Barbershops Serve as Platform to Encourage Colorectal Cancer Screening Among Black Men

Patient navigator programs at local barbershops increased screening for colorectal cancer by 2-fold among aging black men, a recent study found.

These programs employ health care professionals to guide patients towards colorectal cancer screening in a timely fashion.

In the United States, aging black men have a significantly greater risk of dying prematurely of colorectal cancer than any other group, according to a study published in the American Journal of Public Health. Furthermore, they are less likely than their white counterparts to be diagnosed at the early stages of the disease.

In the study, the authors sought to test the efficacy of a preclinical, telephone-based patient navigation intervention to encourage colorectal cancer screening among older Black men.

Titled MISTER B, the 3-parallel armed, randomized clinical trial enrolled 731 Black men recruited at New York City barbershops between 2010 and 2013. Eligibility required participants to be 50 years or older, not be up-to-date on colorectal cancer screening, have uncontrolled high blood pressure, and own a working telephone.

Educational health materials addressing colorectal cancer screening and high blood pressure self-management was reviewed with all study participants.

The participants were randomized into 3 groups: patient navigation by a community health worker for colorectal cancer screening (PN), motivational interviewing for blood pressure control by a trained counselor, or both interventions (PLUS).

Patients in the PN arm received follow-up phone calls from patient navigators within 2 weeks and then periodically over a 6-month period to help them schedule a colonoscopy, or choose another screening method. Those who preferred fecal immunochemical test screening were mailed a kit and instructions, and received follow-up calls to confirm the testing.

After 6 months, the results of the study showed 17.5% of men enrolled in the PN arm and 17.8% in the PLUS arm were screened for colorectal cancer, compared with 8.4% who received no extra support for screening.

Findings also showed several challenges for participants in receiving adequate health care. Only 60% had a personal physician and only 40% had received a checkup within the last year. Furthermore, many were uninsured and had low health literacy.

Although prior studies have linked black men to patient navigators for colon cancer prevention, they were based at clinics. The new study is the first of its scale to examine a community approach.

“Black men are less likely than the general population to be insured and have a person doctor, which is why we went beyond the clinic and to the community,” said principal investigator Joseph Ravenell, MD, MPH. “Barbershops in particular hold special appeal for community-based intervention trials, are popular forums for open conversation, and could be leveraged to lessen the death rate from colorectal cancer in black men.”

First author Helen Cole, DrPH, said “these findings add to the growing body of evidence that health care systems should expand their work in trusted community spaces to reach those who might not be seen in a clinical setting.”