S3100 Racial Disparity of Gender Difference in Prevalence of Adenomatous Polyps

Abstract

INTRODUCTION: The risk for colorectal cancer (CRC) varies based on multiple risk factors including race and gender. Although male gender and African American (AA) race are more likely to be diagnosed with colon cancer, it is not clear where in the adenoma progression to cancer these risks are manifested. Variations of the prevalence of adenomatous polyps in different patient populations have the potential to affect screening recommendations. Using patients from an urban medical center endoscopy suite, we evaluated the influence of race on adenoma detection rate by gender. METHODS: We identified 709 patients whose screening colonoscopy was performed by academic gastroenterologists. The study was limited to academic GI physicians since in our institution, their rate of adenoma detection was higher (46% of patients) as compared to non-Academic GI physicians (24%) and surgeons (14%). A retrospective electronic chart review was conducted for the 630 (89%) AA and 79 (11%) non-AA. There was no difference in age by race or gender (59 years of age; range 46-73 years). The BMI (kg/m2) was slightly higher in females as compared to males (31.2+/-0.4 vs 28.7+/-0.39 P < 0.001) but was not different by race (30.2 vs 28.6). ADR was the number of patients with at least 1 adenoma divided by the total number of patients. RESULTS: ADR was higher in AA males as compared to females(51% vs 35%; Odds Ratio = 1.9 P < 0.001 Pearson chi-square). In contrast, the ADR was similar by gender for non-AA (38% vs 40%; OR = 0.9 P > 0.05) (Table 1). The role of body weight on gender differences was variable with the major gender difference being in overweight (BMI 25-30) AA patients. When evaluated for effect of age, the AA males were more likely to have adenomas detected as compared to females both above and below the age of 60 years. CONCLUSION: This study demonstrated that in contrast to Non-AA, African American males are more likely to have an adenoma as compared to females in screening populations. The reason Non-AA individuals do not have a gender difference is puzzling given the known risk of gender for CRC. However, larger sample of Non-AA patients may generate a statistical difference. Other reasons might be related to geographical difference in the prevalence of the adenomas or the fact most of our population was in the middle range of BMI (ie overweight).Table 1.: Odd’s Ratio and ADR for Male and Female Patients by Race