An examination of early colorectal cancer screening guidelines for African Americans: Hints from the HINTS data

Background: Despite the overall gains in reducing colorectal cancer (CRC) deaths due to the increase in screening, minority racial/ethnic groups who have disparately higher rates of death compared to Whites, also have disproportionately lower screening rates. Patient-provider communication about screening has a strong influence on the uptake of screening. In much the same way that gradual impact was made after the 1996 implementation of guidelines recommending screening starting at age 50 for those at average risk, it may be expected that the American College of Gastroenterology (ACG) guidelines suggesting screening start at 45 for Blacks combined with a recent trend toward increasing incidence of cancer in persons below the age of 50 might influence practitioners to offer screening with greater frequency to those younger minority groups. Methods: This study examines HINTS Cycle 4 data to examine the nationally representative rates at which providers offer patients the option to be screened for CRC, with emphasis on Blacks ages 45-49. We looked for a trend in these rates over time, compared the pooled proportion estimates across racial/ethnic groups aged 45-49, and compared the proportion of Black individuals in this age group to those between ages 50 and 75 who had been told they could choose to have a CRC screening. Results: Approximately 27.14% of Black individuals aged 45-49 had been offered the option of CRC screening by a healthcare provider compared to 32.57% of White individuals of the same age group and 43.53% of Black individuals age 50-75. Discussion: There is not yet any evidence of an increase in adherence to the ACG guidelines for the Black population aged 45-49 and there remains a significant racial disparity in discussion of the CRC screening option. Earlier information regarding the option to be screened may have the potential to reduce disparities CRC screening and mortality, as well as potentially halt a disturbing trend toward early cancers