Differing fears: Age and gender variations in colorectal cancer perceptions among African Americans

Colorectal cancer (CRC) is the second leading cause of cancer-related death in the U.S., with ∼153,000 new cases and over 52,000 deaths annually. Despite advances in screening and early detection, disparities in incidence and outcomes persist. African Americans have higher CRC incidence and mortality and lower screening rates compared to Whites. This disparity may be shaped by emotional, sociocultural, and structural factors.

We conducted a cross-sectional survey at a health fair in Washington, DC, among predominantly African American attendees. An open-ended prompt asked: "In 10 words or less, please share your perception about colorectal cancer." Responses were coded into themes (fear [with subcategories], prevention/screening, hope/self-improvement, awareness, other). Stratification was by age (<50 vs ≥50), sex, prior colonoscopy history, personal CRC history, and whether the respondent knew someone with CRC. Statistical tests included t-tests, Fisher exact, and ANOVA; significance at p < 0.05.

Of 56 respondents (94.9 % of booth visitors), 96.4 % identified as Black/African American; 73 % were female, 27 % male; ages ranged 19-85 (79 % ≥50). Fear dominated responses (51.7 %), especially fear of death (26.8 %). Prevention/screening references accounted for 19.6 %. Among <50 participants, fear of screening was most common; among ≥50 participants and men, fear of death predominated (p = 0.00001, p = 0.0205, respectively).

Emotional perceptions of CRC among African Americans vary by age and gender: younger adults tend to fear the screening process itself, whereas older adults and men more often express fatalistic fears. Tailored, culturally sensitive interventions addressing both procedural anxiety and fatalism may enhance CRC screening uptake in this population.