Can Eth­nic Back­ground In­crease Risk?

Study re­veals Blacks and His­pan­ics are at a higher risk for pre­can­cer­ous col­orec­tal polyps.

Wellness Update - - Hiv -

Blacks and His­pan­ics have a sig­nif­i­cantly higher risk of de­vel­op­ing pre­can­cer­ous col­orec­tal polyps com­pared with whites, ac­cord­ing to a study by re­searchers at NewYork – Pres­by­te­rian Hospi­tal/ Columbia Univer­sity Med­i­cal Cen­ter. The find­ings ap­peared in the on­line edi­tion of Al­i­men­tary Phar­ma­col­ogy and Ther­a­peu­tics.

“Our data sug­gest that we need to re­dou­ble our ef­forts to in­crease colon can­cer screen­ing in ar­eas with large num­bers of racial and eth­nic mi­nori­ties,” said lead au­thor Ben­jamin Leb­wohl, MD, MS, as­sis­tant pro­fes­sor of clin­i­cal medicine and epi­demi­ol­ogy at NewYork – Pres­by­te­rian Hospi­tal/ Columbia Univer­sity Med­i­cal Cen­ter and Columbia Univer­sity’s Mail­man School of Pub­lic Health.

The study also found that blacks and His­pan­ics have a higher risk of de­vel­op­ing polyps in the up­per por­tion of the colon, com­pared with whites. “Th­ese le­sions would have been missed had th­ese pa­tients un­der­gone sig­moi­doscopy, which ex­am­ines only the lower half of the colon,” said Dr. Leb­wohl. “There­fore, colonoscopy, which ex­am­ines the en­tire colon, may be prefer­able to sig­moi­doscopy as a screen­ing test for blacks and His­pan­ics.”

Col­orec­tal can­cer caused an es­ti­mated 51,370 deaths in 2010 – the last year for which data are avail­able. This type of can­cer is largely pre­ventable if caught early, in the form of pre­can­cer­ous polyps, or ade­no­mas. Such polyps are ef­fec­tively treated with re­moval dur­ing colonoscopy.

The re­searchers looked at rates of ad­vanced ade­no­mas — polyps 10 mm or larger that ex­hib­ited ag­gres­sive features un­der mi­cro­scopic ex­am­i­na­tion. “Th­ese are the kinds of polyps that we are most con­cerned may even­tu­ally de­velop into can­cer,” said Fay Kas­tri­nos, MD, MPH, as­sis­tant pro­fes­sor of clin­i­cal medicine at NewYork – Pres­by­te­rian Hospi­tal/Columbia Univer­sity Med­i­cal Cen­ter and se­nior au­thor of the study. “We found that blacks and His­pan­ics were roughly twice as likely to have ad­vanced ade­no­mas, com­pared with whites, af­ter ad­just­ing for fac­tors such as age and fam­ily his­tory.”

Pre­vi­ous stud­ies had shown that col­orec­tal can­cer in­ci­dence and mor­tal­ity are higher in blacks than in whites, and that blacks are typ­i­cally younger at the time of di­ag­no­sis than are whites. Lit­tle was known about the risk of ade­no­mas among His­pan­ics.

In the cur­rent study, the first to com­pare ade­no­mas in white, blacks, and His­pan­ics, the in­ves­ti­ga­tors an­a­lyzed data from 5,075 men and women age 50 or older who un­der­went first-time colonoscopy at NewYork – Pres­by­te­rian Hospi­tal/Columbia Univer­sity Med­i­cal Cen­ter from 2006 to 2010. The study pop­u­la­tion was 70 per­cent white, 18 per­cent His­panic, and 12 per­cent black, with a mean age of 62. None of the sub­jects had signs or symp­toms of colon can­cer at the time of screen­ing. At least one ade­noma was de­tected in 19 per­cent of whites, 22 per­cent of His­pan­ics, and 26 per­cent of blacks, the re­searchers re­ported.

The find­ings run counter to ex­ist­ing statis­tics show­ing that His­pan­ics have a lower rate of colon can­cer com­pared with whites. “Sur­pris­ingly, we found that His­pan­ics have a slightly higher rate of pre­can­cer­ous polyps,” said Dr. Leb­wohl. “This adds to other re­cent ev­i­dence that the rate of col­orec­tal can­cer among His­pan­ics may be in­creas­ing with ac­cul­tur­a­tion.

Doc­tors gen­er­ally ad­vise pa­tients to get an ini­tial screen­ing test at age 50, when over­all rates of colon can­cer be­gin to in­crease. -This in­for­ma­tion pro­vided courtesy of Columbia Univer­sity Med­i­cal Cen­ter

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