CA : A Cancer Journal for Clinicians

In the 2010 Census, just over one-third of the United States (US) population identified themselves as being something other than being non-Hispanic white alone. This group has increased in size from 86.9 million in 2000 to 111.9 million in 2010, representing an increase of 29 percent over the ten year period. Per the American Cancer Society, racial and ethnic minorities are more likely to develop cancer and die from it when compared to the general population of the United States. This is particularly true for colorectal cancer (CRC). The primary aim of this review is to highlight the disparities in CRC among racial and ethnic minorities in the United States. Despite overall rates of CRC decreasing nationally and within certain racial and ethnic minorities in the US, there continue to be disparities in incidence and mortality when compared to non-Hispanic whites. The disparities in CRC incidence and mortality are related to certain areas of deficiency such as knowledge of family history, access to care obstacles, impact of migration on CRC and paucity of clinical data. These areas of deficiency limit understanding of CRC’s impact in these groups and when developing interventions to close the disparity gap. Even with the implementation of the Patient Protection and Affordable Healthcare Act, disparities in CRC screening will continue to exist until specific interventions are implemented in the context of each of racial and ethnic group. Racial and ethnic minorities cannot be viewed as one monolithic group, rather as different segments since there are variations in incidence and mortality based on natural history of CRC development impacted by gender, ethnicity group, nationality, access, as well as migration and socioeconomic status. Progress has been made overall, but there is much work to be done.

/pdf/health-disparities-in-colorectal-cancer-among-racial-and-53qveogam4.pdf

Health disparities in colorectal cancer among racial and ethnic minorities in the United States

Colorectal cancer (CRC) is the fourth most commonly diagnosed gastrointestinal (GI) malignancy and the third leading cause of cancer-related death worldwide. In the current case-control study, an association between diagnosis of CRC, obesity and diabetes was investigated. Demographic characteristics, colonoscopy reports, history of drug, smoking, and medical history were collected from patients referred to a colonoscopy unit. The location, size and number of the polyps were recorded during the colonoscopy. Statistically, t-test was conducted for mean comparison for the groups. Pearson’s chi-squared test (χ2) was applied to categorize variables. Five classification methods based on the important clinicopathological characteristics such as age, BMI, diabetes, family history of colon cancer was performed to predict the results of colonoscopy. Overall, 693 patients participated in this study. In the present study, 115 and 515 patients were evaluated for adenoma/adenocarcinoma and normal colonoscopy, respectively. The mean age of patients positive for adenoma or adenocarcinoma were significantly higher than the negative groups (p value  25 kg/m2) were significantly higher in adenoma positive patients as compared to controls (49.9 and 0.9% respectively, p value = 0.04). The results also demonstrated a significant association between suffering from diabetes and having colon adenoma (OR = 1.831, 95%CI = 1.058–3.169, p value = 0.023). The experimental results of 5 classification methods on higher risk factors between colon adenoma and normal colonoscopy data were more than 82% and less than 0.42 for the percentage of classification accuracy and root mean squared error, respectively. In the current study, the occurrence of obesity measured based on BMI and diabetes in the adenoma positive patient group was significantly higher than the control group although there was no notable association between obesity, diabetes and adenocarcinoma.

/pdf/obesity-diabetes-and-the-risk-of-colorectal-adenoma-and-3w0i61867q.pdf

Obesity, diabetes and the risk of colorectal adenoma and cancer

High-fat Western diet–induced obesity contributes to increased tumor growth in mouse models of human colon cancer

Previous studies have suggested an increase in the incidence of colorectal cancer (CRC) in young adults (younger than 50 years). Among older people, African Americans have disproportionally higher CRC incidence and mortality. We assessed whether this CRC disparity also applies to CRC diagnosed among young people. Using the Surveillance, Epidemiology, and End Results cancer registries, a population-based cancer registry covering 25.6 % of the United States’ African American population, we identified patients diagnosed with CRC between the years of 2000–2012. The age-adjusted rates for non-Hispanic whites (NHW), African Americans, and Asian–Pacific Islanders (API) were calculated for the age categories 20–24, 25–29, 30–34, 35–39, and 40–44. CRC age-adjusted incidence is increasing among all three racial groups and was higher for African Americans compared to NHW and API across all years 2000–2012 (P < 0.001). Stage IV CRC was higher in African Americans compared with NHW, while there was higher stage III CRC in API compared with NHWs. CRC incidence is increasing among the young in all racial groups under study. This increase in frequency of CRC is true among young African American adults who display highly advanced tumors in comparison with other races. While the present attention to screening seems to have decreased CRC prevalence in individuals older than 50, special attention needs to be addressed to young African American adults as well, to counter the observed trend, as they have the highest incidence of CRC among young population groups by race/ethnicity.

