TITLE:
Confounders in Adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer
AUTHORS:
Yakira David, Lorenzo Ottaviano, Jihye Park, Sadat Iqbal, Michelle Likhtshteyn, Samir Kumar, Helen Lyo, Ayanna E. Lewis, Brandon E. Lung, Jesse T. Frye, Li Huang, Ellen Li, Jie Yang, Laura Martello, Shivakumar Vignesh, Joshua D. Miller, Michele Follen, Evan B. Grossman
KEYWORDS:
Colorectal, Cancer, Screening, Adenoma, Quality
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.10 No.4,
April
9,
2019
ABSTRACT: Background and Aims: The incidence and mortality of colorectal cancer is persistently highest
in Black/African-Americans in the United States. While access to care, barriers
to screening, and poverty might explain these findings, there in increased
interest in examining biological factors that impact the colonic environment.
Our group is examining biologic factors that contribute to disparities in
development of adenomas prospectively. In preparation for this and to
characterize a potential patient population, we conducted a retrospective
review of initial screening colonoscopies in a cohort of patients. Methods: A
retrospective review was performed on initial average risk screening
colonoscopies on patients (age 45 - 75 years) during 2012 at three institutions.
Descriptive statistics and multivariable logistic regression models were used
to examine the relationship between potential risk factors and the detection of
adenomas. Results: Of the 2225 initial screening colonoscopies 1495
(67.2%) were performed on Black/African-Americans and 566 (25.4%) on
Caucasians. Multivariable logistic regression revealed that older age, male
sex, current smoking and teaching gastroenterologists were associated with
higher detection of adenomas and these were less prevalent among Black/African-Americas
except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor
insurance was associated with adenoma detection. Conclusion: In this sample,
there was no association between race and adenoma detection. While this may be
due to a lower prevalence of risk factors for adenomas in this sample, our
findings were confounded by a lower detection rate by consultant
gastroenterologists at one institution. The study allowed us to rectify the
problem and characterize patients for future trials.