Colonoscopy Recommended for Elderly African Americans and Hispanics

Two studies presented at the 2010 Digestive Disease Week support the use of colonoscopy in elderly African Americans and Hispanics. The first study recommends revising colorectal cancer (CRC) guidelines for adults aged ≥75 years, especially those who are African American. Although current United States Preventive Services Task Force guidelines recommend against routine screenings for adults aged ≥75 years, Shashideep Singhal, MD, internal medicine resident at the Brooklyn Hospital Center in New York said CRC screening detected high rates of adenoma in asymptomatic elderly African Americans and Hispanic individuals.

Singhal noted that African Americans and Hispanics are less likely to undergo colonoscopy screening because of social inhibitions. “Physicians who treat elderly patients should be aware of the significant risk of asymptomatic advanced adenomas in these patients. Current national guidelines don’t account for the increased risk of some elderly racial groups,” he cautioned.

The researchers examined screening outcomes for 510 elderly African American, Hispanic American, or Asian American patients for whom complete colonoscopy records were available. The majority of patients (67.1%) were women, and 32.9% were men. Patients had a mean age of 80.25 years (range, 75-99 y). Stratified by race, 76% were African American, 22% Hispanic, and 2% Asian. Approximately 10% of patients had a history of CRC, and 23.1% had a history of advanced adenomas. Of the 510 colonoscopies, 46 (9%) had been done as follow-up to a positive fecal occult blood test.

Colonoscopy detected advanced adenomas in 19.4% of patients, and 17.5% had 1 or 2 tubular adenomas. Patients with a prior history of advanced adenomas or CRC were more likely to have adenomas detected by colonoscopy compared with those who had no prior history (28% vs 16.1%, respectively). The adenoma detection rate was 20.1% in African Americans, which was higher than the 16.9% rate in Hispanics. A higher proportion of advanced adenomas were detected on the right side of the colon (66.2%) in African Americans than in Hispanics, who had equal right- and left-sided distribution of adenomas. The overall rate of CRC was 2%; CRC was detected in 2.3% of African Americans and 0.8% of Hispanics. The adequacy of bowel preparation is believed to affect the sensitivity of colonoscopy, and bowel preparation was rated good in 67.9% of patients, suboptimal to fair in 22.3%, and poor in 10%.

“Elderly African Americans have a higher percentage of advanced adenomas on the right side and are hence more likely to benefit from colonoscopies than from other methods of CRC screening,” Singhal said. He and his colleagues strongly recommend considering colonoscopy in elderly African Americans who have a history of advanced melanomas.

Patterns in Hispanics

A second study, conducted at the University of Puerto Rico Cancer Center in San Juan, concluded that although Hispanics typically have lower rates of cancer than non-Hispanic whites, both groups have similar rates of adenomatous polyps in the colon and neoplasia. Researchers looked at data for 647 patients aged ≥50 years undergoing routine CRC screening at a private gastroenterology practice.

Men were twice as likely as women to have colorectal neoplasia and were more likely than women to have multiple polyps. This study also showed that as patients age, they are more likely to have a positive screening for polyps. Patients older than 60 years had a 56% greater chance of having a polyp.

The polyps detected in Hispanics were on the proximal, or right side, of the colon in 70% of cases, which is the opposite

of what is seen in non-Hispanic whites. These findings, like those from the first study, support the use of colonoscopy for CRC screening in Hispanics. Traditional colonoscopy is the best method for detecting polyps in the proximal segment of the colon.

Lead author Marcia Cruz-Correa, MD, associate professor of Medicine and Biochemistry at the University of Puerto Rico Cancer Center, said, “CRC screening rates among Hispanics are dangerously low. Only about 40% get screened despite the fact that colorectal cancer is the second leading cause of death among Hispanic women.” She suggested that the growing adoption of a US-style diet might be contributing to higher rates of CRC in Hispanic women.