Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities.
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.
Laiyemo
Adeyinka O
AO
Department of Medicine, Howard University College of Medicine, Howard University Cancer Center, Washington, DC 20060, USA. adeyinka.laiyemo@howard.edu
Doubeni
Chyke
C
Pinsky
Paul F
PF
Doria-Rose
V Paul
VP
Bresalier
Robert
R
Lamerato
Lois E
LE
Crawford
E David
ED
Kvale
Paul
P
Fouad
Mona
M
Hickey
Thomas
T
Riley
Thomas
T
Weissfeld
Joel
J
Schoen
Robert E
RE
Marcus
Pamela M
PM
Prorok
Philip C
PC
Berg
Christine D
CD
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*