Journal of Community Health

, Volume 42, Issue 5, pp 1044–1061 | Cite as

Medical Mistrust and Colorectal Cancer Screening Among African Americans

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


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 



We thank Sarah Wright, MLS for her contributions to this manuscript.


This research was partially supported by a National Service Research Award Pre-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Grant No. 5T32 HS000032-28.Wizdom Powell is supported by the National Center for Minority Health and Health Disparities (# L60 MD010134), National Institutes of Drug Abuse (#1K01 DA032611-01A1), and the National Cancer Institute (#5U54CA15673306-07). Additional support for Jennifer Richmond was provided by a grant from the Robert Wood Johnson Foundation Health Policy Research Scholars program (#73921).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary material 1 (DOCX 18 KB)


  1. 1.
    Tammana, V. S., & Laiyemo, A. O. (2014). Colorectal cancer disparities: issues, controversies and solutions. World Journal of Gastroenterology, 20(4), 869–876. doi: 10.3748/wjg.v20.i4.869.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    USPTF. Final Update Summary: Colorectal Cancer: Screening. 2015.Google Scholar
  3. 3.
    Steele, C. B., Rim, S. H., Joseph, D. A., King, J. B., & Seeff, L. C. Centers for Disease CDC, et al. (2013) Colorectal cancer incidence and screening - United States, 2008 and 2010. MMWR Supplements, 62(3), 53–60.PubMedGoogle Scholar
  4. 4.
    Dimou, A., Syrigos, K. N., & Saif, M. W. (2009). Disparities in colorectal cancer in African-Americans vs Whites: before and after diagnosis. World Journal of Gastroenterology, 15(30), 3734–3743.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention (CDC), (2013). Vital signs: Colorectal cancer screening test use–United States, 2012. MMWR Morbidity and Mortality Weekly Report, 62(44), 881–888.Google Scholar
  6. 6.
    Agrawal, J., & Syngal, S. (2005). Colon cancer screening strategies. Current Opinion in Gastroenterology, 21(1), 59–63.PubMedGoogle Scholar
  7. 7.
    Agrawal, S., Bhupinderjit, A., Bhutani, M. S., Boardman, L., Nguyen, C., Romero, Y., et al. (2005). Colorectal cancer in African Americans. The American Journal of Gastroenterology, 100(3), 515–523. doi: 10.1111/j.1572-0241.2005.41829.x.CrossRefPubMedGoogle Scholar
  8. 8.
    Gwede, C. K., Ward, B. G., Luque, J. S., Vadaparampil, S. T., Rivers, D., Martinez-Tyson, D., et al. (2010). Application of geographic information systems and asset mapping to facilitate identification of colorectal cancer screening resources. Online Journal of Public Health Informatics, 2(1), 2893.CrossRefPubMedGoogle Scholar
  9. 9.
    Wallace, P. M., & Suzuki, R. (2012). Regional, racial, and gender differences in colorectal cancer screening in middle-aged African-Americans and Whites. Journal of Cancer Education : The Official Journal of the American Association for Cancer Education, 27(4), 703–708. doi: 10.1007/s13187-012-0396-2.CrossRefGoogle Scholar
  10. 10.
    Martinez,K. A, Pollack C. E., Phelan D. F, Markakis D., Bone L., Shapiro G., et al. (2013). Gender differences in correlates of colorectal cancer screening among black medicare beneficiaries in Baltimore. Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 22(6), 1037–1042. doi: 10.1158/1055-9965.epi-12-1215.CrossRefGoogle Scholar
  11. 11.
    Bromley, E. G., May, F. P., Federer, L., Spiegel, B. M., & van Oijen, M. G. (2015). Explaining persistent under-use of colonoscopic cancer screening in African Americans: A systematic review. Preventive Medicine, 71, 40–48. doi: 10.1016/j.ypmed.2014.11.022.CrossRefPubMedGoogle Scholar
  12. 12.
    Katz, M. L., James, A. S., Pignone, M. P., Hudson, M. A., Jackson, E., Oates, V., et al. (2004). Colorectal cancer screening among African American church members: A qualitative and quantitative study of patient-provider communication. BMC Public Health, 4(1), 1.CrossRefGoogle Scholar
  13. 13.
