Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities
Department of Family Medicine and Community Health; Meyers Primary Care Institute
Medical Subject Headings
African Americans; Aged; Colonoscopy; Colorectal; Neoplasms; Delivery of Health Care; Early Detection of Cancer; European Continental Ancestry Group; Female; Genetic Predisposition to Disease; Healthcare Disparities; Humans; Incidence; Lung Neoplasms; Male; Mass Screening; Middle Aged; Ovarian Neoplasms; Prostatic Neoplasms; Randomized Controlled Trials as Topic; Risk Factors; Sigmoidoscopy; Socioeconomic Factors; United States
Health Services Research | Primary Care
BACKGROUND: It is unclear whether the disproportionately higher incidence and mortality from colorectal cancer among blacks compared with whites reflect differences in health-care utilization or colorectal cancer susceptibility.
METHODS: A total of 60, 572 non-Hispanic white and black participants in the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial underwent trial-sponsored screening flexible sigmoidoscopy (FSG) without biopsy at baseline in 10 geographically dispersed centers from November 1993 to July 2001. Subjects with polyps or mass lesions detected by FSG were referred to their physicians for diagnostic workup, the cost of which was not covered by PLCO. The records of follow-up evaluations were collected and reviewed. We used log binomial modeling with adjustment for age, education, sex, body mass index, smoking, family history of colorectal cancer, colon examination within previous 3 years, personal history of polyps, and screening center to examine whether utilization of diagnostic colonoscopy and yield of neoplasia differed by race.
RESULTS: Among 57 561 whites and 3011 blacks who underwent FSG, 13,743 (23.9%) and 767 (25.5%) had abnormal examinations, respectively. A total of 9944 (72.4%) whites and 480 (62.6%) blacks had diagnostic colonoscopy within 1 year following the abnormal FSG screening. When compared with whites, blacks were less likely to undergo diagnostic evaluation (adjusted risk ratio = 0.88, 95% confidence interval = 0.83 to 0.93). Overall, among subjects with diagnostic colonoscopy (n = 10 424), there was no statistically significant difference by race in the prevalence of adenoma, advanced adenoma, advanced pathology in small adenomas (high-grade dysplasia or villous histology in adenomas <10 >mm), or colorectal cancer.
CONCLUSIONS: We observed a lower follow-up for screen-detected abnormalities among blacks when compared with whites but little difference in the yield of colorectal neoplasia. Health-care utilization may be playing more of a role in colorectal cancer racial disparity than biology.
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Citation: J Natl Cancer Inst. 2010 Apr 21;102(8):538-46. Epub 2010 Mar 31. Link to article on publisher's site