Mo1062 Adenoma Prevalence and Distribution Among U.S., Puerto Ricans, and Dominicans Undergoing Screening Colonoscopy: A Prospective Cohort Study

Abstract

Background: Latinos in the U.S. represent a heterogeneous amalgam of subgroups varying in genetic background, culture, and socioeconomic status. Colorectal cancer is the second leading cancer diagnosed among U.S. Latinos. Little is known about the pathological findings at screening colonoscopy (SC) among Latino subgroups. Aim: To determine the prevalence and distribution of histologically confirmed adenomas found at SC among asymptomatic, average-risk U.S.-dwelling Puerto Ricans and Dominicans. Methods: An IRB-approved prospective cohort study was conducted at an academic medical center in New York City using patient navigation to decrease barriers to SC among Latinos. Primary care physicians directly referred patients to SC from 5/2008-12/2011. Participant eligibility included asymptomatic, average-risk Latinos aged ≥ 50, without colorectal cancer screening within the past 5 years, and without significant comorbidities. Statistical analyses were performed on SC findings, characterized by the most advanced lesion on histology, and socio-demographic factors. Results: Of the 461 referrals that qualified for the patient navigation program, 392 were successfully navigated, and 314 completed their SC. Of these, 251 were Puerto Rican (n=194) or Dominican (n=57) with a mean age of 59.4 years and 73.3% women. At least one adenoma was detected in 30.9% of Puerto Ricans and 22.8% of Dominicans (p=NS). Proximal adenomas, with or without distal lesions, were present in 23.7% of Puerto Ricans and 21.1% of Dominicans (p=NS). The prevalence of advanced adenomas (size ≥ 1 cm, any villous component, high-grade dysplasia, or cancer) was 13.4% in Puerto Ricans and 7.0% in Dominicans (p=NS), and the prevalence of proximal advanced adenomas was 10.8% in Puerto Ricans and 7.0% in Dominicans (p=NS). On multivariate regression analysis (Tables), after adjusting for sex, age, nationality, language, education, and smoking status, Puerto Ricans had an increased prevalence of advanced adenomas (odds ratio [OR] 4.12; 95% confidence interval [CI] 1.04-16.42; p=0.04), and a trend toward increased prevalence of adenomas (OR 2.41; 95% CI 0.99-5.86; p=0.05) and proximal advanced adenomas (OR 3.42; 95% CI 0.83-14.10; p=0.09) compared to Dominicans. Notably, compared to English and bilingual speakers, Spanish speakers had higher rates of advanced adenomas and proximal advanced adenomas. Conclusions: Puerto Ricans had an increased prevalence of advanced adenomas and a trend toward increased prevalence of adenomas and proximal advanced adenomas compared to Dominicans. Both subgroups had high rates of neoplasia relative to rates found at SC among U.S. whites (Aliment Pharmacol Ther. 2012;35:1467). These data underscore the importance of better understanding colorectal cancer risk patterns among U.S. Latino subgroups, and promoting screening among those at higher risk.