Past research on prostate and colorectal cancer disparities finds that barriers to screening, such as embarrassment and offensiveness, are often reported. Yet none of this literature investigates why. This study uses masculinity and health theory to examine how men experience two common screenings: digital rectal exams (DREs) and colonoscopies. In-depth interviews were conducted with 64 African American and White men from diverse backgrounds, aged 40 to 64, from North Carolina. Regardless of race or education, men experienced DREs more negatively than colonoscopies because penetration with a finger was associated with a gay sexual act. Some men disliked colonoscopies, however, because they associated any penetration as an affront to their masculinity. Because beliefs did not differ by race, future research should focus on structural issues to examine why disparities persist with prostate and colorectal cancer. Recommendations are provided for educational programs and physicians to improve men’s experiences with exams that involve the rectum.
Allen, J.D., Kennedy, M., Wilson-Glover, A., & Gilligan, T.D. (2007). African-American men’s perceptions about prostate cancer: Implications for designing educational interventions. Social Science & Medicine, 64, 2189-2200.
2.
American Cancer Society. (2007). Prostate cancer. Retrieved December 10, 2007, from http:/www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_prostate_cancer_36.asp
3.
American Cancer Society. (2008). What are the key statistics for colorectal cancer? Retrieved March 30, 2008, from http:/www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=10
4.
Beeker, C., Kraft, J.M., Southwell, B.G., & Jorgensen, C.M. (2000). Colorectal cancer screening in older men and women: Qualitative research findings and implications for intervention. Journal of Community Health, 25, 263-278.
5.
Bleiker, E.M.A., Menko, F.H., Taal, B.G., Kluijt, I., Wever, L.D.V., Gerritsma, M.A., et al. (2005). Screening behavior of individuals at high risk for colorectal cancer. Gastroenterology, 128, 280-287.
6.
Bloom, J.R., Stewart, S.L., Oakley-Girvans, I., Banks, P.J., & Chang, S. ( 2006). Family history, perceived risk, and prostate cancer screening among AfricanAmerican men. Cancer Epidemiology, Biomarkers and Prevention, 15, 2167-2173.
7.
Bourdieu, P. ( 1977). Cultural reproduction and social reproduction. In J. Karabel & A. H. Halsey (Eds.), Power and ideology in education (pp. 487-510). Oxford, UK: Oxford University Press.
8.
Calnan, M., & Rutter, D.R. ( 1986). Preventive health practices and their relationships with socio-demographic characteristics. Health Education Research , 1, 247-253.
9.
ChengWu, X., Chen, V.W., Steele, B., Ruiz, B., Fulton, J., Liu, L., et al. (2001). Subsite-specific incidence rate and stage of disease in colorectal cancer by race, gender and age group in the United States, 1992-1997. Cancer, 92, 2547-2554.
10.
Clegg, L.X., Li., F. P., Hankey, B.F., Chu, K., & Edwards, B.K. ( 2002). Cancer survival among U.S. whites and minorities: A SEER (surveillance, epidemiology and end results) program population-based study . Archives of Internal Medicine, 162, 1985-1993.
11.
Connell, R.W. ( 1987). Gender and power. Stanford, CA: Stanford University Press.
12.
Connell, R. W. (1995). Masculinities. Cambridge: Polity Press. Connell, R. W. (1998). Masculinities and globalization. Men and Masculinities, 1, 3-23.
Consedine, N.S., Horton, D., Ungar, T., Joe, A.K., Ramirez, P., & Borrell, L. ( 2007). Fear, knowledge, and efficacy beliefs differentially predict the frequency of digital rectal examination versus prostate specific antigen screening in ethnically diverse samples of older men. American Journal of Men’s Health, 1, 29-43.
15.
Courtenay, W.H. ( 2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science & Medicine, 50, 1385-1401.
16.
Denberg, T.D., Melhado, T.V., Coombes, J.M., Beaty, B.L., Berman, K., Byers, T.E., et al. (2005). Predictors of nonadherence to screening colonoscopy. Journal of General Internal Medicine, 20, 989-995.
17.
Esterberg, K.G. ( 2002). Qualitative methods in social research. Boston: McGraw Hill.
18.
Forrester-Anderson, I.T. ( 2005). Prostate cancer screening perceptions, knowledge and behavior among African American men: Focus group findings. Journal of Health Care for the Poor and Underserved, 16, 22-30.
19.
Giuffre, P.A., & Williams, C.L. (2000). Not just bodies: Strategies for desexualizing the physical examination of patients. Gender & Society, 14, 457-482.