    Sarfaty, M., & Feng, S. (2006). Choice of screening modality in a colorectal cancer education and screening program for the uninsured. Journal of Cancer Education : The Official Journal of the American Association for Cancer Education, 21(1), 43–49. doi: 10.1207/s15430154jce2101_14.CrossRefGoogle Scholar
  14. 14.
    Ozawa, S., & Sripad, P. (2013). How do you measure trust in the health system? A systematic review of the literature. Social Science & Medicine, 91, 10–14. doi: 10.1016/j.socscimed.2013.05.005.CrossRefGoogle Scholar
  15. 15.
    LaVeist, T. A., Nickerson, K. J., & Bowie, J. V. (2000). Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Medical Care Research and Review, 57(Suppl 1), 146–161.CrossRefPubMedGoogle Scholar
  16. 16.
    Hammond, W. P., Matthews, D., Mohottige, D., Agyemang, A., & Corbie-Smith, G. (2010). Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-American men. Journal of General Internal Medicine, 25(12), 1300–1308. doi: 10.1007/s11606-010-1481-z.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    McKinstry, B., Ashcroft, R. E., Car, J., Freeman, G. K., & Sheikh, A. Interventions for improving patients’ trust in doctors and groups of doctors. The Cochrane Database of Systematic Reviews. 2006(3), CD004134. doi: 10.1002/14651858.CD004134.pub2.
  18. 18.
    Thompson, H. S., Valdimarsdottir, H. B., Winkel, G., Jandorf, L., & Redd, W. (2004). The group-based medical mistrust scale: Psychometric properties and association with breast cancer screening. Preventive Medicine, 38(2), 209–218.CrossRefPubMedGoogle Scholar
  19. 19.
    Yang, T. C., Matthews, S. A., & Hillemeier, M. M. (2011). Effect of health care system distrust on breast and cervical cancer screening in Philadelphia, Pennsylvania. American Journal of Public Health, 101(7), 1297–1305. doi: 10.2105/AJPH.2010.300061.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Carpenter, W. R., Godley, P. A., Clark, J. A., Talcott, J. A., Finnegan, T., Mishel, M., et al. (2009). Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use. Cancer, 115(21), 5048–5059. doi: 10.1002/cncr.24539.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association, 99(8), 879–885.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Fiscella, K., Franks, P., & Clancy, C. M. (1998). Skepticism toward medical care and health care utilization. Medical Care, 36(2), 180–189.CrossRefPubMedGoogle Scholar
  23. 23.
    Thompson,V. L. S, Bugbee, A., Meriac, J. P., & Harris, J. K. (2013). The utility of cancer-related cultural constructs to understand colorectal cancer screening among African Americans. Journal of Public Health Research, 2(2), e11.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Gordon,T. F., Bass,S. B., Ruzek,S. B., Wolak,C., Rovito,M. J., Ruggieri,D. G., et al. (2014). Developing a typology of African Americans with limited literacy based on preventive health practice orientation: Implications for colorectal cancer screening strategies. Journal of Community Health, 19(11), 1259–1277. doi: 10.1080/10810730.2013.872725.CrossRefGoogle Scholar
  25. 25.
    Sanders Thompson, V., Lewis, T., & Williams, S. (2013). Refining the use of cancer-related cultural constructs with African Americans. Health Promotion Practice, 14(1), 38.CrossRefPubMedGoogle Scholar
  26. 26.
    Stacy,R., Torrence,W. A., Mitchell,C. R. (2008) Perceptions of knowledge, beliefs, and barriers to colorectal cancer screening. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 23(4), 238–240. doi: 10.1080/08858190802189030.CrossRefGoogle Scholar
  27. 27.
    Tabbarah, M., Nowalk, M. P., Raymund, M., Jewell, I. K., & Zimmerman, R. K. (2005). Barriers and facilitators of colon cancer screening among patients at faith-based neighborhood health centers. Journal of Community Health, 30(1), 55–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Jandorf, L., Cooperman, J. L., Stossel, L. M., Itzkowitz, S., Thompson, H. S., Villagra, C., et al. (2013). Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system. Health Education Research, 28(5), 803–815. doi: 10.1093/her/cyt003.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    BeLue, R., Menon, U., Kinney, A. Y., Szalacha, L. A., (2011). Psychosocial risk profiles among black male veterans administration patients non-adherent with colorectal cancer screening. Psycho-Oncology, 20(11), 1151–1160. doi: 10.1002/pon.1838.CrossRefPubMedGoogle Scholar
