Cancer screening is important for health promotion and a key element in reducing the disparities in cancer morbidity and mortality. African Americans lag behind other race/ethnic groups for colonoscopy, mammography, and Pap test utilization.9–12
The results of the current study revealed that approximately 60% of the BWHS participants aged 50 and older had undergone colorectal cancer screening during an 8-year period. The high colorectal screening rates observed in the BWHS may be due to the relatively high rates of health insurance coverage as well as to high socioeconomic status of the study population.
Shapiro et al13
analyzed data from the Behavioral Risk Factor Surveillance Survey and found that the reported uses of colorectal cancer screening tests increased with each decade of age from 50 to 80 years and with increasing educational level and income. Similar findings were observed in the current study with respect to education. The colonoscopy rates were 55.9% and 64.5% for educational level less than or equal to 12 years and greater than or equal to 16 years, respectively.
Mammography utilization was the strongest predictor of colonoscopy utilization in the BWHS participants, which is consistent with the literature.7–9
With increased education and awareness regarding screening and early detection, concurrent promotion of multiple cancer screenings (ie, mammography and colonoscopy) may be a good approach to increasing colonoscopy utilization among women. Having health insurance was the next strongest predictor of colonoscopy use, underscoring the need for full coverage of this screening procedure. As might be expected, indicators of health consciousness (more physical activity, nonsmoking) were also associated with colonoscopy use. We are unable to explain the regional differences in colonoscopy use observed in our study.
A strength of the present study is that the data on risk factors were collected prospectively relative to the reporting of colonoscopy use. The sample size was large, and the women were from all areas of the country. In addition, associations were examined within levels of education, which has not been done previously. A limitation is that reports of colonoscopy use were not validated. Misclassification, if random, would have weakened associations.
The participants in the BWHS were recruited largely from subscribers to a general readership magazine targeted to African American women. Although the study participants were from all regions of the United States, the BWHS was a convenience sample. The study under-represented women who had less than a high school education. However, the associations with colonoscopy use were present within strata of education and region, suggesting that the findings are applicable to African American women aged 50 and older.
The lower colonoscopy screening rates in African Americans, compared to whites, nationally undoubtedly contribute to the disparities observed in colorectal cancer incidence and mortality. The present data imply that continued efforts are needed to give access to colonoscopy screening and educate adults on the benefits of tests available for colorectal cancer screening. Among the most educated women, only 64% had had a colonoscopy in the past 8 years. These efforts may help reduce the disparities associated with the colon cancer burden among African American women.