Stacey A. Fedewa, PhD, MPH; W. Dana Flanders, MD, DSc; Kevin C. Ward, PhD, MPH; Chun Chieh Lin, PhD; Ahmedin Jemal, DVM, PhD; Ann Goding Sauer, MSPH; Chyke A. Doubeni, MD, MPH *; Michael Goodman, MD, MPH *
Disclaimer: This study used the linked SEER–Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. Dr. Doubeni is a member of the U.S. Preventive Services Task Force (USPSTF). This article does not necessarily represent the views and policies of the USPSTF.
Acknowledgment: The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services; and the SEER Program tumor registries in the creation of the SEER–Medicare database.
Funding Source: Data analysis for this research was supported by the American Cancer Society. Dr. Doubeni's contribution was supported by an award (U01CA151736) from the National Cancer Institute of the National Institutes of Health.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1154.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Fedewa (e-mail, email@example.com).
Requests for Single Reprints: Stacey A. Fedewa, PhD, MPH, American Cancer Society, 250 Williams Street, 6th Floor, Atlanta, GA 30303; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Fedewa, Lin, and Jemal and Ms. Sauer: American Cancer Society, 250 Williams Street, Atlanta, GA 30303.
Drs. Flanders, Ward, and Goodman: Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322.
Dr. Doubeni: Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, PPMC Andrew Mutch Building, Floor 7, 51 North 39th Street, Philadelphia, PA 19104.
Author Contributions: Conception and design: S.A. Fedewa, C.A. Doubeni, M. Goodman.
Analysis and interpretation of the data: S.A. Fedewa, W. Flanders, A. Jemal, C.A. Doubeni, M. Goodman.
Drafting of the article: S.A. Fedewa, A. Goding Sauer.
Critical revision for important intellectual content: S.A. Fedewa, W. Flanders, C.C. Lin, A. Jemal, C.A. Doubeni, M. Goodman.
Final approval of the article: S.A. Fedewa, C.A. Doubeni, W. Flanders, A. Goding Sauer, M. Goodman, A. Jemal, Chun Chieh Lin, K. Ward.
Statistical expertise: S.A. Fedewa, W. Flanders.
Obtaining of funding: S.A. Fedewa, C.A. Doubeni.
Administrative, technical, or logistic support: S.A. Fedewa, A. Jemal, C.C. Lin, C.A. Doubeni.
Collection and assembly of data: S.A. Fedewa, C.A. Doubeni.
Interval colorectal cancer (CRC) accounts for 3% to 8% of all cases of CRC in the United States. Data on interval CRC by race/ethnicity are scant.
To examine whether risk for interval CRC among Medicare patients differs by race/ethnicity and whether this potential variation is accounted for by differences in the quality of colonoscopy, as measured by physicians' polyp detection rate (PDR).
Population-based cohort study.
Patients aged 66 to 75 years who received colonoscopy between 2002 and 2011 and were followed through 2013.
Kaplan–Meier curves and adjusted Cox models were used to estimate cumulative probabilities and hazard ratios (HRs) of interval CRC, defined as a CRC diagnosis 6 to 59 months after colonoscopy.
There were 2735 cases of interval CRC identified over 235 146 person-years of follow-up. A higher proportion of black persons (52.8%) than white persons (46.2%) received colonoscopy from physicians with a lower PDR. This rate was significantly associated with interval CRC risk. The probability of interval CRC by the end of follow-up was 7.1% in black persons and 5.8% in white persons. Compared with white persons, black persons had significantly higher risk for interval CRC (HR, 1.31 [95% CI, 1.13 to 1.51]); the disparity was more pronounced for cancer of the rectum (HR, 1.70 [CI, 1.25 to 2.31]) and distal colon (HR, 1.45 [CI, 1.00 to 2.11]) than for cancer of the proximal colon (HR, 1.17 [CI, 0.96 to 1.42]). Adjustment for PDR did not alter HRs by race/ethnicity, but differences between black persons and white persons were greater among physicians with higher PDRs.
Colonoscopy and polypectomy were identified by using billing codes.
Among elderly Medicare enrollees, the risk for interval CRC was higher in black persons than in white persons; the difference was more pronounced for cancer of the distal colon and rectum and for physicians with higher PDRs.
American Cancer Society.
Fedewa SA, Flanders WD, Ward KC, et al. Racial and Ethnic Disparities in Interval Colorectal Cancer Incidence: A Population-Based Cohort Study. Ann Intern Med. 2017;166:857–866. [Epub ahead of print 23 May 2017]. doi: https://doi.org/10.7326/M16-1154
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Published: Ann Intern Med. 2017;166(12):857-866.
Published at www.annals.org on 23 May 2017
Colonoscopy/Sigmoidoscopy, Colorectal Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer, Healthcare Delivery and Policy.
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