title: Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities.
abstract: BACKGROUND
  It is unclear whether the disproportionately higher incidence and mortality from colorectal cancer among blacks compared with whites reflect differences in health-care utilization or colorectal cancer susceptibility.
  
  
  METHODS
  A total of 60, 572 non-Hispanic white and black participants in the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial underwent trial-sponsored screening flexible sigmoidoscopy (FSG) without biopsy at baseline in 10 geographically dispersed centers from November 1993 to July 2001. Subjects with polyps or mass lesions detected by FSG were referred to their physicians for diagnostic workup, the cost of which was not covered by PLCO. The records of follow-up evaluations were collected and reviewed. We used log binomial modeling with adjustment for age, education, sex, body mass index, smoking, family history of colorectal cancer, colon examination within previous 3 years, personal history of polyps, and screening center to examine whether utilization of diagnostic colonoscopy and yield of neoplasia differed by race.
  
  
  RESULTS
  Among 57 561 whites and 3011 blacks who underwent FSG, 13,743 (23.9%) and 767 (25.5%) had abnormal examinations, respectively. A total of 9944 (72.4%) whites and 480 (62.6%) blacks had diagnostic colonoscopy within 1 year following the abnormal FSG screening. When compared with whites, blacks were less likely to undergo diagnostic evaluation (adjusted risk ratio = 0.88, 95% confidence interval = 0.83 to 0.93). Overall, among subjects with diagnostic colonoscopy (n = 10 424), there was no statistically significant difference by race in the prevalence of adenoma, advanced adenoma, advanced pathology in small adenomas (high-grade dysplasia or villous histology in adenomas <10 mm), or colorectal cancer.
  
  
  CONCLUSIONS
  We observed a lower follow-up for screen-detected abnormalities among blacks when compared with whites but little difference in the yield of colorectal neoplasia. Health-care utilization may be playing more of a role in colorectal cancer racial disparity than biology.
authors.affiliation: Department of Medicine, Howard University College of Medicine, Howard University Cancer Center, Washington, DC 20060, USA. adeyinka.laiyemo@howard.edu
authors.forename: Adeyinka O
authors.initials: AO
authors.lastname: Laiyemo
authors.forename: Chyke
authors.initials: C
authors.lastname: Doubeni
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pinsky
authors.forename: V Paul
authors.initials: VP
authors.lastname: Doria-Rose
authors.forename: Robert
authors.initials: R
authors.lastname: Bresalier
authors.forename: Lois E
authors.initials: LE
authors.lastname: Lamerato
authors.forename: E David
authors.initials: ED
authors.lastname: Crawford
authors.forename: Paul
authors.initials: P
authors.lastname: Kvale
authors.forename: Mona
authors.initials: M
authors.lastname: Fouad
authors.forename: Thomas
authors.initials: T
authors.lastname: Hickey
authors.forename: Thomas
authors.initials: T
authors.lastname: Riley
authors.forename: Joel
authors.initials: J
authors.lastname: Weissfeld
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schoen
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Marcus
authors.forename: Philip C
authors.initials: PC
authors.lastname: Prorok
authors.forename: Christine D
authors.initials: CD
authors.lastname: Berg
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000235:genetics / Q000401:mortality / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer; D005260:Female; D020022:Genetic Predisposition to Disease; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000517:prevention & control; D011471:Prostatic Neoplasms / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012812:Sigmoidoscopy; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*