Background: While previous research suggests that patients who have one cancer screening may be positively inclined to have additional screenings, cultural and ethnic differences in attitudes towards screenings are less well explored. Drawing on both qualitative and quantitative data, we will outline variation in cancer screening utilization and attitudes across four ethnic groups in a primary care setting.

Methods: In our multimethod, prospective study, “The Impact of Cultural Differences on Health Literacy and Chronic Disease Outcomes,” we explore factors associated with attitudes towards cancer screening among patients at a Section 330 community health center. Standard knowledge, belief and attitude (KBA) and utilization scales were completed by 350 patients from 4 ethnic groups (Latino, Vietnamese, African-American, white) as part of larger epidemiological surveys conducted with patients diagnosed with diabetes and/or hypertension. Surveys are orally administered in the language of the patient's choice by bilingual, bicultural interviewers. Quantitative data are analyzed using SPSS and qualitative data using Atlas.ti.

Results: Participants' attitudes towards cancer screening tend to generalize across screening types. High levels of internal consistency were found across items examining attitudes towards several types of cancer screening tests (for men, PSA, DRE, FOBT, colonoscopy; for women, mammogram, BSE, FOBT, colonoscopy). Attitudinal consistency was particularly marked for men, for African-American, and for Latino participants, especially when individual items were combined into scales reflecting overall positive or negative beliefs about cancer screening (e.g., a given screening will be painful, expensive, or take too much time). In addition, we find consistent differences in attitudes among the four ethnic groups. Latinos have the most negative beliefs about cancer screenings, while Vietnamese participants have the most positive attitudes. Among all ethnic groups, negative attitudes towards cancer screenings appear closely related to utilization. For example, with few exceptions, those who have not had a given test hold more negative attitudes towards the test in question.

Discussion: These results suggest that a favorable attitude towards one form of cancer screening might favorably dispose a patient toward all forms, and that utilization of any cancer screening test may positively influence a patient's attitudes towards other types of screenings.

Conclusions: Given that Latinos underutilize many types of cancer screenings, it perhaps not surprising that they also hold the most negative attitudes in our study if screening utilization positively influences attitudes towards screenings. Expanding access to cancer screenings by addressing barriers to care including language and insurance coverage may be important interventions to address Latinos' and other groups' attitudes towards cancer screenings. We present recommendations for primary health care providers for improving communication with ethnically diverse patients with limited health literacy around cancer screening utilization.

Second AACR International Conference on the Science of Cancer Health Disparities— Feb 3–6, 2009; Carefree, AZ