Risk Factors for Colorectal Cancer in African Americans: Supporting the Rationale for Early Screening

Abstract

Purpose: African Americans have the highest colorectal cancer incidence and mortality rates in the U.S. with an earlier age at diagnosis. The distribution of colonic tumors is reported to be more right sided making screening colonoscopy the tool of choice in this population. This study looks at demographics and patterns of colon cancer in a typical inner city African American population. Methods: Adult patients who underwent surgery for colon cancer between 2004 and 2012 were enrolled in this retrospective study. We recorded demographics, tumor location and histology, and presence of metastases. Data were analyzed using SPSS; results are shown as median (range). Results: 640 subjects underwent surgery for colon cancer during the study period. 515 (81%) subjects were African American (AA) with 57% females. The median age at time of surgery was 67 (range 25-97). 61% of the AA group who underwent surgery were female compared to 42% in the White (W) group (p<0.001).There were no differences noted in age, BMI, presence of diabetes mellitus, history of smoking or drinking, family history of colon cancer, and presence of metastatic disease. Tumors tended to be located more proximally in the AA group compared to the W group, although the difference did not reach statistical significance (p=0.07). Conclusion: This study indicates that a majority (57%) of AA undergoing surgery for colorectal cancer were female. This finding is contrary to prior studies showing higher colon tumor predilection among AA males. AA females also were at significantly higher percentage than W females in our cohort. The trend towards right sided lesions in AA, seen in previous studies, was confirmed. There were no significant differences between the AA and W subjects in terms of risk factors, and supports the need for access, improved health education, and participation in early screening in the African-American population.