Despite screening, black persons far more likely than whites to be diagnosed with colon cancer

1. In this study, interval colorectal cancer diagnoses were significantly higher in black patients compared to white patients.

2. The disparity between ethnicities was more pronounced for cancer of the distal colon and rectum.

Evidence Rating Level: 2 (Good)

Study Rundown: Colorectal cancer (CRC) is a significant health concern. As the third most common cancer among men and women, it is important that appropriate CRC screenings and screening intervals are in place. Despite guidelines regarding screening, 3-8% of diagnosed CRCs develop in between screening intervals. One of the challenges with screening intervals is that disparities exist in terms of CRC risk depending on ethnicity. For instance, within the black population in the United States, incidence rates of CRC are 22 to 27% higher than in white populations. Considering the high prevalence of CRC in the black population, the purpose of this study was to examine whether risk for interval CRC among Medicare patients differs by race/ethnicity. The study also aimed to assess whether this potential variation is accounted for by differences in the quality of colonoscopy. In general, the results of this study suggested that the risk for interval CRC was higher in black patients than white patients. This study has several limitations. Mainly, colonoscopy and polypectomy were identified using billing codes. Additionally, polyp detection rates were based on Medicare fee-for-service patients—these patients may not be representative all patient populations. Overall, this study suggests that there is a higher interval CRC risk in black persons than white persons.

Click to read the study, published today in the Annals of Internal Medicine

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In-Depth [prospective cohort]: In this population-based cohort study, 61 433 Medicare patients aged 66 to 75 were included in the study. Kaplan-Meier survival curves were then used to estimate the probability of interval CRC. Generally, black patients had a higher rate of interval CRC. The probability of interval CRC by the end of follow-up was 7.1% in black persons and 5.8% in white persons. Additionally, black persons had a higher risk for interval CRC (HR 1.31, 95%CI 1.13 to 1.51). This trend was further exaggerated in distal colon cancer (HR 1.56, 95%CI 1.00 to 2.11) and rectal cancer (HR 1.70, 95%CI 1.25 to 2.31).

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