S3120 African Americans Are Less Frequently Assessed for Hereditary Colon Cancer

Abstract

INTRODUCTION: Approximately 5% of colorectal cancer (CRC) results from hereditary cancer syndromes. Identification of individuals at increased risk for CRC is important to determine initiation, frequency, method of screening and referral for genetic counselling. A detailed family history is recommended as an initial component of cancer risk assessment. African-Americans (AA) are more often diagnosed with CRC, have more advanced disease and greater mortality rate. There is limited data on screening of AA for hereditary CRC. This study evaluated the rate of hereditary CRC risk assessment in AA and white patients in a university GI clinic. METHODS: A chart review of all self-described AA and white patients referred for CRC screening in a university GI clinic during a 3 month period was performed. Patient gender, age and documentation of multi-generational family medical history (3 + generations) were obtained. Amsterdam II Criteria, Bethesda Criteria and Colorectal Cancer Risk Assessment Tool were used to determine which patients had family histories that warrant genetic counseling and referrals. Statistical analysis was performed using Fisher’s Exact Test with significance set at P < 0.05. The study was IRB approved. RESULTS: 715 medical records were reviewed. There were 452 AA (276 females, 176 males; mean age 60.2) and 263 whites (123 females, 140 males; mean age 59.4). A multi-generational family history was obtained in 62 AA (13.7%; 47 females, 15 males) and 58 whites (22.1%; 37 females, 21 whites). There was a significant difference (P = 0.0050) in the rate at which a detailed family history is obtained AA and whites. There was no significant difference (P = 0.7915) in the rate at which AA (36, 58.1%; 30 females, 6 males) and whites (29, 50%; 19 females, 10 males) qualified for genetic counselling. There was no significant difference (P = 0.7586) in the referral rate of qualified AA (7, 19.4%; 6 females, 1 male) and whites (8; 27.6%; 6 females, 2 males) for genetic testing. CONCLUSION: This study revealed that CRC risk assessment with detailed family medical histories was inconsistently performed in all patients. There was a significantly lower rate of obtaining multi-generational family medical histories in AA. Additionally, there was insufficient referrals of all patients for genetic counselling and testing. It is important that there is appropriate identification of individuals at increased risk for hereditary cancer syndromes, with special attention to decreasing potential disparities in care.