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Findings support recommended colorectal cancer screening for blacks aged 45 to 49
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2010 Digestive Disease Week
NEW ORLEANS — Results of a study conducted at Temple University Hospital showed that the prevalence of polyps and their anatomical distribution was similar in average-risk blacks aged 45 to 49 and those aged 50 to 59, but that younger blacks were much more likely to evidence high-grade dysplasia.
This data supports the American College of Gastroenterology guidelines for colorectal cancer screening that recommend screening for average-risk blacks aged 45 to 49, said Frank K. Friedenberg, MD. Friedenberg, professor of gastroenterology at Temple University School of Medicine, discussed the data during a press conference at the 2010 Digestive Disease Week.
“If you look at the individuals under the age of 50 who develop colorectal cancer, it’s twice as likely that patient will be African American compared with a Caucasian,” Friedenberg said. “There are a number of lines of indirect evidence that we should be screening African-Americans at a younger age.”
Researchers reviewed the results of all complete colonoscopy exams with at least a good prep performed in average-risk black patients between the ages of 45 and 49. Patients had undergone colonoscopy at Temple Hospital from 2007 to 2008 (n=109). Patients with signs or symptoms of colorectal cancer, as well as those with a family history of the disease were excluded from the study.
The control group consisted of asymptomatic average-risk blacks aged 50 to 59 who completed a good quality colonoscopy during the same two years (n=226). Each patient was compared with two controls and researchers did not discover any cancers in either group.
Friedenberg said 22.3% of younger patients had polyps compared with 19.7% of the older cohort. Younger patients were also more likely to have polyps containing villous features (2.7% vs. 1.3%) and they were much more likely to have polyps with high-grade dysplasia (4.5% vs. 0.4%).
“Theoretically, there were several individuals walking around at age 45, 46, or 47 who would have waited three or four years for a colonoscopy,” he said. “By then they may have had a colon cancer.”
Prevalence of right-sided polyps was roughly 10% in both groups. In patients with adenomas, about 30% of both groups had evidence of more than one polyp.
Patients in the 50 to 59 group were more likely to drink alcohol (43.3% vs. 21.5%) and smoke (47.6% vs. 37.4%) compared with the younger group, but they were also more likely to take aspirin on a regular basis (26.1 vs. 13.5%). Friedenberg suggested that aspirin may have had a protective effect.
“We should be thinking about screening age 45 to 49 African-Americans,” Friedenberg said. “This needs to be studied on a larger scale, but I think what we’re seeing is real.” – by Jason Harris
When you compare African-Americans aged 45 to 49, they had the same number of polyps as people aged 50 to 59. This is confirmation of what we knew from the national databases: African-Americans develop adenomatous polyps earlier. Additionally, younger African-Americans are developing high-risk polyps, those that are more prone to become cancer. This study is a prospective confirmation of other data and strengthens the notion that we should be screening younger African-Americans.
– John Carethers, MD
Chair, Internal
Medicine, University of Michigan Medical School
For more information:
- Sankineni A. #M1528. Colorectal Cancer Screening in African Americans 45-49 years-old. Presented at: the 2010 Digestive Disease Week; May 1-6, 2010; New Orleans.
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