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Original Research |

Prevalence of Advanced Colorectal Neoplasia in White and Black Patients Undergoing Screening Colonoscopy in a Safety-Net Hospital

Paul C. Schroy III, MD, MPH; Alison Coe, MA; Clara A. Chen, MHS; Michael J. O’Brien, MD, MPH; and Timothy C. Heeren, PhD
[+] Article, Author, and Disclosure Information

From Boston University School of Medicine and Boston University School of Public Health, Boston, Massachusetts.

Acknowledgment: The authors thank Shamini R. Mylvanaman, MPH; Maria A. Lydotes, BS; Patricia A. Robinson, BSN; Julie T. Davis, MPH; Tania Medeiros, MPH; Carolyn Borsch, MPH; and Jennifer Farraye, MSN, for their assistance with data acquisition. They also thank Linda Rosen, MSEE, for her technical support.

Grant Support: By the National Cancer Institute (grant R01 CA13119; Dr. Schroy).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2733.

Reproducible Research Statement: Study protocol: Not available. Statistical code: Available from Dr. Schroy (e-mail, paul.schroy@bmc.org). Data set: Certain portions of the deidentified analytic data set are available to approved individuals through written agreements with the author.

Requests for Single Reprints: Paul C. Schroy III, MD, MPH, Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02118; e-mail, paul.schroy@bmc.org.

Current Author Addresses: Dr. Schroy: Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02118.

Ms. Coe: Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02118.

Ms. Chen: Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118.

Dr. O’Brien: Department of Anatomic Pathology, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118.

Dr. Heeren: Department of Biostatistics, University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118.

Author Contributions: Conception and design: P.C. Schroy.

Analysis and interpretation of the data: P.C. Schroy, C.A. Chen, M.J. O’Brien, T.C. Heeren.

Drafting of the article: P.C. Schroy, C.A. Chen.

Critical revision of the article for important intellectual content: P.C. Schroy, M.J. O’Brien, T.C. Heeren.

Final approval of the article: P.C. Schroy, C.A. Chen, T.C. Heeren.

Statistical expertise: T.C. Heeren.

Obtaining of funding: P.C. Schroy.

Collection and assembly of data: A. Coe, M.J. O’Brien.

Ann Intern Med. 2013;159(1):13-20. doi:10.7326/0003-4819-159-1-201307020-00004
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Chinese translation

Background: Black persons are more likely than white persons to be diagnosed with colorectal cancer and to die from it. The extent to which genetic or biological factors versus disparities in screening rates explain this variance remains controversial.

Objective: To define the prevalence and location of presymptomatic advanced colorectal neoplasia (ACN) among white and black persons undergoing screening colonoscopy, controlling for other epidemiologic risk factors.

Design: Cross-sectional survey between 22 March 2005 and 31 January 2012.

Setting: Urban, open-access, academic, safety-net hospital in Massachusetts.

Participants: Asymptomatic, average-risk white (n = 1172) and black (n = 1681) persons aged 50 to 79 years undergoing screening colonoscopy.

Measurements: Adjusted prevalence and location of ACN, defined as a tubular adenoma 10 mm or more in size, any adenoma with villous features or high-grade dysplasia, any dysplastic serrated lesion, or invasive cancer.

Results: The prevalence of ACN was higher among white patients than black patients (6.8% vs. 5.0%; P = 0.039) but varied by sex (white vs. black men, 9.3% vs. 5.7%; white vs. black women, 3.5% vs. 4.3%; interaction P = 0.034). After controlling for many risk factors, black men were 41% less likely than white men (adjusted odds ratio [AOR], 0.59 [95% CI, 0.39 to 0.89]) to have ACN. No statistically significant difference was seen for women (AOR, 1.32 [CI, 0.73 to 2.40]). Black patients with ACN had a higher percentage of proximal disease (52% vs. 39%) after adjustment for age and sex (P = 0.055).

Limitation: Single-institution study with inadequate statistical power for subgroup analyses and recall bias.

Conclusion: Black men are less likely than white men to have ACN at screening colonoscopy in a safety-net health care setting. Disparities in access to screening and differential exposure to modifiable risk factors rather than genetic or biological factors may be largely responsible for the higher incidence of CRC among black men. Genetic or biological factors may explain the predilection for proximal disease.

Primary Funding Source: National Cancer Institute.




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