An Elevated Rate of Adenoma Detection in an Urban Latin American Population Undergoing Colorectal Cancer Screening

Abstract

Purpose: Colorectal cancer is the second leading cause of cancer death in the United States. African Americans (AA) are known to have an elevated rate of colonic neoplasms compared to the general population. There is limited data on Latin Americans (LA) undergoing screening colonoscopies with respect to the incidence and location of neoplasms. We retrospectively reviewed screening colonoscopies performed at an inner city university hospital that serves a predominately minority population to detail colon polyp size, distribution, and pathology with respect to ethnicity. Methods: There were a total of 2,698 colonoscopies performed at the University Hospital in Newark, NJ from 2005–2006. Of these, 756 were screening colonoscopies performed on patients who were asymptomatic. These cases were analyzed for presence, location, size, and pathology of polyps with respect to patient ethnicity. Results: Of the 756 screening colonoscopies, 287 (38%) were performed in LA and 331 (44%) in AA. In LA, 112 patients (39%) were found to have at least one polyp. This was not significantly different from AA (145 patients; 44%). Additionally, 56 (19%) LA were found to have a right-sided lesion (proximal to the splenic flexure), which was comparable to AA (64 patients; 19%). Significant pathology was defined as adenomatous change (AD), tubular adenoma (TA), tubulovillous adenoma (TVA), villous adenoma, or carcinoma (CA). Of the AA patients screened, 67 (46%) had pathologically significant lesions (5 AD, 53 TA, 6 TVA, and 3 CA). LA had a similar incidence (54 patients; 48%) and distribution of pathologically significant lesions (2 AD, 47 TA, 5 TVA, 0 CA). The percentage of pathologically significant right-sided polyps were similar in AA (40 patients, 62%) and LA (32 patients, 57%). Of note, AA were significantly more likely to have a large (> 1 cm) polyp than LA (8.5% vs. 3.1%, P < .01), and were more likely to have a large right sided colonic polyp (4.6% vs. 1.7%, P= .07). Conclusion: This study provides evidence that LA undergoing screening colonoscopy have a higher than expected incidence of colonic polyps, pathologically significant lesions, and pathologically significant right-sided lesions. These findings were similar to those of AA, a known high-risk group. Our study suggests that screening guidelines for LA should reflect those for AA and warrants further prospective trials.