A 50-year review of colorectal cancer in African Americans: implications for prevention and treatment.
BACKGROUND
African-Americans (AA) have the highest rate of colorectal cancer (CRC) incidence and mortality in the US. CRC in AA is more advanced and right-sided. Although screening has been shown to reduce mortality from CRC in the general US population, AA continue to experience a disproportionately higher CRC death compared to other ethnic groups. This study aimed at assessing the trend of CRC in AA, focusing on the changing pattern of in situ tumors in this ethnic group and how observed trends may guide current and future preventive and treatment strategies.


METHODS
All pathologic reports from 1959 to 2006 in Howard University Hospital (n = 150,000) were reviewed manually. The pathology reports showing colorectal cancer were carefully reviewed and selected by a GI pathologist. Intraepithelial or intramucosal carcinomas were diagnosed as in situ carcinoma. Reviewed pathological information were entered into Microsoft Excel and checked for duplication and missing data. Differences in situ and advanced cancer by sex, histology, location, and years of diagnosis were assessed by Chi-square test.


RESULTS
A total of 1,753 CRC cases were diagnosed in this period. About 56% of the cases were female and 51% of the tumors were left-sided. Mean (SD) age was 66 (13) years. The frequency of in situ tumor was 5.8% in this period. There was no statistically significant difference between in situ and advance tumor by age, sex, and tumor location. The rate of in situ tumor peaked in the 1990s at 8.5% (P = 0.0001). We observed a decade-to-decade increasing rate of right-sided tumors, which started at 36% in the period 1959-1970 and peaked in the period of 2001-2006 at 60% (P = 0.0001).


CONCLUSIONS
The recent increasing number of advanced and right-sided tumor in our study is concordant with SEER data and has great importance in developing CRC prevention and treatment strategies for AA population.
Ashktorab
Hassan
H
Department of Medicine and Cancer Center, Howard University, College of Medicine, Washington, DC 20060, USA. hashktorab@howard.edu
Nouraie
Mehdi
M
Hosseinkhah
Fatemeh
F
Lee
Edward
E
Rotimi
Charles
C
Smoot
Duane
D
D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000208:ethnology* / Q000473:pathology / Q000517:prevention & control; D003106:Colon / Q000473:pathology; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000517:prevention & control; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D012737:Sex Factors