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Race, Sex, and Age Differences in the Prevalence of Colon Polyps

Large polyps are more common in blacks, men, and older patients.

The incidence of colorectal cancer (CRC) is roughly 20% higher in blacks than in whites, and associated mortality is roughly 40% higher in blacks. Researchers used a national database of gastroenterology patients to evaluate prospective data on 80,061 whites and 5464 blacks (approximately equal numbers of men and women) who underwent screening colonoscopies.

The prevalence of polyps (1 cm in diameter) was 7.7% in blacks and 6.2% in whites. White women had significantly lower risk than did white men (odds ratio, 0.59 for women), but risk was similar in black women and black men. Compared with white women, black women had significantly higher risk (OR, 1.62); compared with white men, black men had significantly higher risk (OR, 1.16). As expected, the prevalence of large polyps increased with age in all groups.

Comment: Some organizations, such as the American Cancer Society, recommend the initiation of colorectal screening at age 50 for all average-risk patients; however, the American College of Gastroenterology recommends that screening start earlier in blacks — at age 45. Although these new data appear to support the ACG recommendation, no hard evidence shows that beginning screening at age 45, compared with beginning at age 50, would lower colorectal cancer mortality in blacks. Editorialists suggest that this study is an example of many to come that will focus on defining personalized screening recommendations.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine September 25, 2008

Citation(s):

Lieberman DA et al. Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients. JAMA 2008 Sep 24; 300:1417.

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Roy HK and Bianchi LK. Colorectal cancer risk: Black, white, or shades of gray? JAMA 2008 Sep 24; 300:1459.

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• Medline abstract (Free)

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• colorectal screening
  Walter J. Lee, 27 Apr 2009 4:16 PM EST
  Recommendations are considered in "standard of care" quotations by attorneys. Why are these ridiculous "health plans" making it difficult to... [more]