title: African Americans should be screened at an earlier age for colorectal cancer.
abstract: BACKGROUND
  African Americans (AAs) have been shown to exhibit a higher incidence of colorectal cancer and experience lower survival compared with whites. There is disagreement regarding the age at which to initiate screening in AAs.
  
  
  OBJECTIVE
  To calculate the age-specific incidence in AAs compared with whites while controlling for differences in socioeconomic status (SES) and to calculate the joinpoint at which the incidence begins to increase in each race.
  
  
  METHODS
  Retrospective database review.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results database.
  
  
  METHODS
  All patients with adenocarcinoma of the colon or rectum from 2000 through 2011 in the SEER 18 database.
  
  
  METHODS
  We calculated the joinpoint of the upward trend of the age-adjusted incidence rate to determine the age at which the slope of the incidence curve began to increase in each race, while controlling for differences in SES by using a composite socioeconomic index.
  
  
  METHODS
  Age-adjusted incidence of colon and rectal cancer.
  
  
  RESULTS
  The age-specific incidence of colorectal cancer (cases per 100,000 population) was 0.3 versus 0.4 in whites compared with AAs at 20 years of age. At 50 years of age, the incidence was 44.2 compared with 62.6 in whites compared with AAs. The model indicated a joinpoint at 47 years of age for whites (95% confidence interval, 45-49) and 43 for AAs (95% confidence interval, 42-45) (P < .001.) When SES was considered in stratification, joinpoints for whites were 48, 47, and 46 at high, middle, and low SES, respectively. Conversely, joinpoints of 43, 44, and 42 in the corresponding SES for AAs were noted (P ≤ .001).
  
  
  CONCLUSIONS
  There was no intervention, and we cannot conclude that changing screening policy would affect this disparity.
  
  
  CONCLUSIONS
  There is a disparity in the age-specific incidence of colorectal cancer in AAs compared with whites beginning at 45 years of age. These differences persist across socioeconomic strata.
authors.affiliation: Department of Surgery and Cincinnati Research in Outcomes and Safety in Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paquette
authors.affiliation: Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Ying
authors.affiliation: Department of Surgery and Cincinnati Research in Outcomes and Safety in Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Department of Surgery and Cincinnati Research in Outcomes and Safety in Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Shuk-Mei
authors.initials: SM
authors.lastname: Ho
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000208:ethnology*; D001741:Black or African American; D017677:Age Distribution; D000367:Age Factors; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States / Q000453:epidemiology