Predictors of Endoscopy in Minority Women

Posted by James

INTRODUCTION

Colorectal cancer (CRC) is the second leading cause of cancer related deaths in the United States. Race and ethnicity are significant determinants of cancer incidence, mortality and survival, with minorities disproportionately experiencing an increased burden of disease as compared with whites. African Americans have a 28% increased mortality rate for colon cancer (Generic Casodex treating prostate cancer) and 44% increased mortality rate for rectal cancer compared with whites. When CRC is detected and treated at an early localized stage, the five-year survival is 90%. The survival rate drops substantially to 65% and 9% when the cancer (Nolvadex tablet is an anti-estrogen used to treat or prevent breast cancer) spreads to regional and distant metastatic sites, respectively. While Hispanics experience lower incidence and mortality rates than whites, they are still more likely to present with advanced stage CRC at diagnosis. Data provided by the National Cancer Data Base (NCDB) from 1995 demonstrated that nearly 60% of whites presented with early stage rectal adenocarcinoma versus 54% for Hispanics and 51% for African Americans. Disappointingly, of the 147,000 new cases of CRC diagnosed in 2004, only 37% have been detected in the early stages.

One reason for the disparities in CRC incidence and mortality is that rates for CRC screening among African Americans and Hispanics are significantly lower than the national norms identified by the Centers for Disease Control and Prevention (CDC). As of 2000, the fecal occult blood testing (FOBT) and lower endoscopy rates in African Americans were 21.6% and 35%, respectively. The screening rates for Hispanics are the lowest of all ethnic groups, with 31.2% having ever received an endoscopy. African Americans and Hispanics lag behind whites, who report a 39.2% use of endoscopy.

There are several hypotheses, such as differences in socioeconomic and insurance status, to explain the disparities in CRC screening rates. However, a recent study of Medicare beneficiaries showed that African Americans were significantly less likely to utilize CRC procedures for screening purposes. Moreover, even when controlled for age, gender, income and access to care, African Americans have been shown to be less likely to have had colonoscopy or sigmoidoscopy compared with whites. Therefore, socioeconomic status alone does not explain all of the disparities in CRC screening use, particularly by endoscopic methods.

It is crucial, therefore, that we analyze how other factors may contribute to the disparities in CRC screening in order to devise strategies to eliminate the disparities. In the past, three major categories of factors have been associated with cancer (Casodex canadian is an oral non-steroidal anti-androgen for prostate cancer) screening in the community. These include socioeconomic, medical and psychosocial factors. Socioeconomic factors, such as age, race, income, education, insurance coverage, language and marital status, are by far the most widely investigated. Previous studies have associated age <65, low income and education, being uninsured, single and a monolingual Spanish speaker with a low use of CRC screening tests. However, the association of these factors with endoscopic screening has not been evaluated. We evaluate these socioeconomic factors in this study.

Medical characteristics that have been evaluated as predictors for CRC screening use include patient, provider and organizational factors. For the patient, exposure to cancer through either personal diagnosis, familial diagnosis, or care of a spouse or family member with cancer (Generic Nolvadex treating breast cancer that has spread to other sites in the body) has been found to positively influence screening behavior. Additionally, participation in other cancer screening activities, such as mammography, has been associated with higher rates of CRC screening adherence. Receiving a physician recommendation has been identified by numerous studies as one of the most important factors associated with screening among minority women. The association of the factors described above with adherence to endoscopy in minority women will be assessed in this study.

Additionally, there are psychosocial factors that have been found to impact CRC screening behavior. Peterson refers to psychological factors as those that include anxiety and the ability to deal with information about oneself. Previously, systematic models, such as the transtheoretical model (TTM), have been used to examine psychosocial factors and their effect on health screening behaviors. Such measures as: 1) pros and cons, which are beliefs about the advantages and disadvantages of screening and are constructs from the TTM; 2) cancer worry; 3) acculturation barriers; 4) medical mistrust; 5) fatalism; 6) and temporal orientation have previously been found to be associated with an individual’s decision regarding cancer screening. In this paper, we will examine the impact the factors described above have on whether minority women in East Harlem undergo endoscopy.

Sigmoidoscopy decreases mortality from CRC within the area reached by the sigmoidoscopy by 60%. Moreover, colonoscopy with polypectomy decreases mortality from CRC by 90%. All three methods are accepted procedures for CRC screening by the ACS. However, colonoscopy is increasingly becoming the “standard of care” for CRC screening. Most importantly, African Americans have been shown to have a greater preponderance of right-sided lesions, which may only be detected by colonoscopy. In the present study, we focus on the endoscopic methods of screening defined as either sigmoidoscopy or colonoscopy; however, sigmoidoscopy is inadequate for detecting right colon lesions, which are more common in African Americans compared to whites.