05 Dec RESEARCH ARTICLE Interventions for increasing colorectal cancer

RESEARCH ARTICLE

Interventions for increasing colorectal cancer

screening uptake among African-American

men: A systematic review and meta-analysis

Charles R. RogersID 1*, Phung Matthews1, Lei Xu2, Kenneth Boucher3, Colin Riley1,

Matthew Huntington 1 , Nathan Le Duc

1 , Kola S. Okuyemi

1 , Margaret J. Foster

4

1 Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah,

United States of America, 2 Department of Health Education and Promotion, East Carolina University,

Greenville, NC, United States of America, 3 Cancer Biostatistics Shared Resource, Huntsman Cancer

Institute, Salt Lake City, UT, United States of America, 4 Medical Sciences Library, Texas A&M University,

College Station, TX, United States of America

* [email protected]

Abstract

Background

African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer

(CRC) of any racial group, which may partly stem from low screening adherence. It is imper-

ative to synthesize the literature evaluating the effectiveness of interventions on CRC

screening uptake in this population.

Materials and methods

In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane

CENTRAL were searched for U.S.-based interventions that: were published after 1998–

January 2020; included African-American men; and evaluated CRC screening uptake

explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess

risk of bias, and meta-regression and sensitivity analyses were employed to identify the

most effective interventions.

Results

Our final sample comprised 41 studies with 2 focused exclusively on African-American men.

The most frequently adopted interventions were educational materials (39%), stool-based

screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed

to provide details about the blinding of the participant recruitment method, allocation con-

cealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analy-

sis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or

patient navigation were most effective at increasing CRC screening completion, with odds

ratios of 9.60 (95% CI 2.89–31.82, p = 0.0002) and 2.84 (95% CI 1.23–6.49, p = 0.01). No

evidence of publication bias was present for this study registered with the International Pro-

spective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510).

PLOS ONE

PLOS ONE | https://doi.org/10.1371/journal.pone.0238354 September 16, 2020 1 / 27

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OPEN ACCESS

Citation: Rogers CR, Matthews P, Xu L, Boucher K,

Riley C, Huntington M, et al. (2020) Interventions

for increasing colorectal cancer screening uptake

among African-American men: A systematic review

and meta-analysis. PLoS ONE 15(9): e0238354.

https://doi.org/10.1371/journal.pone.0238354

Editor: Joseph Telfair, Georgia Southern University,

UNITED STATES

Received: March 4, 2020

Accepted: August 7, 2020

Published: September 16, 2020

Copyright: © 2020 Rogers et al. This is an open access article distributed under the terms of the

Creative Commons Attribution License, which

permits unrestricted use, distribution, and

reproduction in any medium, provided the original

author and source are credited.

Data Availability Statement: All relevant data are

within the paper and its Supporting Information

files.

Funding: This study was supported by the National

Cancer Institute of the National Institutes of Health

(NIH) [grant number K01CA234319]. The content

is solely the responsibility of the authors and does

not necessarily represent the official views of the

NIH.

Competing interests: The authors have declared

that no competing interests exist.