A new study has found that African-Americans and Caucasians in the southern United States have similar rates of cancer screening for cervical and breast cancer. However, rural residents and African Americans in the south are less likely to receive colorectal cancer screening than small town and suburban residents and Caucasians.

Racial and regional disparities in cancer screening rates are narrowing but persist. However, findings in a recent study published in the journal Cancer indicate that racial and regional differences were less apparent for cervical and breast cancer than for colorectal cancer in a region of the United States covering nearly contiguous counties in 11 states from Virginia to Florida to Texas that is predominantly rural, agricultural, and African-American, what the authors referred to as the southern Black Belt region.

The U.S. Department of Health and Human Services set nationwide goals for breast, cervical and colorectal cancer screening to be met by 2010 with a primary goal to eliminate health care disparities. Recent studies have shown that national screening rates for breast, cervical, and colorectal cancer are similar among African-Americans and Caucasians. However, differences in cancer rates that stem from race and socioeconomic status have been reported. This makes screening important for underserved populations who suffer more severe disease and poorer prognosis.

Coughlin et al used epidemiological data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS) to investigate the effects of race and regional residence on the rates of cancer screening in the southern U.S.

The BRFSS telephone survey collected demographic and socioeconomic information, general health status, alcohol and tobacco use and information about various health topics, including the recent and past use of mammography for breast cancer, Papanicolau (Pap) tests for cervical cancer, and fecal occult blood test (FOBT), flexible sigmoidoscopy and colonoscopy for colorectal cancer.

Data for breast cancer and cervical cancer screening rates were collected from 1998 -2000 and data for colorectal cancer screening was available from 1997 and 1999. Responders were categorized according to current screening guidelines for each cancer: 5840 women age 40 years and older for breast cancer screening; 5888 women age 18 years and older for cervical cancer screening; and 1198 men and 2165 women age 50 years and older for colorectal cancer screening.

Regional factors affected screening rates for breast and cervical cancers more than racial factors. From 1998 to 2000, 66.3% of African-American women in the Black Belt had received a mammogram within the last two years compared to 69.3% of Caucasian women in the same region.

In contrast 74.2% of African-American and 74.6% of Caucasian women in non-Black Belt southern counties and 77.7% of African-American and 75.5% of Caucasian women in the remainder of the U.S. received screening mammograms. Rates for Pap smears for cervical cancer showed no regional or racial variation.

Some of the factors associated with not using mammogram or Pap smears included older age, lower educational level, lower income, unemployment status, lack of health insurance, and failure to see a physician in the last year. Residence in a health professional shortage area and rural residence were also associated with not receiving a mammogram.

However, colorectal cancer screening rates were significantly lower for African-Americans and for southern Black Belt residents compared to the Caucasians and other parts of the U.S. In 1997 and 1999, only 29.3% of African-American women in the southern Black Belt had received a FOBT compared to 36.9% in non-Black Belt counties and 42.5% in the remainder of the U.S. Caucasian women reported significantly higher screening rates of 37.7% in the same southern Black Belt counties, 44.0% in non-Black Belt counties and 45.3% in the remainder of the US.

Similar disparate trends characterized women who were screened by flexible sigmoidoscopy or colonoscopy. Some of the factors associated with not receiving colorectal screening included lower educational level, lower income, lack of health insurance, unemployment status, having three or more persons in a household, residence in a health professional shortage area, rural residence, and failure to see a physician in the last year.

The authors conclude, "the results of the current study suggest that women in nonmetropolitan counties of the southern Black Belt region of the U.S. may be approaching" the 2010 screening goals for mammography and Pap smears set by the US Department of Health and Human Services. However, colorectal screening rates remain low, and regional and racial disparity persist in the southern U.S. when compared to the rest of the US.

The authors add, "the need remains to ensure that medically underserved persons such as those in the southern Black Belt region have access to cancer screening and that they receive educational messages, outreach, and provider recommendations concerning the importance of routine cancer screening."

SOURCE:
Cancer, November 15, 2002