Adenoma Detection Rate in Index Screening Colonoscopy in Predominantly Immigrant Urban Black Population: A Retrospective Study

Abstract

Introduction: Screening colonoscopy is the preferred procedure for colon cancer screening and has resulted in reduction in, the incidence of colorectal adenocarcinoma(CRC). However, the incidence and mortality of CRC in black population is considerably high compared to other races. Brooklyn, NY is home to a large immigrant black population and the baseline adenoma detection rate (ADR) in screening index colonoscopy in this immigrant population has not been reported before. We aimed to study the baseline ADR in this population and look at different variables that can influence ADR Methods: Retrospective chart review was done in all patients undergoing colonoscopy at University hospital of Brooklyn, NY and Kings county hospital center, Brooklyn, NY from January 1, 2012 to December 31, 2012. Patients were included in the study if they were identified as African-American, African-Caribbean or African, aged between 45 and 75 and if they were undergoing screening index colonoscopy. Demographic history, past medical history, social history and endoscopic history including pathology were collected for all the patients. Primary aim of the study is calculation of baseline ADR in this population. Secondary endpoints were sex specific ADR and whether fellow participation improves ADR. Results: A total of 1692 patients met the inclusion criteria. Baseline characteristics of these patients are shown in image 1. Baseline total ADR for this population was calculated to be 18.7%. ADR for black males was 21.3% and for female black patients was 17.3%. On comparison of colonoscopy with and without fellow participation, there was a statistically significant improvement in ADR with fellow participation for female patients (23.2% with fellows vs 16.4% without fellows, p=0.027). Patients with type 2 Diabetes mellitus had high risk of adenomas than patients who did not have (OR-1.33 [1.033 to 1.72]), however use of aspirin or metformin use were not associated with decreased risk of adenomas in our cohort Conclusion: This is the first study looking at baseline ADR in this predominantly immigrant black population in Brooklyn, NY. Our study cohort had almost 2/3rd of the patients as females which may potentially explain slightly lower overall ADR in our study. Fellow participation improved ADR in female patients in our study cohort. Larger studies with longer followup interval are needed to confirm if baseline ADR is consistently lower compared to average ADR of US population undergoing screening colonoscopy263 Figure 1. Baseline characteristics