Racial and Gender Disparities in Colon Cancer Presentation and Stage at Diagnosis
Brewer, Katherine C.
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This dissertation examines racial and gender disparities in the ways in which patients come to be diagnosed with colon cancer, and the complex interactions between patient and healthcare factors in the path to diagnosis. Three distinct methods were used to analyze data from a study of 407 recently diagnosed non-Hispanic African American (AA) and white colon cancer patients from the Chicago area. First, qualitative methods were used to analyze narrative data to identify barriers and facilitators of timely detection, and findings from qualitative analyses were integrated with quantitative methods to analyze racial and gender differences in mode of detection. Second, mediation of the association between gender and mode of presentation of cancer was analyzed. Last, structural equation modeling was utilized to simultaneously model mediation, direct effects, and indirect effects between patient and healthcare factors, mode of detection, and stage at diagnosis, and to assess differences by gender and race. A number of interesting differences in the patterns of presentation of colon cancer for men and women and for AAs and whites were identified in this dissertation. Results indicate that women are at a disadvantage clinically when it comes to mode of presentation of colon cancer, experiencing a higher ratio of barriers to facilitators of timely diagnosis than men and presenting more frequently than men with vague, non-specific symptoms. Colon cancer screening was found to be protective against symptomatic presentation for men but not women, a finding of particular concern. The racial differences identified in this analysis are consistent with previous studies, and add to the literature by identifying specific factors that can be intervened upon in future efforts to reduce disparities in colon cancer presentation and prognosis. The findings from this dissertation highlight the different types of barriers to detection patients experience based on their personal health experiences and social backgrounds, and emphasize the need for a personalized approach to care regarding colon cancer diagnoses.