnic minority groups. Performing cultural assessments and becoming partners with the community will help health care providers develop trust and successfully provide services (Hamlyn, 2007).
  • Increase knowledge and awareness. Interventions should strive to increase knowledge and awareness of the risks of colorectal cancer and the importance and benefits of screening among racial and ethnic minorities. They should also strive to address any misconceptions in order to reduce barriers to screening. One way to do this is by providing information about screening recommendations, epidemiology, causes, risk factors and symptoms, which can increase screening (Natale-Pereira, 2008).
  • Modify diet. Interventions that promote healthy eating behaviors, such as eating low-fat proteins, fruits, vegetables and fiber, may be useful to improve the healthy eating behaviors of racial and ethnic minorities (Hamlyn, 2007).
  • Increase access.  In primary care settings, healthcare providers can use the Fecal Occult Blood Test (FOBT) as a simple and inexpensive way of screening people for colorectal cancer (Hamlyn, 2007). By using this inexpensive and easy test, access to screening can be increased because it is less costly to screen larger numbers of people.
  • Provide affordable tests. People will not undergo screening if they cannot afford the screening test. When possible, interventions should include tests that are low-cost or free-of-charge and easily accessible.
  • Tailor educational materials. Educational interventions should include materials and methods that take into account language, educational level, socio-economic level and level of interest of racial and ethnic minorities (Natale-Pereira, 2008). When working with racial and ethnic minorities, educational materials should include information about early detection and treatment success rates to help address fears of being diagnosed with cancer (Green, 2008).
  • Arrange for transportation. Helping to arrange an escort or providing shuttle service to and from the screening site could decrease transportation barriers (Green, 2008).
  • Organize support groups.  Providing for a linkage to peers who have undergone colonoscopy for support could encourage racial and ethnic minorities to seek or follow through with screening (Green, 2008).

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