Racial Differences in Colorectal Adenomas at Screening Colonoscopy in the United States

Black Americans experience a higher incidence of colorectal cancer than Whites despite undergoing prevention screenings similar to those of Whites since 2010. We compared the colorectal adenoma status of Black and White patients at screening colonoscopy, a measure of colorectal cancer risk.

Using cross-sectional, observational data, we studied colorectal adenomas at first-time screening colonoscopy in average-risk patients aged 40 to 89 years, screened between September 2001 and July 2016 in South Carolina. We analyzed the age-adjusted odds of Black men and women (vs. White) having adenomas, advanced adenomas, ≥3 nonadvanced adenomas, and right hyperplastic polyps, and compared their total polyp burden (the sum of the diameters of all adenomas and right polyps detected).

Among 28,100 patients (58.4% Black and 53.8% women), we found that Black patients had lower age- and gender-adjusted odds than White patients of having adenoma (OR = 0.88, P < 0.01) and right hyperplastic polyp (OR = 0.74, P < 0.01), with a similar pattern within gender groups. Black and White patients were similar about advanced adenoma and 3+ nonadvanced adenoma. Among patients with lesions, mean polyp burden ranged from 8.5 mm (±7.2) for Black women aged 40 to 49 years to 12.3 mm (±7.4) for Black men aged more than 70 years. Age-adjusted polyp burden was 0.4 mm higher for Black men than for White men and 0.3 mm lower for Black women than for White women patient groups (P < 0.01).

In a large, racially balanced patient sample, Black and White patients showed similar polyp profiles.

Given similar adenoma status, other evidence-supported clinical factors associated with suboptimal polyp detection should be explored to understand the continuing colorectal cancer disparities affecting Black Americans.