Systematic review reveals reasons for mistrust linked to colorectal cancer screenings in African-Americans

May 17, 2017

A new article in the Journal of Community Health explores the current evidence linking medical mistrust to colorectal cancer (CRC) screening rates among African-Americans.

Despite the well-documented benefits of CRC screening, African-Americans are less likely to be screened; they also have higher CRC incidence and mortality than whites. To explore emerging evidence that suggests medical mistrust may influence CRC screening disparities among African-Americans, a team of researchers conducted a systematic review of the literature to summarize reported associations between medical mistrust and CRC screening.

Leslie Adams

Leslie Adams

Jennifer Richmond

Jennifer Richmond

Dr. Wizdom Powell

Dr. Wizdom Powell

Dr. Giselle Corbie-Smith

Dr. Giselle Corbie-Smith

The authors are Leslie B. Adams, doctoral student, Jennifer Richmond, doctoral student, and Wizdom Powell, PhD, associate professor, all in the Department of Health Behavior in the UNC Gillings School of Global Public Health, along with Giselle Corbie-Smith, MD, professor, with the Department of Social Medicine in UNC’s School of Medicine. Powell also is a member of the UNC Center for Health Equity Research, where Corbie-Smith serves as director.

After conducting a review of 27 articles, the researchers found that the majority of studies linked higher mistrust scores with lower rates of CRC screening among African-Americans. While most studies examined mistrust at the physician level, a few analyzed mistrust at an organizational level (i.e. health-care systems, insurance, etc.).

“While we know there are disparate rates of CRC screening, this review highlights the role that mistrust in providers and health-care systems plays in driving these outcomes, particularly in the African-American community,” said Adams, the study’s first author.

The review also focused on gender differences related to medical mistrust and found key distinctions in themes of mistrust between African-American men and women. Several studies illustrated that mistrust centered on questioning provider motives and competence existed across genders, while mistrust based on the fear of experimentation and/or discomfort with the intrusiveness of screening methods were unique themes among African-American men.

Accordingly, Adams said, “Future studies should focus on more nuanced investigations of gender role norms in the context of CRC-related preventive services use.”

The research article concludes with recommendations for future research and practice in this area, including the development of multi-level measures of medical mistrust and the inclusion of robust measures of CRC screening completion in clinical practice. The authors hope the findings from their review will facilitate more in-depth studies and interventions to reduce trust-related barriers to CRC screening among African-Americans.

The full article, titled “Medical Mistrust and Colorectal Cancer Screening Among African Americans,” was published online April 24.


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Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu

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