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Article Excerpt
Abstract: African American women are more likely to die of colorectal cancer than are women of any other racial or ethic group. Early diagnosis depends on routine examination and screening. However, studies have shown that African American women are not utilizing available screening tools. African American women age fifty or older were questioned about their risk factors and frequency of CRC screening. The conceptual framework used was the Health Belief Model. Women who perceived fewer barriers, more benefits, higher perceived susceptibility, and increased confidence in the accuracy of screening, were likely to undergo screening. Implications for nursing practice are discussed especially focused on the role of advanced practice nurses as primary care providers. Utilization of a faith-based approach to reaching this population was also suggested.
Key Words: Colon Cancer Screening: Black Females
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Colorectal carcinoma (CRC) is the second most common cause of cancer mortality in the United States. Despite the fact that it is highly preventable, approximately 147,500 new cases of CRC were predicted to be diagnosed in 2003 with 57,100 people dying from the disease (Cancer Research and Prevention Foundation, 2004). Although this cancer can be cured if detected early, over half of all cases are diagnosed with distal disease, decreasing the 5-year survival. African Americans had higher incidence and mortality rates from 1998 through 2000, while these rates decreased for Caucasians (American Cancer Society [ACS], 2003). American women are more likely to die of colon cancer than are women of any other racial or ethic group (ACS, 2003). These women often tall in the high risk category because of multiple risk factors including obesity, low fiber, high protein diets and low physical activity levels (Cancer Prevention and Research Foundation, 2004).
Colorectal cancer screening (CRC) offers potential for both primary and secondary prevention. A combination of three screening methods is used to accomplish early detection of colorectal cancer. These include rectal examination, fecal occult blood testing (FOBT) and a test used to evaluate the colon and rectum, the flexible sigmoidoscopy, colonoscopy, or barium enema. Scientific evidence supports the effectiveness of CRC in reducing mortality (Helm, Russo, Biddle, Simpsin, Ranoboff, & Sandler, 2000).
The ACS offers three options for regular colorectal surveillance screening beginning at age 50:
1. Baseline FOBT and flexible sigmoidoscopy initially, then FOBT repeated annually and sigmoidoscopy repeated every five years after initial screening.
2. Baseline total colon exam (TCE) with Distal Colon Barium Enema (DCBE) every five years.
3. Baseline TCE with colorectal every ten years.
These guidelines are based on a normal first exam. A strong personal and/or family history of colorectal cancer or polyps should prompt colorectal screening earlier.
Unfortunately, while African American women are at high risk, they are less likely than Caucasian women to receive this screening (ACS, 2003).
Several studies have addressed the health of minorities and women, regarding knowledge and participation in primary prevention activities such as cancer screening. (cf: Mann, Sherman, Clayton et al., 2002; Felton, 2000; Shanker, 1995). Specifically related to CRC, Lipkus (1996) found that over half of a sample of 1,318 African American, the age of 50 plus, placed themselves at average or low risk for CRC and over a third did not know their...
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