The effect of knowledge on cancer screening intentions and behaviors among African Americans

Cancer Epidemiology, Biomarkers & Prevention. American Association of Cancer Prevention

DOI: 10.1158/1538-7755.DISP15-B71 Published March 2016



Background: Early cancer detection is widely recommended to reduce cancer mortality, for cancer is most successfully treated during the early stage. In Maryland, only 44.6% of all cancers are detected at the early stage, which may partially account for the fact that blacks in Baltimore City experience significantly higher mortality rates related to breast, cervical, and colorectal cancers. Access to cancer screening and early detection services and early education are critical in reducing cancer mortality and disparities. Past studies have examined the factors that influence cancer-screening behaviors, however, few have directly assessed how the association between knowledge and behavioral intentions relative to cancer screening varies with age.

Methods: The data was collected from the Advancing Community Outreach Study (March 2014-June 2015) conducted by the Johns Hopkins Center to Reduce Cancer Disparities in collaboration with community partners in Baltimore City. The data was obtained via convenience sampling at health fairs and community presentations, and study participants (n=294) responded to various questions to assess knowledge, attitudes, and behavioral intentions based on past and future communications with a health care provider about screening for breast, cervical, and colorectal cancers. Cancer knowledge focused on screening methods and National Cancer Institute’s recommendations for screening. The primary outcome measure was defined by behavioral intentions indicated by the participant.

Results: Preliminary analyses showed that the study population was 83.1% female and 88.5% black. Individuals were separated into three age groups (<50, 50-59, and >60 years of age) to examine the association between cancer screening knowledge and behaviors/intentions. Significant differences in knowledge of cervical cancer (p=0.030) and colorectal cancer (p<0.000) screening guidelines by age group were noted. Past actions related to getting cancer screening varied with age as well. After adjusting for differences in age, gender, and race, positive associations were found between knowledge of cervical cancer screening guidelines and past actions (OR, 3.4; 95% CI, 1.5-7.7) as well as between knowledge of colorectal cancer screening guidelines and past actions (OR, 4.2; 95% CI, 1.7-10.2). Stratifying by age groups indicated that individuals under 50 with knowledge of cervical cancer screening guidelines had higher odds of having positive intentions (OR, 3.6; 95% CI, 1.1-12.3) and positive past actions (OR, 11.1; 95% CI, 1.8-66.3). A positive association was also found in individuals over 60 with knowledge of colorectal cancer screening guidelines, for they had higher odds of both positive health intentions (OR, 5.2; 95% CI, 1.0-27.3) and past actions (OR, 6.7; 95% CI, 1.2-38.3). Knowledge of breast, cervical, and colorectal cancer screening methods was high across the study population (% individuals with correct knowledge >92.0 in all knowledge questions) and showed non-significant differences by age group.

Conclusions: Study findings suggest that individuals closer in age to a specific cancer screening guideline demonstrate a positive association between cancer screening knowledge and behavioral intentions linked to obtaining cancer screening. The findings highlight the importance of increasing early and consistent education about cancer screenings to encourage early detection of cancer and to ultimately reduce the disparity in cancer mortality rates. Further research should be conducted to explore the additional factors that influence knowledge of cancer screening methods and guidelines and how that level of knowledge affects cancer screening behaviors.


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