20.
Gough, B. ( 2006). Try to be healthy, but don’t forgo your masculinity: Deconstructing men’s health discourse in the media. Social Science & Medicine, 63, 2476-2488.
21.
Greiner, K.A., Born, W., Nollen, N., & Ahluwalia, J.S. (2005). Knowledge and perceptions of colorectal cancer screening among urban African Americans. Journal of General Internal Medicine, 20, 977-983.
22.
Grossfeld, G.D., Latini, D.M., Downs, T., Lubeck, D.P., Mehta, S.S., & Carroll, P.R. ( 2002). Is ethnicity an independent predictor of prostate cancer recurrence after radical prostatectomy? The Journal of Urology , 168, 2510-2515.
23.
Janz, N.K., Lakhani, I., Vijan, S., Hawley, S.T., Chung, L.K., & Katz, S.J. ( 2007). Determinants of colorectal cancer screening use, attempts, and non-use. Preventive Medicine, 44, 452-458.
24.
Kimmel, M.S. ( 1994). Masculinity as homophobia: Fear, shame and silence in the construction of gender identity. In H. Brod & M. Kaufman (Eds.), Theorizing masculinities (pp. 119-141). Thousand Oaks, CA: SAGE Publications.
25.
Krieger, N., Williams, D.R., & Moss, N.E. ( 1997). Measuring social class in US public health research: Concept, methodologies, and guidelines. Annual Review of Public Health, 18, 341-378.
26.
Lane, C., & Rollnick, S. ( 2007). The use of simulated patients and role play in communication skills training: A review of the literature to August 2005. Patient Education and Counseling, 67, 13-20.
27.
Lewis, G.B. ( 2003). Black-White difference in attitudes toward homosexuality and gay rights. Public Opinion Quarterly, 67, 59-78.
28.
Lichtenstein, B. ( 2004). Caught at the clinic: African American men, stigma, and STI treatment in the deep south. Gender & Society, 18, 369-388.
29.
McFall, S.L., Hamm, R.M., & Volk, R.J. ( 2006). Exploring beliefs about prostate cancer and early detection in men and women of three ethnic groups. Patient Education and Counseling, 61, 109-116.
30.
Myers, R.E., Wolf, T.A., McKee, L., McGrory, G., Burgh, D.Y., Nelson, G.T., et al. (1996). Factors associated with intention to undergo annual prostate cancer screening among African American men in Philadelphia . Cancer, 78, 471-479.
31.
O’Brien, R., Hunt, K., & Hart, G. ( 2005). "It’s caveman stuff, but that is to a certain extent how guys still operate": Men’s accounts of masculinity and help seeking . Social Science & Medicine, 61, 503-516.
32.
Oliffe, J., & Thorne, S. ( 2007). Men, masculinities, and prostate cancer: Australian and Canadian patient perspectives of communication with male physicians. Qualitative Health Research, 17, 149-161.
33.
Regan, L.J. ( 1997). Engendering the dread disease: Women, men, and cancer . American Journal of Public Health, 87, 1779-1787.
34.
Rich, J.A., & Stone, D.A. ( 1996). The experience of violent injury for young African-American men: The meaning of being a "sucker." Journal of General Internal Medicine, 11, 77-82.
35.
Sanchez, M.A., Bowen, D.J., Hart, A., & Spigner, C. ( 2007). Factors influencing prostate cancer screening decisions among AfricanAmerican men. Ethnicity & Disease, 17, 374-380.
Schofield, T., Connell, R.W., Walker, L., Wood, J.F., & But-land, D.L. (2000). Understanding men’s health and illness: A gender-relations approach to policy, research and practice . Journal of American College Health, 48, 247-256.
38.
United States Preventive Services Task Force. ( 2002). Screening for colorectal cancer: Recommendations and rationale. Rockville, MD: Agency for Healthcare Research and Quality.
39.
Webb, C.R., Kronheim, L., Williams, J.E., Jr. , & Hartman, T.J. (2006). An evaluation of the knowledge, attitudes and beliefs of African-American men and their female significant others regarding prostate cancer screening. Ethnicity & Disease, 16, 234-238.
40.
Weinrich, S.P., Seger, R., Miller, B.L., Davis, C., Kim, S., Wheeler, C., et al. (2004). Knowledge of the limitations associated with prostate cancer screening among low-income men. Cancer Nursing, 27, 442-451.
41.
White, R. ( 2002). Social and political aspects of men’s health. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 6, 267-285.
