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For African Americans Screening Should Begin at 45 – Five Years Before Current Guidelines
Bethesda, MD, March 21, 2005 – Physician experts from the American
College of Gastroenterology have issued new recommendations to healthcare providers
to begin colorectal cancer screening in African Americans at age 45 rather
than 50 years. Colonoscopy is the preferred method of screening for colorectal
cancer and data support the recommendation that African-Americans begin screening
at a younger age because of the high incidence of colorectal cancer and a greater
prevalence of proximal or right-sided polyps and cancerous lesions in this
population.
The recommendations are published in the March issue of the American Journal
of Gastroenterology. Overall, colorectal cancer is the second leading
cause of cancer deaths in the United States. African Americans are diagnosed
with colorectal cancer at a younger age than whites, and African Americans
with colorectal cancer have decreased survival compared with whites. The
article reviews the evidence why African Americans should have their colons
screened for cancer at age 45 instead of age 50, five years earlier than
the current recommendations. The article was drafted by the American College
of Gastroenterology’s Committee on Minority Affairs and Cultural Diversity.
The Committee recommends colonoscopy as a “first line” screening procedure
for colorectal cancer for African Americans rather than flexible sigmoidoscopy
because of the high overall risk and as well as some evidence that African
Americans have more right-sided cancers and polyps. The right side of the colon
includes the cecum, ascending colon and proximal transverse colon and cannot
be reached by flexible sigmoidoscopy.
Clinical gastroenterologists play an important role in promoting colorectal
cancer awareness and the need for screening in African Americans. Evidence
suggests African Americans are more responsive to screening recommendations
from their personal physicians than from other sources. The College urges physicians
to provide culturally sensitive patient education on colorectal cancer to African
Americans.
Reducing the high morbidity and mortality associated with colorectal cancer
among African Americans continues to be a major healthcare challenge in the
United States. In response to this challenge, the leadership of the American
College of Gastroenterology asked the Committee on Minority Affairs and Cultural
Diversity to develop a position paper on colorectal cancer in African Americans.
The committee has done an extensive review of the literature on colorectal
cancer screening and issues related to screening in African Americans to support
their recommendations. One important goal was to improve awareness among primary
care physicians and gastroenterologists of the important differences in colorectal
cancer between African Americans and Caucasians.
Facts about Colorectal Cancer in African Americans
- African Americans have the highest incidence of colorectal cancer of any
racial or ethnic group. Data from the population-based cancer registries
that constitute the Surveillance, Epidemiology, and End Results (SEER) Program
of the National Cancer Institute show that during 1975–2000 colorectal incidence
rates in White men and women peaked in 1985 and have declined since.
- In 2000 the incidence rates in White men and women were 20–25 percent lower
than peak rates in 1985 and 10–15 percent lower than the rates in 1975. During
this same interval, incidence rates in African American men increased, and
the rates were stable in African American women.
- From 1996 to 2000, incidence rates in African Americans as a group were
12.3 percent higher than those in Caucasians, 9.5 percent higher in African
American men when compared to Caucasian men, and 17.5 percent higher in African
American women when compared to Caucasian women.
- The reasons for higher incidence rates in African Americans are unclear;
however, dietary, nutritional factors, rates of physical inactivity, variability
in screening rates, lower use of diagnostic testing, and increasing smoking
rates have been most commonly implicated.
- African Americans with colorectal cancer have decreased survival compared
with whites. From 1992-1999, the five-year survival rate in African Americans
was 53 percent, and 63 percent in whites. Part of the explanation for the
decreased survival of African Americans with colorectal cancer is that a
great proportion present with Stage IV diseases. This effect has been ascribed
to lower screening rates, less use of diagnostic tests, and less access to
health care.
- For African Americans and whites with the same stage disease (Stage II
or III), survival is lower for African Americans, except in the Veterans
Administration system, where access to care is equal.
- According to the U.S. Census Department there are 2.6 million African American
men and women between age 45 and 49 in the United States (July 2003 data)
- For more information on racial disparities in colorectal cancer see SEER
Cancer Statistics Review 1975-2001 http://seer.cancer.gov/csr/1975_2001/
- Full text of the recommendations can be found online at the American
Journal of Gastroenterology www.amjgastro.com
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