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Elderly blacks had higher rates of detection for adenomas, colorectal cancer
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2010 Digestive Disease Week
NEW ORLEANS — United States Preventive Services Task Force guidelines discourage routine screening for adults aged 75 years and older, but older blacks should undergo screening because researchers detected high rates of adenomas and colorectal cancers in those patients, results of a study conducted at the Brooklyn Hospital Center suggest.
Speaking at Digestive Disease Week 2010, Shashideep Singhal, MD, a resident in internal medicine at Brooklyn Hospital Center, said there are minimal data on screening in elderly patients, and minority patients are often under-represented in those studies.
“It seems that African-Americans older than 75 who have a history of advanced adenomas might be a reasonable group to target for awareness efforts and encouraging them to undergo screening,” Singhal said.
Researchers reviewed colonoscopy screening results for 510 black, Hispanic and Asian patients (mean age, 80.25 years). Blacks made up 76% of the cohort, Hispanics 22% and Asians 2%. Ten percent of patients had a history of colorectal cancer and 23.1% had a history of advanced adenomas.
The detection rate for advanced adenomas was 19.4%, and 17.5% of patients had one or two tubular adenomas. In patients with a history of advanced adenomas, the detection rate was 28% compared with 16.1% for those with no history of advanced adenomas or colorectal cancer.
Blacks had the highest detection rate for adenomas, at 20.1%. Advanced adenomas were detected in right side of colon in 66.2% of black patients. Distribution was equal in Hispanic patients.
The combined colorectal cancer detection rate was 2%. The rate for black patients was 2.3% compared with 0.8% for Hispanics. The detection rate for patients with a prior history of disease was 4.3% compared with 1.2% for patients without a prior history of advanced adenomas or colorectal cancer.
“Physicians treating elderly patients need to be aware of the significant risk of asymptomatic advanced adenomas for this population when considering screening recommendations, especially for African-American patients,” Singhal said. “Current national guidelines don’t account for the increased risk of some elderly racial groups.”
For more information:
- Singhal S. #W1465. Colonoscopy for CRC Screening in Asymptomatic Elderly African Americans, Hispanics and Asian Americans. Presented at: the 2010 Digestive Disease Week; May 1-6, 2010; New Orleans.
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