Abstract B81: Barriers to colorectal cancer screening in Hispanic/Latino women in Connecticut
Authors: Jones Beth A. , Quintero Juliana , Rios Maria , Doyle Margaret 
Published: October 2015

Background: Colorectal cancer is the 2nd most commonly diagnosed and the 3rd leading cause of cancer death in Hispanic/Latino (H/L) women, falling behind breast and lung cancer. Although the incidence is 16% lower in H/L women compared with non-Hispanic White women, there are geographic differences, with Hispanic rates in the US higher than those reported for Puerto Rico and Central and South America, suggesting that rates increase with increased acculturation. A factor that may contribute to worse outcomes is the relatively lower colorectal cancer screening rates reported for Hispanic/Latinos. These rates are even lower for those with low education and/or for those who lack insurance.

Purpose: Employing a mixed methods approach, the goal of this investigation is to identify barriers to colorectal cancer screening in a cohort of Hispanic/Latinas, ages 50-75, living in Connecticut. With little information on cancer screening behaviors on HLs living in the Northeast, US, this study should help inform strategies for improving colorectal cancer screening.

Methods: Qualitative: Following a structured format, we conducted 3 focus groups with urban, community-living H/Ls (21 women, ages 50 and older) recruited from a local primary care clinic. Quantitative: Building on an established cohort of 1600 community-based Hispanic/Latino women, ages 45-70 in association with the Cancer Screening in Hispanic/Latinas Living in the Northeast, US (RO1 CA134276, Beth A Jones, PI), we conducted preliminary descriptive analyses on 813 women, ages 50 and older. Information on history of colorectal cancer screening (sigmoidoscopy, colonoscopy, and fecal occult blood testing (FOBT) and extensive information on socio-demographic, medical care, psychosocial, acculturation factors, and health beliefs were collected in a one hour telephone interview (85% in Spanish language).

Results: Qualitative: 84% of focus group participants (mean age 59) were from Puerto Rico, 61% reporting household incomes of less than $10,000 and low education levels. 35% of the participants reported receipt of colonoscopy in last 10 years and 33% reported a FOBT in last 10 years. There was significant variability in the knowledge and prior experience with all colorectal cancer screening among participants. Discomfort in discussing colorectal cancer screening and embarrassment associated with undergoing colorectal cancer screening were mentioned in all focus groups. Distrust of the MDs performing the test and history of sexual abuse emerged as potential barriers for women. Logistical barriers (time needed for the prep, time away from work, transportation and escort availability) were also identified. Quantitative: 813 H/L women between the ages of 50-75 were available for this analysis; 17% were age 65 or older. Similar to qualitative findings, women were of low socioeconomic status. 340 of the 813 women (41.8%) had not received endoscopic screening in specified time period. Older women (age 65+) were slightly more likely to have received either colonoscopy or sigmoidoscopy.

Conclusions: With little published scientific literature on colorectal cancer screening in the Hispanic/Latino population in the Northeast, US, this mixed methods study has confirmed low colorectal cancer screening rates in H/L women as well as unique cultural barriers to receiving screening. Our results suggest that it will be critical to address educational and unique cultural belief and attitudinal barriers in order to improve colorectal cancer screening in this at-risk population.

Citation Format: Beth A. Jones, Juliana Quintero, Maria Rios, Margaret Doyle. Barriers to colorectal cancer screening in Hispanic/Latino women in Connecticut. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B81.