Access to Care May Narrow Ethnic Disparities in Colorectal Adenoma

Abstract

Introduction: African Americans have been noted to present with more advanced colorectal cancer (CRC) and to face a higher cancer-related mortality rate from CRC than Caucasians. Detection and resection of adenomatous polyps prevents colon cancer. This study evaluated the adenoma detection rate in African American and white patients at an urban university medical center to identify differences in the prevalence of adenomas. Methods: A retrospective medical record review of all colonoscopies performed at an urban university medical center in a 12-month period was conducted using an electronic health record. Exclusion criteria included colonoscopies for indications other than screening and patients whose colonoscopy reports could not be matched to a complete medical record. Patient demographics and colonoscopy results were recorded. Ethnicity was extracted from clinical and/or administrative data. Microsoft Excel was used to generate a database that maintained patient confidentiality. Statistical analysis was performed using Fisher Exact test with significance set at p. Results: There were 1523 screening colonoscopies reviewed. The patients comprised 462 Caucasians (30.3%), 768 African-Americans (50.4%), 133 Hispanic patients (8.7%), and 160 (10.5%) of other or undocumented ethnicity. There were 656 (43.1%) males and 867 (56.9%) females. There were 471 African American women and 176 with adenoma (37.4%). Among 216 white women, 83 had adenoma (38.4%) (p=0.7997). Adenomatous polyps were found in 132 of 246 white males (53.7%) and in 136 of 297 African American males (45.8%) (p=0.0708). Conclusion: There was no significant difference in the rate of adenoma detection between African American and White patients. African Americans have been reported to present with more advanced CRC and to have higher mortality rates than white patients. The lack of excess adenomas in our African American cohort suggests that these disparities are not solely biologic. Our patients have with access to primary and subspecialty care and presented for outpatient screening colonoscopy. This study suggests that, while African Americans have had poorer colorectal cancer outcomes, access to care may mitigate those differences.