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Barriers and Facilitators of Colorectal Cancer Screening Among a Hispanic Community in Michigan

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Colorectal cancer (CRC) is the third leading cause in the USA for cancer-related deaths. Hispanics demonstrate the lowest CRC screening (CRCS) rate and research suggests that causes of screening disparities differ among ethnic groups and geographic locations. The aim of this study was to determine the rate of CRCS and to identify barriers and facilitators to screening in the Hispanic population of Flint, Michigan


Cross-sectional study. Consenting participants completed a previously validated survey in their language of preference. Variables obtained included sociodemographic information, insurance status, language preference, primary care physician (PCP), language spoken by PCP, recommendation of CRCS, acculturation, and fatalism. Univariate and multivariate logistic regressions were performed to determine the association between predictors associated with previous CRCS.


Seventy subjects completed the survey. Overall previous CRCS rate was 60%. Multivariate results indicated that having a physician that speaks both English and Spanish significantly increases the likelihood of CRCS. It also indicated that those who have been living in the USA for equal or less than 30 years and those that physician had never recommended screening were less likely to have been screened.


Our study provides important preliminary data that may help improve CRCS among this Hispanic population. Interventions include providing a list of bilingual physicians in the community and to educate them regarding CRCS to mitigate the lack of physician recommendations. Notably, this study highlights the importance of cultural sensitivity and competence in preventive healthcare to promote inclusiveness of minority populations.

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  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019.

    Google Scholar 

  2. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. Accessed 8 March 2019.

  3. Vespa J, Armstrong DM, Medina L. Demographic turning points for the United States: population projections for 2020 to 2060 population estimates and projections Current population reports.; 2018. Accessed 8 March 2019.

  4. Byrd TL, Calderón-Mora J, Salaiz R, Shokar NK. Barriers and facilitators to colorectal cancer screening within a Hispanic population. Hisp Health Care Int. 2019;17(1):23–9.

    Article  PubMed  Google Scholar 

  5. Ward E, Jemal A, Cokkinides V, Singh GK, Cardinez C, Ghafoor A, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54(2):78–93.

    Article  Google Scholar 

  6. Sauer AG, Siegel RL, Jemal A, Fedewa SA. Updated review of prevalence of major risk factors and use of screening tests for cancer in the United States. Cancer Epidemiol Biomark Prev. 2017;26(8):1192–208.

    Article  Google Scholar 

  7. Myers RE, Stello B, Daskalakis C, et al. Decision support and navigation to increase colorectal cancer screening among Hispanic patients. Cancer Epidemiol Biomark Prev. 2019;28(2):384–91.

    Article  Google Scholar 

  8. Vega KJ. iMedPub Journals Health disparities in colorectal cancer among African and Hispanic Americans in the United States Abstract CRC among African-Americans incidence and mortality. 2016;(January). doi:

  9. De Los Monteros KE, Gallo LC. The relevance of fatalism in the study of Latinas’ cancer screening behavior: a systematic review of the literature. Int J Behav Med. 2011;18(4):310–8.

    Article  Google Scholar 

  10. Niederdeppe J, Levy AG. Fatalistic beliefs about cancer prevention and three prevention behaviors. Cancer Epidemiol Biomarkers Prev. 2007;16(5):998–1003.

    Article  Google Scholar 

  11. Gorin SS. Correlates of colorectal cancer screening compliance among urban Hispanics. J Behav Med. 2005;28(2):125–37.

    Article  Google Scholar 

  12. Shah M, Zhu K, Potter J. Hispanic acculturation and utilization of colorectal cancer screening in the United States. Cancer Detect Prev. 2006;30(3):306–12.

    Article  Google Scholar 

  13. Goodman MJ, Ogdie A, Kanamori MJ, Cañar J, O AS. Barriers and facilitators of colorectal cancer screening among mid-Atlantic Latinos: focus group findings Accessed 11 March 2019.

  14. Otiniano ME, Wood RC, Poursani RS, Katerndahl DA, Siddiqui S, Nadeau MT. Association of knowledge, attitudes, and behaviors for colon cancer screening in Hispanic patients. Ethn Dis. 2013;23(3):343–8 Accessed 11 March 2019.

    PubMed  Google Scholar 

  15. Fernández ME, Savas LS, Wilson KM, et al. Colorectal cancer screening among Latinos in three communities on the Texas-Mexico border. Health Educ Behav. 2015;42(1):16–25.

