Medical Mistrust and Colorectal Cancer Screening Among African Americans

  • Leslie B. Adams
  • Jennifer Richmond
  • Giselle Corbie-Smith
  • Wizdom Powell

DOI: 10.1007/s10900-017-0339-2

Cite this article as:
Adams, L.B., Richmond, J., Corbie-Smith, G. et al. J Community Health (2017). doi:10.1007/s10900-017-0339-2


Despite well-documented benefits of colorectal cancer (CRC) screening, African Americans are less likely to be screened and have higher CRC incidence and mortality than Whites. Emerging evidence suggests medical mistrust may influence CRC screening disparities among African Americans. The goal of this systematic review was to summarize evidence investigating associations between medical mistrust and CRC screening among African Americans, and variations in these associations by gender, CRC screening type, and level of mistrust. MEDLINE, CINAHL, Web of Science, PsycINFO, Google Scholar, Cochrane Database, and EMBASE were searched for English-language articles published from January 2000 to November 2016. 27 articles were included for this review (15 quantitative, 11 qualitative and 1 mixed methods study). The majority of quantitative studies linked higher mistrust scores with lower rates of CRC screening among African Americans. Most studies examined mistrust at the physician level, but few quantitative studies analyzed mistrust at an organizational level (i.e. healthcare systems, insurance, etc.). Quantitative differences in mistrust and CRC screening by gender were mixed, but qualitative studies highlighted fear of experimentation and intrusiveness of screening methods as unique themes among African American men. Limitations include heterogeneity in mistrust and CRC measures, and possible publication bias. Future studies should address methodological challenges found in this review, such as limited use of validated and reliable mistrust measures, examination of CRC screening outcomes beyond beliefs and intent, and a more thorough analysis of gender roles in the cancer screening process.


Medical mistrust African Americans Colorectal cancer Preventive screening 

Supplementary material

10900_2017_339_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 KB)

Funding information

Funder NameGrant NumberFunding Note
National Institute of Minority Health and Health Disparities
  • L60 MD010134
Agency for Healthcare Research and Quality
  • 5T32 HS000032-28
National Cancer Institute
  • 5U54CA15673306-07
Robert Wood Johnson Foundation
  • 73921
National Institute on Drug Abuse
  • 1K01 DA032611-01A1

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Leslie B. Adams
    • 1
  • Jennifer Richmond
    • 1
  • Giselle Corbie-Smith
    • 2
    • 3
  • Wizdom Powell
    • 1
    • 2
  1. 1.Department of Health BehaviorUNC Gillings School of Global Public HealthChapel HillUSA
  2. 2.Center for Health Equity ResearchUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of Social MedicineUNC School of Medicine, University of North Carolina at Chapel HillChapel HillUSA

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