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

Yuqi Wu1, Piet C de Groen2, Nabil Natafgi1

  • 1Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina.

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
|March 10, 2025
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Black and White patients had similar colorectal polyp profiles during screening colonoscopies. Further research is needed to understand persistent colorectal cancer disparities in Black Americans.

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Area of Science:

  • Gastroenterology
  • Oncology
  • Health Disparities

Background:

  • Black Americans exhibit higher colorectal cancer incidence than White Americans.
  • This disparity persists despite similar screening rates since 2010.
  • Colorectal adenoma status at screening colonoscopy is a key indicator of cancer risk.

Purpose of the Study:

  • To compare colorectal adenoma status between Black and White patients undergoing screening colonoscopy.
  • To investigate differences in adenoma detection, advanced adenomas, non-advanced adenomas, and hyperplastic polyps.
  • To analyze and compare the total polyp burden between racial groups.

Main Methods:

  • Utilized cross-sectional, observational data from screening colonoscopies.
  • Included average-risk patients aged 40-89 screened between 2001 and 2016 in South Carolina.
  • Analyzed age-adjusted odds of adenomas and polyp burden, comparing Black and White patients by gender.

Main Results:

  • Black patients had lower odds of adenoma (OR=0.88) and right hyperplastic polyps (OR=0.74) compared to White patients.
  • No significant difference was observed in advanced or multiple non-advanced adenomas between racial groups.
  • Mean polyp burden varied by age and gender, with Black men showing a slightly higher burden than White men, and Black women a slightly lower burden than White women.

Conclusions:

  • Black and White patients demonstrated similar polyp profiles in a large, racially balanced sample.
  • The similar adenoma status suggests other factors contribute to colorectal cancer disparities.
  • Further investigation into clinical factors affecting polyp detection is warranted to address disparities.