Colorectal cancer screening among Mexican Americans at a community clinic

Background: Mexican Americans tend to under-utilize colorectal cancer (CRC) prevention. Yet little is known about sociocultural factors associated with CRC screening. This study assessed predictors of three primary CRC tests among low-income Mexican Americans. Methods: From May to December 2003, an availability sample of 287 patients, aged 50 to 89 years, who presented for routine care at a community health center near the U.S.-Mexico border completed surveys on CRC knowledge, awareness, attitudes toward screening, logistic barriers, perceptions of health, locus of control, acculturation, whether their doctor discussed CRC screening, and sociodemographics. Participants also reported whether they had ever had a fecal occult blood test, flexible sigmoidoscopy, or colonoscopy. Logistic regression identified predictors of having had these tests. Results: Overall, 41% reported having ever had any of the three tests; 34.1% had a fecal occult blood test; 6.6%, flexible sigmoidoscopy; and 11.8%, colonoscopy. Few respondents reported any clear knowledge about CRC, and only 41% said their doctor had ever discussed screening with them. Yet "doctor discussed screening" was the only consistent screening predictor across tests. CRC knowledge (p =0.006) and insurance coverage (p =0.009) predicted having had a flexible sigmoidoscopy. Perceptions of general poor health also predicted having had a flexible sigmoidoscopy or a colonoscopy (p =0.04). Being employed marginally predicted whether patient had ever had any of the three tests (P =0.05). Conclusions: Results show that even those in contact with community medical services exhibit low CRC screening rates. They further suggest that interventions focused on clinical settings are an important first step toward CRC prevention in this community.