Barriers to colorectal cancer screening among ethnically diverse high- and average-risk individuals

Telephone interviews with 67 ethnically diverse first-degree relatives of colorectal cancer cases indicated that only 19% believed they were at elevated risk. Nonwhites were much more likely to underestimate their risk compared with whites. The most common barrier to screening was fear of finding cancer. Pain associated with sigmoidoscopy was cited much more often by nonwhites (82%) compared with whites (45%), as were feeling "violated," not knowing where to obtain screening, and difficulties in obtaining an appointment for screening. Focus group data on 56 mixed-risk participants revealed that among Hispanic men, the shame of being seen as sick or weak was a major disincentive to be screened. African American men cited a general mistrust of physicians and a lack of physicians' sensitivity as barriers. Chinese participants expressed a preference for exhausting all Eastern forms of treatment before seeking care from Western physicians. These findings can help to guide development of interventions to increase participation in routine screening.