Disparities in Colorectal Cancer Screening in Latinos and Non-Hispanic Whites

Area of Science:

• Oncology
• Public Health
• Health Disparities

Background:

• Colorectal cancer (CRC) is a significant cause of cancer mortality among Latinos in the U.S.
• Previous research has not clearly established differences in CRC screening method utilization between Latinos and non-Hispanic Whites.

Purpose of the Study:

• To compare colorectal cancer screening method rates among English-preferring Latinos, Spanish-preferring Latinos, and non-Hispanic Whites.
• To identify disparities in screening modalities within a large, multi-state community health center network.

Main Methods:

• Utilized electronic health records from 686 community health centers across 21 states.
• Included 204,243 patients aged 50-75 years, categorized as English-preferring Latinos, Spanish-preferring Latinos, or non-Hispanic Whites.
• Compared five CRC screening outcomes between 2012 and 2017: any screening, stool-based screening, annual stool testing rates, any endoscopy referral, and endoscopy referral after positive stool test.

Main Results:

• Spanish-preferring Latinos showed higher odds of any CRC screening (OR=1.44) and stool-based testing (OR=1.82) compared to non-Hispanic Whites.
• Both English- and Spanish-preferring Latinos had lower odds of receiving an endoscopy referral (OR=0.23 and OR=0.55, respectively) than non-Hispanic Whites.
• This disparity in endoscopy referral persisted even after a positive stool-based screening result (English: OR=0.14; Spanish: OR=0.33).

Conclusions:

• Latino patients aged over 50 were more likely to undergo stool-based CRC screening but less likely to be referred for endoscopy than non-Hispanic Whites.
• The study highlights a critical gap in indicated endoscopy referrals for Latino patients, even with positive screening results.
• Future public health initiatives should focus on improving and encouraging appropriate lower gastrointestinal endoscopy referrals to enhance CRC outcomes for Latino populations.