Differences in Colorectal Cancer Screening Rates Among Ethnic Groups

Abstract

Purpose: Colorectal cancer is the most common cause of preventable cancer death in the United States. Over the last decade, death rates from colon cancer have decreased due to the widespread implementation of colonoscopy/polypectomy. Unfortunately, many patients have not undergone this potentially life-saving procedure. Prior studies have shown that certain patient groups are an increased risk of morbidity and mortality from colorectal cancer screening. In order to better understand the role of gender, age, language and ethnicity, the following study was performed. Methods: All patients eligible for colorectal cancer screening seen during a 12 month period in a multi-ethnic clinic in Brooklyn, NY were studied. All patients were offered colorectal cancer screening by colonoscopy. Despite the multilingual nature of the clinic, translators were available. Colonoscopy referrals were made to a Gastroenterology clinic where multilingual translators were also available. Outcome was whether a colonoscopy was performed. Results: Two-thousand four hundred eighty seven patients eligible for colorectal cancer screening were seen in the clinic during the period off study, mean age 65.2 + 9.7 years, 1531 female, 956 male patients. 1105 were Caucasian, 631 Hispanic, 321 Asian, 199 African-American, 94 Indian, 78 Middle-eastern, 59 other. Almost 30 languages were spoken, including English, Arabic, Bengali, Chinese, Creole, French, Greek, Hebrew, Russian, Spanish, Urdu, Vietnamese, Italian and Hindi. Of the 2487 patients referred for colonoscopy for colorectal cancer screening, 1642 (66%) completed the examination within 6 months of referral. Women were more likely to undergo colonoscopy compared to men, 546/985 vs 299/657 (P= 0.03). Asians (118/321), Middle Eastern (32/78), Indian 41/94) and Caucasians (379/1105) were more likely to undergo colorectal cancer screening compared to African American (59/199) and Hispanic (190/631) patients (P < 0.02). Language and age of patients did not appear to play a significant role in undergoing colonoscopy (P > 0.05). Conclusion: We conclude that gender and race are important factors to consider when discussing colorectal cancer screening with patients. These results may explain gender and racial differences in colorectal cancer morbidity and mortality. Male patients, African- Americans and Hispanics may need additional attention from health care professionals when discussing colorectal cancer screening in order to increase compliance.