restricted access Predictors of Cancer Screening Among Low-Income Primary Care Patients

Although population-based studies report lower rates of cancer screening among racial/ethnic minorities than among Whites in the U.S., few studies have examined predictors of screening among low-income Hispanic, Black, and Chinese primary care patients. We examined utilization of mammography, Pap smear, digital rectal examination, fecal occult blood testing, sigmoidoscopy/colonoscopy, and prostate-specific antigen testing in 833 patients from 2 community health centers in New York City, ascertaining relationships between use of screening and race/ethnicity, income, education, years in the U.S., insurance, cancer risk perception, family disease history, and physician recommendation. Despite similar access to primary care, Hispanics and Blacks reported higher utilization rates of all screening tests than Chinese (p<.01). Physician recommendation and more years in the U.S. were associated with greater use of all screening services (p<.001), with physician recommendation most strongly associated with screening. Interventions to enhance screening by at-risk groups should emphasize both physician recommendation and culturally-sensitive patient education.