Original ArticleBarriers to colorectal cancer screening in Hispanics in the United States: An integrative review
Introduction
According to the CDC, of cancers affecting both men and women, colorectal cancer (CRC) is the second leading cancer killer in the United States. In the United States in 2007, 142,672 people were diagnosed with colorectal cancer, and 53,219 people died from it. Colorectal cancer affects men and women of all racial and ethnic groups, and is most often found in people aged 50 years or older. If everybody aged 50 or older had regular screening tests, as many as 60% of deaths from colorectal cancer could be prevented (CDC, 2010). CRC screening tests include those that are ordered for patients that are asymptomatic and designed to detect disease at an early stage, as opposed to diagnostic tests, which are ordered for patients presenting with signs or symptoms of disease (Getrich et al., 2012). Recommended screening tests for CRC include fecal occult blood test (FOBT), fecal immunochemical test (FIT), double-contrast barium enema, flexible sigmoidoscopy, and the gold-standard, colonoscopy (Rex et al., 2009). As one of the most preventable cancers, detection and removal of adenomatous polyps have been shown through randomized trials to reduce CRC incidence and mortality (Getrich et al., 2012).
Even though CRC screening is consistently recommended by clinical practice guidelines and has demonstrated decreased CRC incidence, adherence to these recommendations in Hispanics is lower than that of other races, and the majority of Hispanics do not get screened for CRC (American Cancer Society, 2011, American Cancer Society, 2012). A low 31.9% of Hispanics of eligible age report having had a CRC screening test, which may contribute to a later stage of disease at presentation and poorer prognosis than non-Hispanic Whites. Interestingly, the rates of CRC screening among Hispanics are low in contrast to their rates of screening for other cancers, such as breast and cervical (Natale-Pereira, Marks, Vega, & Mouzon, 2008). Data suggest that the low rates of CRC screening for Hispanics may not stem from a lack of access to care or from a general tendency to forgo cancer screening, but that there seems to be specific barriers related to CRC screening among this specific population. Some of these include: low health literacy, influence of their social groups, including family and friends, decreased confidence in healthcare providers, fatalism, and acculturation in immigrants of Hispanic origin and others (Shelton, Jandorf, Ellison, Villagra, & DuHamel, 2011). It is very important to understand these culture-specific barriers, and then develop targeted interventions to increase CRC screening among this population. The purpose of this paper is to synthesize the published research on barriers to colorectal cancer screening practices in the Hispanic population in the United States.
Section snippets
Background
About nine out of every 10 people whose colorectal cancer is found early and treated are still alive 5 years later (American Cancer Society, 2008). While screening rates have definitely increased in the U.S. over the past several years, not enough people are getting screened for colorectal cancer; as of 2008, 62.9% of adults aged 50–75 years were screened as recommended. In 2002, only 51.9% of Americans were screened as recommended. And while screening rates continue to rise in the U.S., 22
Research methods
The plan for searching the literature included a comprehensive examination of articles pertaining to the barriers of colorectal screening among the Hispanic population. The databases that were searched included CINAHL and PubMed. The Cochrane library was initially examined to verify that there were no other synthesis studies available on this specific topic.
Specific search words that were utilized in CINAHL were: colorectal neoplasms, cancer screening, and Hispanics. Health beliefs was
Results
As can be seen in Table 1, eight studies were included in this synthesis (Diaz et al., 2008, Garcia-Dominic et al., 2012, Getrich et al., 2012, Goldman et al., 2009, Fernandez et al., 2008, Natale-Pereira et al., 2008, Jandorf et al., 2010, Varela et al., 2010). The purpose of these articles was to identify the barriers to colorectal cancer screening among the Hispanic population. Four articles explored general barriers in the Hispanic population (Fernandez et al., 2008, Goldman et al., 2009,
Conclusions
The results of this research synthesis demonstrate that there are indeed many commonly perceived culture-specific barriers to CRC screening specific to and among the Hispanic population and also supports the notion of limited English proficiency as possibly the largest marker for decreased access to healthcare, lower health literacy, and lower acculturation. Fear is another frequently discussed theme among these studies. Results are consistent with past research that identifies fear, cost, and
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