  30. 30.
    Brittain, K., Christy, S. M., & Rawl, S. M. (2016). African American Patients’ intent to screen for colorectal cancer: Do cultural factors, health literacy, knowledge, age and gender matter? Journal of Health Care for the Poor and Undeserved, 27(1), 51–67. doi: 10.1353/hpu.2016.0022.CrossRefGoogle Scholar
  31. 31.
    Bynum, S. A., Davis, J. L., Green, B. L., & Katz, R. V. (2012). Unwillingness to participate in colorectal cancer screening: Examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. American Journal of Health Promotion, 26(5), 295–300. doi: 10.4278/ajhp.110113-QUAN-20.CrossRefPubMedGoogle Scholar
  32. 32.
    O’Malley, A. S., Sheppard, V. B., Schwartz, M., & Mandelblatt, J. (2004). The role of trust in use of preventive services among low-income African-American women. Preventive Medicine, 38(6), 777–785. doi: 10.1016/j.ypmed.2004.01.018.CrossRefPubMedGoogle Scholar
  33. 33.
    Griffith, K. A., Passmore, S. R., Smith, D., & Wenzel, J. (2012). African Americans with a family history of colorectal cancer: Barriers and facilitators to screening. Oncology Nursing Forum, 39(3), 299–306. doi: 10.1188/12.ONF.299-306.CrossRefPubMedGoogle Scholar
  34. 34.
    Bastani, R., Gallardo, N. V., & Maxwell, A. E. (2001). Barriers to colorectal cancer screening among ethnically diverse high- and average-risk individuals. Journal of Psychosocial Oncology, 19(3–4), 65–84. doi: 10.1300/J077v19n03_06.CrossRefGoogle Scholar
  35. 35.
    Powell, W., Adams, L. B., Cole-Lewis, Y., Agyemang, A., & Upton, R. D. (2016). Masculinity and race-related factors as barriers to health help-seeking among African American Men. Behavioral Medicine (Washington, D. C.), 42(3), 150–163. doi: 10.1080/08964289.2016.1165174.CrossRefGoogle Scholar
  36. 36.
    Cheatham, C. T., Barksdale, D. J., & Rodgers, S. G. (2008). Barriers to health care and health-seeking behaviors faced by black men. Journal of the American Academy of Nurse Practitioners, 20(11), 555–562.CrossRefPubMedGoogle Scholar
  37. 37.
    Born, W., Engelman, K., Greiner, K. A., Bhattacharya, S. B., Hall, S., Hou, Q., et al. (2009). Colorectal cancer screening, perceived discrimination, and low-income and trust in doctors: A survey of minority patients. BMC Public Health, 9, 363. doi: 10.1186/1471-2458-9-363.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Grenier, K. A., James, A. S., Born, W., Hall, S., Engelman, K. K., Okuyemi, K. S., et al. (2005). Predictors of fecal occult blood test (FOBT) completion among low-income adults. Preventive Medicine, 41(2), 676–684.CrossRefGoogle Scholar
  39. 39.
    Purnell, J. Q., Katz, M. L., Andersen, B. L., Palesh, O., Figueroa-Moseley, C., Jean-Pierre, P., et al. (2010). Social and cultural factors are related to perceived colorectal cancer screening benefits and intentions in African Americans. Journal of Behavioral Medicine, 24–34(1), 11. doi: 10.1007/s10865-009-9231-6.Google Scholar
  40. 40.
    LaVeist, T. A., Isaac, L. A., & Williams, K. P. (2009). Mistrust of health care organizations is associated with underutilization of health services. Health Services Research, 44(6), 2093–2105. doi: 10.1111/j.1475-6773.2009.01017.x.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Bass, S. B., Gordon, T. F., Ruzek, S. B., Wolak, C., Ward, S., Paranjape, A., et al. (2011). Perceptions of colorectal cancer screening in urban African American clinic patients: Differences by gender and screening status. Journal of Cancer Education, 26(1), 121–128. doi: 10.1007/s13187-010-0123-9.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Brandzel, S., Chang, E., Tuzzio, L., Campbell, C., Coronado, N., Bowles, E. J., et al. (2016). Latina and Black/African American women's perspectives on cancer screening and cancer screening reminders. Journal of Racial and Ethnic Health Disparities. doi: 10.1007/s40615-016-0304-2.PubMedGoogle Scholar
  43. 43.