Colorectal Cancer in Young African Americans: Is It Time to Revisit Guidelines and Prevention?

Objectives

Obesity is associated with the activation of the molecular pathways that increase the risk of colorectal cancer. Increasing body mass index may accelerate the development of adenomatous polyps, the antecedent lesion of colorectal cancer. The aim of this study was to assess the BMI effect on the risk of colonic polyp and adenoma in African-American.



Methods

The records of 923 patients who underwent colonoscopy were examined. Demographic and clinical data were collected before colonoscopy. Polyp and adenoma diagnosis were confirmed by pathology examinations.



Results

Overall, 43% of the patients were male, median age was 57 years and 77% had BMI ≥ 25.0 kg/m2. The frequency of colorectal polyps and adenomas were 61 and 35%, respectively. BMI ≥ 25.0 (OR = 1.61, 95% CI = 1.14-2.26), smoking (OR = 1.61, 95% CI = 1.15-2.26) and history of colon polyps (OR = 1.64, 95% CI = 1.09-2.47) were associated with higher risk of colon polyp. BMI ≥ 25.0 (OR = 1.81, 95% CI = 1.24-2.62), age (OR = 1.04, 95% CI = 1.02-2.05 for each year), male gender (OR = 1.38, 95% CI = 1.02-1.86), and smoking (OR = 1.73, 95% CI = 1.23-2.42) were associated with higher risk of colon adenoma.



Conclusion

Male and overweight African-Americans are at higher risk of colorectal adenoma. The findings of this study could be applied for risk stratification and modifying the colorectal cancer prevention including screening guideline in African Americans.

/pdf/bmi-and-the-risk-of-colorectal-adenoma-in-african-americans-7qd0ekh14d.pdf

BMI and the risk of colorectal adenoma in African Americans

Background: It is unclear whether there is a shared pathway in the development of diverticular disease (DD) and potentially neoplastic colorectal lesions since both diseases are found in similar age groups and populations Aim: To determine the association between DD and colorectal pre-neoplastic lesions in an African-American urban population Methods: Data from 1986 patients who underwent colonoscopy at the Howard University Hospital from January 2012 through December 2012 were analyzed for this study The presence of diverticula and polyps was recorded using colonoscopy reports Polyps were further classified into adenoma or hyperplastic polyp based on histopathology reports Multiple logistic regression was done to analyze the association between DD and colonic lesions Results: Of the 1986 study subjects, 1,119 (56%) were females, 35% had DD and 56% had at least one polyp There was a higher prevalence of polyps (70 vs 49%; OR = 23; 95% CI: 19-28) and adenoma (43 vs 25%; OR = 20; 95% CI: 17-25) in the diverticular vs non-diverticula patients Among patients who underwent screening colonoscopy, the presence of diverticulosis was associated with increased odds of associated polyps (OR = 99; 95% CI: 54-168) and adenoma (OR = 51; 95% CI: 34-78) Conclusion: Patients with DD are more likely to harbor colorectal lesions These findings call for more vigilance on the part of endoscopists during colonoscopy in patients known to harbor colonic diverticula

Association between Diverticular Disease and Pre-Neoplastic Colorectal Lesions in an Urban African-American Population

Background
The disproportionately higher incidence of and mortality from colorectal cancer (CRC) among African Americans (AA) led the American College of Gastroenterology to recommend screening starting at age 45 in 2005.

/pdf/prevalence-of-colorectal-neoplasia-among-young-african-56w4wkgxb4.pdf

Prevalence of colorectal neoplasia among young African Americans and Hispanic Americans.

Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding

Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding.

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BMI and the risk of colorectal adenoma in African Americans

Association between Diverticular Disease and Pre-Neoplastic Colorectal Lesions in an Urban African-American Population

Prevalence of colorectal neoplasia among young African Americans and Hispanic Americans.

Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding.