Discrepancy in colonoscopy screening among ethnic groups

Issue: May 10, 2008

Compared with whites, blacks with first-degree relatives who have colon cancer are less likely to undergo colonoscopy screening.

Researchers from Tennessee and Maryland analyzed 41,830 participants from the Southern Community Cohort Study to determine the number of colonoscopy procedures among individuals with strong family histories of colon cancer and whether discrepancies exist among races.

Of those with first-degree relatives diagnosed with colon cancer before the age of 50 years, 27.3% of blacks reported a colonoscopy within the past five years, compared with 43.1% of white participants (P<.001), according to the study. After adjustments and compared with white participants, blacks had an OR of 0.51 (95% CI, 0.38-0.68) for undergoing recommended screening measures.

Compared with whites, blacks who had undergone endoscopy and had several affected first-degree relatives diagnosed before age 50 years were less likely to report a history of colon polyps (OR, 0.29; 95% CI, 0.20-0.42), according to the study. – by Stacey L. Adams

Arch Intern Med. 2008;168:625-631.

While blacks have a higher incidence of colorectal cancer, etiology underneath is not clear, though it may be related to ethnicity, genetics, diet and compliance or availability of preventive measures. One thing that is clear is that colonoscopy prevents colon cancer and saves lives. This is something that professionals can compare to other factors related to causation of colon cancer where we have limited data or much less to offer at the moment, such as genetic differences.

This study brings alarm to physicians and people (both non-patients and patients), as well as to our system and society, for a need to enhance awareness of colon cancer, both publically and in our clinics, as well as the need to implement better methods to follow high-risk (irrespective of race) patients. They say to strike while the iron is hot, so the best time to counsel family members is when someone related to them is diagnosed with colon cancer. Moreover, the need for simple, patient-friendly tests is warranted, and stool DNA tests may be one of the hopes to overcome this hurdle.

– M. Wasif Saif, MD, MBBS

Associate Professor and Co-Director
Gastrointestinal Cancers Program, Yale Cancer Center

Blacks have the highest risk of developing colon cancer, followed by whites, Asians and Hispanics. This study shows that blacks who have a significant family history are less likely to undergo colonoscopy than whites. We need to develop culture-sensitive tools to educate about screening and identify the higher-risk populations. There are many organizations and sources for information on the prevention of colon cancer, but they are not addressing the differences in cultural background and its impact for cancer screening. For example, initiatives such as the Stennis Foundation in Los Angeles are trying to increase awareness of colon cancer screening in the black community through their churches.

The data are very interesting since there was no difference in the insurance status between blacks and whites; however, there were significant differences in income and education. Not only were blacks less likely to undergo colonoscopy, but they were also less likely to consider chemoprevention strategies such as aspirin, calcium, folic acid or physical exercise. Blacks were also less likely see their doctor for a checkup. This study suggests that we need better educational tools directed to the need of the black community, and we need to recognize culture differences in how cancer screening and prevention education are being developed. There is no ‘one size fits all’ approach for education.

– Heinz- Josef Lenz, MD

Associate Director
Norris Gastrointestinal Oncology Program, University of Southern California