Abstract B104: Medical mistrust and cancer screening in an underserved population
Authors: Arnold Lauren D. , Cooper J. Kyle , Wang Jean S. , James Aimee S. 
Published: June 2012

Racial/ethnic minorities and those of lower socioeconomic status suffer disproportionate rates of cancer incidence and mortality. They are also less likely to engage in preventive screening practices. The potential impact for improved screening rates is great. Screening for breast and colon cancer, two of the top five cancer sites, has been shown to reduce mortality. Results are more controversial for the effect on prostate cancer mortality, another of the top five cancer sites in men. Among reported reasons for lower screening practices are mistrust of the healthcare system, fear of the procedures or results, lack of or inadequate insurance coverage, and fatalistic beliefs. Racial/ethnic minorities are typically thought to exhibit higher levels of medical mistrust than their Caucasian counterparts.

The purpose of this analysis was to examine associations between medical mistrust and specific cancer screening behaviors – breast, colon, and prostate cancer screening – in a low-income urban and predominately racial minority adult population. As part of a longitudinal survey study to assess colon cancer screening practices, participants were recruited from federally qualified health centers in an urban Midwest city. Eligibility included age ≥40 and being a patient at a federally qualified health center. Interviewer-administered surveys were used to collect baseline data on self-reported cancer screening practices, health history, insurance status, and demographics. Medical mistrust was assessed using the Group Based Medical Mistrust Scale.

The study population included 144 individuals and was 61% male, with an average age of 51 years (±6.73 SD). Participants were predominately African American (87.5%), uninsured (52%), and low income, with 42.4% earning a monthly income &lt; $400. Only 15% were married or in a marriage-like relationship, and just under half reported good/excellent overall health.

Preliminary results indicate that there were no significant differences in medical mistrust by gender, having a healthcare home (defined as one particular doctor's office individuals visit when sick), or by ever having been screened for colon, breast, or prostate cancer. Bivariate analysis found that having a healthcare home was significantly associated with having had a mammography (p=0.02), CRC screening (p=0.012), and prostate cancer screening (p &lt; 0.001). Mistrust levels did not vary by healthcare home status.

Medical mistrust may be a less important determinant in nonadherence of low-income, racial/ethnic minority adults to screening guidelines than previously thought. As medical mistrust levels did not differ by gender or healthcare home status, it may be that focusing efforts on connecting low-income individuals with regular sources of care in which they will experience a greater continuity in care has the potential to increase cancer screening and preventive behaviors. This may provide avenues for interventions focused on eliminating disparities in cancer screening rates among minorities and those of lower socioeconomic status.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B104.