Use of cancer-screening tests in the San Francisco Bay area: comparison of Latinos and Anglos.

BACKGROUND: Compared with Anglos (non-Latino whites), incidences of breast and colorectal cancers are lower for Latinos and incidences of cervical cancer are higher for Latinos. In regional and national studies, Latinos obtain fewer cancer screening tests for cervical, breast, and colorectal cancers when compared with Anglo populations. It remains unclear if these differences are due solely to socioeconomic status.

PURPOSE: To evaluate self-reported use of these tests by ethnicity, we conducted telephone interviews about the use of the Pap smear, clinical breast examination, mammogram, rectal examination, fecal occult blood test, and sigmoidoscopy.

METHODS: Cross-sectional, random-digit dialing telephone surveys of Latino and Anglo adults, 35-74 years of age, living in San Francisco and Alameda Counties, Calif. were used. A total of 798 Latinos (398 men and 408 women) and 436 Anglos (214 men and 222 women) completed the interview.

RESULTS: Age-adjusted rates showed that 82.0% of Latinas reported a Pap smear within 3 years compared with 85.1% of Anglo women. A clinical breast examination within 2 years was reported by 82.1% of Latinas and by 88.9% of Anglo women. Screening mammograms within 2 years were reported by 57.8% of Latinas and by 72.3% of Anglo women (difference = -14.5%; 95% confidence interval [CI] = -21.5, -7.5). Compared with Anglos, fewer Latinos reported digital-rectal examinations within 2 years (44.6% versus 61.8%; difference = -17.2%; 95% CI = -22.6, -11.8). There were no significant differences by ethnicity in obtaining a fecal occult blood test within 2 years (32.3% versus 34.0%) and sigmoidoscopy within 5 years (18.9% versus 21.5%). After adjusting for age, education, health insurance, employment, marital status, county of residence, and self-perceived health status, Latino ethnicity was a significant predictor only for digital-rectal examination within 2 years (odds ratio [OR] = 0.65; 95% CI = 0.49-0.86) and digital-rectal examination ever (OR = 0.54; 95% CI = 0.40-0.74). Latinos were significantly more likely to cite forgetfulness, lack of transportation, long wait for appointments, and need for child care as reasons for not having cancer screening tests.

CONCLUSION: We conclude that after accounting for socioeconomic factors, Latino ethnicity is a relatively minor predictor of use of cancer screening tests. Increasing the availability of culturally appropriate educational materials and providing universal health care coverage are more important priorities to promote appropriate use of cancer screening tests by Latinos.