Background The American College of Gastroenterology recommends colorectal cancer (CRC) screening for average risk Blacks Americans ages 45-49. This is based on this group’s younger age for the development of adenomas and CRC. Our purpose was to determine the yield of CRC screening in average risk Black Americans including those < age 50. We also aimed to identify whether there was a higher prevalence of proximal adenomas in Black Americans. Study Cross sectional, retrospective. All colonoscopy examinations from 2007 through 2010 were reviewed. Complete examinations with a good/excellent preparation in average risk Black patients 45-49 were selected. We excluded patients with signs, symptoms, or family history of CRC. Defined two control groups: average risk Black and White patients ages 50-59 who completed a colonoscopy during the same period. Patient’s height, weight and use of statin medications and aspirin were recorded. Patients currently using tobacco at least weekly were identified. Results There were 1,230 patients with an adenoma for a prevalence of 40.7%. We included 304 Black Americans 45-49 years, 669 Black Americans 50-59 years, and 257 Whites 50-59 years. There was no association between race/age group and the presence of at least one adenoma, proximal adenomas, or advanced adenomas. In regression modeling, both male sex and active smoking were associated with all three outcomes. Conclusions Male sex and active smoking are risk factors for prevalent adenomas, proximal adenomas, and advanced adenomas. The prevalence of adenomas is similar in Black Americans 45-49 compared to older Black and White patients. We did not find that the recognized proximal distribution of CRC in Black Americans parallels a similar distribution in adenomas in this group.

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