    Fyffe, D. C., Hudson, S. V., Fagan, J. K., & Brown, D. R. (2008). Knowledge and barriers related to prostate and colorectal cancer prevention in underserved black men. Journal of the National Medical Association, 100(10), 1161–1167.CrossRefPubMedGoogle Scholar
  44. 44.
    Gao, G., Burke, N., Somkin, C. P., & Pasick, R. (2009). Considering culture in physician—patient communication during colorectal cancer screening. Qualitative Health Research, 19(6), 778–789. doi: 10.1177/1049732309335269. CrossRefPubMedCentralGoogle Scholar
  45. 45.
    Greiner, K. A., Born, W., Nollen, N., & Ahluwalia, J. S. (2005). Knowledge and perceptions of colorectal cancer screening among urban African Americans. Journal of General Internal Medicine, 20(11), 977–983. doi: 10.1111/j.1525-1497.2005.00165.x.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Greiner, K. A., James, A. S., Born, W., Hall, S., Engelman, K. K., Okuyemi, K. S., & Ahluwalia, J. S. (2005). Predictors of fecal occult blood test (FOBT) completion among low-income adults. Preventive Medicine, 41(2), 676–684. doi: 10.1016/j.ypmed.2004.12.010.CrossRefPubMedGoogle Scholar
  47. 47.
    Gupta, S., Brenner, A. T., Ratanawongsa, N., & Inadomi, J. M. (2014). Patient trust in physician influences colorectal cancer screening in low-income patients. American Journal of Preventive Medicine, 47(4), 417–423. doi: 10.1016/j.amepre.2014.04.020.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Holmes-Rovner, M., Williams, G. A., Hoppough, S., Quillan, L., Butler, R., & Given, C. W. (2002). Colorectal cancer screening barriers in persons with low income. Cancer Practice, 10(5), 240–247.CrossRefPubMedGoogle Scholar
  49. 49.
    Lasser, K. E., Ayanian, J. Z., Fletcher, R. H., & Good, M. J. (2008). Barriers to colorectal cancer screening in community health centers: A qualitative study. BMC Family Practice, 9, 15. doi: 10.1186/1471-2296-9-15.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Lumpkins, C. Y., Vanchy, P., Baker, T. A., Daley, C., Ndikum-Moffer, F., & Greiner, K. A. (2016). Marketing a healthy mind, body, and soul: An analysis of how African American men view the church as a social marketer and health promoter of colorectal cancer risk and prevention. Health Education and Behavior, 43(4), 452–460. doi: 10.1177/1090198115604615.CrossRefPubMedGoogle Scholar
  51. 51.
    Nicholson, R. A., Kreuter, M. W., Lapka, C., Wellborn, R., Clark, E. M., Sanders-Thompson, V., et al. (2008). Unintended effects of emphasizing disparities in cancer communication to African-Americans. Cancer Epidemiology, Biomarkers and Prevention, 17(11), 2946–2953. doi: 10.1158/1055-9965.epi-08-0101.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Palmer, R. C., Midgette, L. A., & Dankwa, I. (2008). Colorectal cancer screening and African Americans: Findings from a qualitative study. Cancer Control, 15(1), 72–79.CrossRefPubMedGoogle Scholar
  53. 53.
    Thompson, V. L., Bugbee, A., Meriac, J. P., & Harris, J. K. (2013). The utility of cancer-related cultural constructs to understand colorectal cancer screening among African Americans. Journal of Public Health Research, 2(2), e11. doi: 10.4081/jphr.2013.e11.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Thompson, V. L., Kalesan, B., Wells, A., Williams, S. L., & Caito, N. M. (2010). Comparing the use of evidence and culture in targeted colorectal cancer communication for African Americans. Patient Education and Counseling, 81(Suppl 1), S22–33. doi: 10.1016/j.pec.2010.07.019.CrossRefPubMedGoogle Scholar
  55. 55.
    Safran, D. G., Kosinski, M., Tarlov, A. R., Rogers, W. H., Taira, D. A., Lieberman, N., & Ware, J. E. (1998). The primary care assessment survey: Tests of data quality and measurement performance. Medical care, 36(5), 728–739.CrossRefPubMedGoogle Scholar
  56. 56.
    Dugan, E., Trachtenberg, F., & Hall, M. A. (2005). Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Services Research, 5(1), 64.CrossRefPubMedPubMedCentralGoogle Scholar

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
    Email author
  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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