Barriers to Colorectal Cancer Screening With Fecal Occult Blood Testing in a Predominantly Minority Urban Population: A Qualitative Study

Colorectal cancer is the second leading cause of cancer death in the United States.1 Appropriate screening can reduce incidence of and mortality from colorectal cancer.2–5 The US Preventive Services Task Force recommends that all average-risk individuals aged 50 years and older receive colorectal cancer screening.6 The American Cancer Society recommends several acceptable approaches to screening, including an annual 3-card home fecal occult blood test.7 The Healthy People 2010 objective is to increase the proportion of people aged 50 and older who have received a fecal occult blood test within the preceding 2 years to at least 50%.8 Lack of knowledge, confidence, and skills; negative attitudes toward the tests themselves; fear of the consequences of screening; and inadequate social support all have been suggested as possible barriers to colorectal cancer screening,9 whereas positive attitudes toward colorectal cancer screening and physician encouragement have been associated with receipt of a fecal occult blood test with a home stool kit.10 Despite these studies, gaps remain in what is known about barriers to successful interventions to increase colorectal cancer screening, particularly in minority populations.11,12 This study is based on the assumption that identification and definition of barriers to colorectal cancer screening in low-income, underserved minority populations can help guide the development of effective interventions.