Colorectal Cancer Prevalence and Adherence to Colon Cancer Screening in Asian Patients: A Single-Center, Cross-Sectional Study

Abstract

Introduction: Colorectal cancer (CRC) incidence varies globally and is highest in North America, Europe, Australia and lower in South/Central Asia (although the incidence is rising). Colonoscopy, flexible sigmoidoscopy, fecal occult blood test provide benefit in CRC prevention. Genetic, environmental factors, adherence to the CRC screening differ among ethnic groups. The aim of the study is to compare CRC screening and CRC prevalence between Asian patients and Caucasian English-speaking patients receiving care in the large community-based multispecialty group. Methods: Adults over 18 years of age were included if they had a primary care physician (PCP) within Palo Alto Medical Foundation system for at least 3 years, and had at least one PCP visit with within the past 2 years. Racial/ethnic groups were identified based on patient-reported race, Hispanic ethnicity, ancestry, and language preference. The reference group consisted of Caucasian English-speaking patients. Asian patients were sub-classified as Chinese, Filipino, Japanese, Korean, South Asian, or Vietnamese. Patients 50-75 years of age were classified as currently being compliant/not compliant with AGA guidelines for CRC screening. History of colon polyps, CRC, BMI, and other data were obtained from patients’ electronic health records. Odds ratios/mean differences were used to compare each Asian group/subgroup with the reference group, after age and gender adjustment. Results: Asian patients had significantly lower BMI than did the reference group (24.7 kg/m2vs. 26.9 kg/m2; p<0.05) (Table 1). Asian patients overall, and Vietnamese, Chinese, and Japanese patients, were significantly more likely, but South Asian patients significantly less likely, than reference group patients to be adherent to CRC screening guidelines (p<0.05). Asian patients, overall, had a lower prevalence of colon polyps (9.1% vs 18.4%) and colon cancer (3.4% vs 5.7%) compared to the reference group. Japanese patients, however, had the highest prevalence of colon polyps (18.9%, OR 1.03; pp<0.05). Conclusion: Japanese patients had the highest prevalence of CRC and were more likely to be receiving recommended CRC screening when compared to Caucasian, English speaking group. CRC screening in South Asian patients remains challenging; cultural barriers may play a role. Additional studies are needed to identify sources of disparities and to develop appropriate educational materials and interventions.301 Figure 1 No Caption available.