Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Do "evidence-based" cancer screening recommendations that do not consider racial/ethnic variation in disease patterns contibute to to the more advanced disease stage at diagnosis and higher mortality observed for some racial/ehnic minority populations?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Compares the effect of compliance with recommendations based on the general population to compliance with recommendations based on specific risks associated with race/ethnicity (e.g. overall higher incidence, earlier age at onset, higher prevalence of colorectal cancers and polyps in the distal colon and prostate cancer among African Americans).

(1) Studies that examine race/ethnicity and variation in the benefit/risk of screening with prostate specific antigen (PSA testing). Specifically, whether or not African Americans are more or less likely than NHWs to benefit from routine prostate cancer screening with PSA given their higher incidence and mortality. (2)Studies that examine the comparative effectiveness of initiating colorectal screening colorectal screening before age 50 among racial/ethnic minorities compared with the current recommendations to begin colorectal screening at 50.

(3)Studies that examine the comparative effectiveness of primary screening with colonoscopy compared with other screening modalities among African Americans.

(4) Studies that examine whether or not the literature available and used in evidence-based recommendations result in recommendations that are more or less likely to result in recommended health practices that may not be optimal for all racial/ethnic groups.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Racial/ethnic minority patients who have disease patterns that differ from the majority population.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

African Americans, Asian Americans, Hispanic Americans, Native Americans

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

More relevant and and specific recommendations for

screening minority population

Describe any health-related risks, side effects, or harms that you are concerned about.

The role that failure to make specific cancer screening recommendations regarding populations with disease patterns and experiences that differ from the majority population might play in disparities in cancer outcomes.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer

AHRQ Priority Populations

• Minority groups

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Racial/ethnic minorities suffer disproportionately from diseases for which screening tests that detect cancer early or that can be preventive exist. Incidence and mortality rates from cancers of the colon and rectum, breast, cervix, and prostate are higher among racial/ethnic minorities compared to Non-Hispanic whites. For example, both incidence and mortality rates for cancers of the prostate and colon and rectum are higher for African Americans than Non-Hispanic whites. Furthermore disease patterns frequently differ for racial/ethnic minorities compared with Non-Hispanic whites including earlier age at onset, poorer clinical characteristics and prognostic factors and higher mortality. This is compounded by poorer access to care in general and the lower quality of care often received by racial/ethnic minority patients.

Health recommendations are frequently based on average risk individuals. Despite racial/ethnic variation in risk factors and patterns of disease that place them at higher risk of morbidity and mortality, health recommendations often do not include specific recommendations for these groups. There are consistent reports of the earlier age of onset of colorectal cancer and predominance of right-sided tumors among African Americans however, the American College of Gastroenterology is the only major organization that recommends beginning screening African Americans at age 45 with colonoscopy. Furthermore, little information is available that will provide insight into possible racial/ethnic variation in the benefit/risk ratio of prostate specific antigen testing for routine screening for prostate cancer. Furthermore, it is not clear whether patients or providers adjust their specific health recommendations to account for racial/ethnic variation in risks and patterns of disease.

Evidence-based health recommendations are based on findings from the published literature. There is often an insufficient number of racial/ethnic minorities included

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Recent changes in screening recommendations particularly for cancers for which racial/ethnic differencs in disease patterns have been consistently found.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Raises questions regarding the appropriateness of screening recommendations that ignore racial/ethnic variation in patterns of disease.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

This question raises questions regarding differential risk/benefit of selected cancer screening practices

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program