African Americans who had multiple first-degree relatives with colon cancer were much less likely to undergo the recommended screening colonoscopy than their white counterparts, according to the findings of a large cohort study.
“Physicians and other health care providers need to elicit family history information for all patients and ensure that African Americans with affected relatives appropriately receive colon cancer screening,” concluded Dr. Harvey J. Murff of Vanderbilt University, Nashville, Tenn., and his associates.
The investigators assessed colonoscopy screening rates in the Southern Community Cohort Study, an ongoing prospective observational study of disparities in cancer incidence and mortality across racial and geographic groups treated at 48 community health centers throughout 12 southeastern states. Their assessment included 41,830 subjects aged 40–79 years.
A total of 538 African Americans and 255 whites reported having multiple affected first-degree relatives or at least one first-degree relative diagnosed before age 50, putting them at increased risk for the disease.
Only 34% of these African Americans aged 50 and older reported that they had undergone colonoscopy within the preceding 5 years, compared with 50% of whites. Similarly, 21% of high-risk African Americans in their 40s had undergone colonoscopy, compared with 34% of high-risk whites in that age group.
This racial disparity persisted after the data were adjusted to account for participants' education status, income level, and insurance status, Dr. Murff and his associates said (Arch. Intern. Med. 2008;168:625–31).
For subjects of both races, the most often cited reason for not undergoing colonoscopy was that their health care providers never recommended the procedure. African Americans were much more likely to cite this reason than were whites. “However, it is unlikely that this difference completely explains the [racial] variation in the rate of colonoscopy procedures,” the investigators said.