Abstract
The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there is increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45-75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance were associated with adenoma detection. In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.
Highlights
Colorectal Cancer (CRC) is the fourth most common cancer in the United States (US) and second most lethal [1]
Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/AfricanAmericas except for age
While rates of colonoscopy completion have been used as measures of success of these programs, this finding in our study indicates the importance of continued surveillance of the quality of these colonoscopies to ensure that the optimal benefit is being achieved
Summary
Colorectal Cancer (CRC) is the fourth most common cancer in the United States (US) and second most lethal [1]. Multiple studies have reported increased risk of colon cancer regardless of racial group to be associated with age, male sex, family history in a first degree relative, smoking, as well as diabetes mellitus and BMI which can be a reflection of diet and activity level [9] [10]. Inflammatory processes are associated with colon tumorigenesis [11] We hypothesize that these factors contribute to a higher incidence of precancerous colon polyps and sought to characterize the impact of these factors in our patients. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients.
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