Abstract B104: Disparities in colorectal cancer screening among motivated men participating in a prostate cancer risk assessment program
Authors: Hall Michael J. , Ruth Karen , Giri Veda N. 
Published: December 2010

Background: In 2010, more than 145,000 new cases of colorectal cancer (CRC) will be diagnosed. While those with localized disease have very high survival rates, those with locally advanced and metastatic disease have poorer outcomes, and many will die of CRC. Incidence and death rates from CRC remain higher for African Americans (AA) as compared to Caucasian Americans (CA). However, CRC screening rates among AA men have lagged behind those of CA men. AA men are also at increased risk for prostate cancer (PCA), and many AA men are motivated to seek PCA risk assessment and screening which is an ideal time to motivate AA men to perform CRC screening. This study was performed to assess self-reported CRC screening rates and predictors among men at high-risk for PCA (AA men and men with a family history of PCA) who are motivated to enroll in a PCA risk assessment program in order to understand CRC screening behaviors and predictors to pursue CRC screening.

Methods: The Prostate Cancer Risk Assessment Program (PRAP) at Fox Chase Cancer Center is a PCA screening, risk counseling, and research program for men at high risk for PCA. Eligibility criteria include any man between 35-69 years with (1) at least 1 first-degree relative with PCA, (2) at least 2 second-degree relatives with PCA on the same side of the family or (3) any AA man regardless of family history of PCA. CRC screening information was self-reported by participants on standard PRAP health history questionnaires. Frequency and differences in CRC screening methods (fecal occult blood testing [FOBT], colonoscopy/sigmoidoscopy) by race were assessed using chi-squared tests and predictors of CRC screening was assessed using multivariate logistic regression (SAS version 9.1).

Results: 740 PRAP participants were analyzed, of whom 62% were AA. Overall, AA men had statistically significant lower rates of any CRC screening measure compared to CA PRAP participants (46% vs 58% respectively, p=0.0015). Among PRAP participants age &gt;50 years, AA men reported significantly lower FOBT (p=0.03), colonoscopy/ sigmoidoscopy (p=0.01), and any CRC screening test (p=0.04) compared to CA men. On multivariate logistic regression analysis among 704 PRAP participants with complete socioeconomic and demographic data, race remained a significant predictor of any CRC screening test after adjusting for age (p=0.007), but was not significant after adjusting for marital status, education, and income. For colonoscopy/sigmoidoscopy, race remained a significant predictor after adjusting for age (p=0.0013), education (p=0.0085), and marital status (p=0.0013) and was borderline significant after adjusting for income (p=0.051).

Conclusion: Even among motivated AA men participating in a PCA screening program, screening for CRC remains suboptimal. These results highlight an opportunity to intervene for AA men seeking PCA screening to discuss and pursue CRC screening to lower mortality from CRC.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B104.