Despite Disparities for Black Men with Colorectal Cancer, Data on Screening Interventions Are Limited

The death of Black Panther star Chadwick Boseman late last month was a tragedy in Hollywood. In 2016 the 43-year-old actor, also known for his roles in 42, Get on Up, and Marshall, was reportedly diagnosed with stage III colon cancer, which eventually progressed to stage IV and resulted in his tragic, untimely passing. Boseman’s death also shed light on a troubling disparity: among all racial groups, black men have the poorest survival rates for colorectal cancer (CRC). It is known that, across cancer types, increased screening may be an effective intervention.

A recent systematic review and meta-analysis published in PLOS ONE investigating the literature on increasing CRC screening among black men and came up somewhat empty: there are not enough available data to help increase CRC screening in black men.

“Understanding and implementing evidence-based interventions that increase screening uptake among African-American men is a challenge. Intervention studies have reported mixed results about determining the most efficacious methods of increasing CRC screening uptake overall, and few studies of this nature specific to African-American men have been conducted. Furthermore, many of these trials are of low quality,” the study authors explained.

They queried Medline, CINAHL, Embase, and Cochrane CENTRAL for U.S.-based interventions published after 1998 through January 2020 that included black men and specifically analyzed CRC screening uptake.

A total of 41 studies made up the final analysis; two specifically focused on black men. The top three interventions reported in the data were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Specific study data were lacking in most of the randomized, controlled trials, including “details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment.”

The meta-analysis included 17 studies. The most effective intervention to increase CRC screening was stool-based kits (odds ratio [OR]=9.60; 95% confidence interval [CI], 2.98 to 31.82; P=0.0002), followed by patient navigation (OR=2.84; 95% CI, 1.23 to 6.49; P=0.01).

Lead study author Charles R. Rogers, PhD, MPH, MS, MCHES, said that future studies on CRC screening need to focus specifically on recruiting black men in order to minimize the disparity. Dr. Rogers and colleagues also noted in their study that community-based interventions should be implemented. In their conclusion they wrote, “To achieve the National Colorectal Cancer Roundtable’s challenge to attain screening rates of 80% or higher in every community, further study is warranted that considers employing evidence-based, cost-effective, and culture-specific techniques targeting CRC screening completion among African-American men outside of traditional clinic settings.”

Dr. Rogers reiterated in a press release, “It’s key to meet people where they live, work, play, and worship.”