    Article  PubMed  Google Scholar 

  16. Jilcott Pitts SB, Lea CS, May CL, et al. “ Fault-line of an earthquake ”: a qualitative examination of barriers and facilitators to colorectal cancer screening in rural, Eastern North Carolina. J Rural Health. 2013;29(1):78–87.

    Article  PubMed  Google Scholar 

  17. U.S. Census Bureau QuickFacts: Flint city, Michigan. Accessed 8 March 2019.

  18. Marin G, Sabogal F, Marin BV, Otero-Sabogal R, Perez-Stable EJ. Development of a Short Acculturation Scale for Hispanics. Hisp J Behav Sci. 1987;9(2):183–205.

    Article  Google Scholar 

  19. Powe BD. Fatalism among elderly African Americans. Effects on colorectal cancer screening. Cancer Nurs. 1995;18(5):385–92 Accessed 8 March 2019.

    Article  CAS  Google Scholar 

  20. Bureau UC. Income, poverty and health insurance coverage in the U.S.: 2017. Accessed 21 May 2019.

  21. Wang J, Moehring J, Stuhr S, Krug M. Barriers to colorectal cancer screening in Hispanics in the United States: an integrative review. Appl Nurs Res. 2013;26(4):218–24.

    Article  PubMed  Google Scholar 

  22. Joseph DA, King JB, Miller JW, Richardson LC. Centers for Disease Control and Prevention (CDC). Prevalence of colorectal cancer screening among adults--behavioral risk factor surveillance system, United States, 2010. MMWR Suppl. 2012;61(2):51–6 Accessed 13 March 2019.

    PubMed  Google Scholar 

  23. Natale-Pereira A, Marks J, Vega M, Mouzon D, Hudson SV, Salas-Lopez D. Barriers and facilitators for colorectal cancer screening practices in the Latino community: perspectives from community leaders. Cancer Control. 2008;15(2):157–65.

    Article  PubMed  Google Scholar 

  24. Cameron KA, Francis L, Wolf MS, Baker DW, Makoul G. Investigating Hispanic/Latino perceptions about colorectal cancer screening: a community-based approach to effective message design. Patient Educ Couns. 2007;68(2):145–52.

    Article  PubMed  Google Scholar 

  25. Wolf MS, Satterlee M, Calhoun EA, et al. Colorectal cancer screening among the medically underserved. J Health Care Poor Underserved. 2006;17(1):47–54.

    Article  PubMed  Google Scholar 

  26. Ko LK, Reuland D, Jolles M, Clay R, Pignone M. Cultural and linguistic adaptation of a multimedia colorectal cancer screening decision aid for Spanish-speaking Latinos. J Health Commun. 2014;19(2):192–209.

    Article  PubMed  Google Scholar 

  27. Ho MY, Lai JY, Cheung WY. The influence of physicians on colorectal cancer screening behavior. Cancer Causes Control. 2011;22(12):1659–68.

    Article  PubMed  Google Scholar 

  28. Ge Gao G, Burke N, Somkin CP, Pasick R. Considering culture in physician—patient communication during colorectal cancer screening. Qual Health Res. 2009;19(6):778–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ellison J, Jandorf L, Villagra C, Winkel G, DuHamel K. Screening adherence for colorectal cancer among immigrant Hispanic women. J Natl Med Assoc. 2011;103(8):681–8 Accessed 13 March 2019.

    Article  Google Scholar 

  30. Shih Y-CT, Elting LS, Levin B. Disparities in colorectal screening between US-born and foreign-born populations: evidence from the 2000 National Health Interview Survey. J Cancer Educ. 2008;23(1):18–25.

    Article  PubMed  Google Scholar 

  31. Colorectal Cancer Facts & Figures 2017-2019. Accessed 11 March 2019.

  32. Grzywacz V, Hussain N, Ragina N. Racial disparities and factors affecting Michigan colorectal cancer screening. J Racial Ethn Health Disparities. 2018;5(4):901–6.

    Article  PubMed  Google Scholar 

  33. Guessous I, Dash C, Lapin P, et al. Colorectal cancer screening barriers and facilitators in older persons. Prev Med. 2010;50(1-2):3–10.

    Article  PubMed  Google Scholar 

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We thank Dr. Carlos F. Rios-Bedoya for his assistance with our methodology, and Dr. Vineet Chopra for his aid in editing and improving the manuscript.

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Correspondence to Juan Jose Gonzalez.

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Gonzalez, J., Wahab, A., Samalik, J. et al. Barriers and Facilitators of Colorectal Cancer Screening Among a Hispanic Community in Michigan. J. Racial and Ethnic Health Disparities 7, 137–143 (2020).

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