Should Recent Immigrants to the US From Areas with Low Incidence of Colorectal Cancer (CRC) Undergo a Screening Colonoscopy?

Abstract

Should Recent Immigrants to the US From Areas with Low Incidence of Colorectal Cancer (CRC) Undergo a Screening Colonoscopy? Ari Wiesen, Daniel Gelrud, Charles Hall, Daniel Mishkin Purpose: The incidence of CRC is low in Africa and parts of Asia when compared to the Western hemisphere. The aim of this study was to determine the prevalence of colorectal neoplasia in average risk recent immigrants from Africa and the Indian subcontinent compared to a group of average risk local residents of mostly Hispanic and African American origin referred for screening colonoscopy. Methods: We analyzed the records of people undergoing CRC screening from January 2002 to October 2004. We identified average risk patients that were self-described as Indian, Pakistani, African or Asian from the database of 3 inner-city teaching hospitals (study group); most of these patients in our community are recent immigrants. As a reference group, we used 440 consecutive average risk local residents referred for screening colonoscopy. The majority of our local residents consist of Hispanics and African Americans. We compared the incidence of adenomas, carcinomas, distribution of lesions as well as other demographic variables. Results: We identified 156 patients in the study group. Eighty-four were females (54%) and 72 were males (46%) with a mean age of 58.5 years. Patients were from Africa (30.8% nZ 48), India and Pakistan (41% nZ 64), and Asia (28.2% n Z 44). One (0.6%) adenocarcinoma, and 16 (10.3%) adenomas were found in the study group. Ten (62.5%) of the lesions were found proximal to the splenic flexure. Only one (0.6%) adenoma was larger than 1 cm. In comparison, the control group had 294 females (67%) and 146 males (33%) with a mean age of 60.6 years. Three (0.6%) adenocarcinomas and 87 (19.7%) adenomas were found. Fifty four (62%) of the lesions were proximal to the splenic flexure. Nineteen (4.3%) adenomas were larger than 1 cm in the control group. When compared to the control group, the study group had a significantly lower overall proportion of patients with adenomas (p Z 0.01), and a lower proportion of females screened (p Z 0.01). The difference in adenocarcinomas, adenomas greater than 1 cm and proximal lesions did not reach significance. Conclusion: Although our study group of mostly recent immigrants had a higher proportion of males, it nevertheless had a lower incidence of adenomas when compared to our traditional population of Abstracts