Colonoscopy for Colorectal Cancer Screening Above Age 75: Outcomes in Symptomatic African American and Hispanic Adults

Singhal, Shashideep; Verma, Arun Kumar; Anand, Kris

doi:10.1007/s12029-010-9190-8

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…In older patients, procedure risk-benefit analysis needs to be individualized and considered based on each patient's comorbidities, symptoms, colonoscopy interval, and CRC risk factors. 29,30 This study has several limitations. Its retrospective nature means it is not possible to exclude all bias.…”

Section: Discussionmentioning

confidence: 96%

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Older age, symptoms, or anemia: Which factors increase colorectal cancer risk with a positive fecal immunochemical test?

Hamarneh

Symonds

Kholmurodova

et al. 2019

J of Gastro and Hepatol

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Background and Aim Fecal immunochemical tests (FIT) are used to screen asymptomatic individuals aged 50–74 years for colorectal cancer (CRC) within the Australian screening program. Gastrointestinal symptoms or iron deficiency anemia (IDA) may also drive primary care physicians to request a FIT. This study aimed to examine factors that may increase neoplasia risk associated with a positive FIT, specifically age, gastrointestinal symptoms, or IDA. Methods A retrospective audit was performed on colonoscopies performed in a single hospital in South Australia for a positive FIT (from all referral sources) between 2014 and 2017. Patients aged < 50 years, or who had a colonoscopy in the preceding 5 years, were excluded. A subgroup (n = 198) was evaluated to assess whether age ≥ 75 years, symptoms, or IDA, as well as other demographics, comorbidities, and medications, were associated with risk of neoplasia. Features found to be associated with risk for CRC or high‐risk adenoma were examined in the entire cohort using multivariate analysis. Results Colonoscopies (750/4221, 17.8%) were completed in patients ≥ 50 years for a positive FIT. Of these, 7.6% (n = 57) also had gastrointestinal symptoms, 5.5% (n = 41) IDA, and 13.1% (n = 98) were ≥ 75 years. At colonoscopy, 2.8% (n = 21) were diagnosed with CRC and 23.2% (n = 174) with high‐risk adenoma. CRC was more prevalent in ≥ 75 years compared with 50–74 years (7.1% vs 2.1%, P = 0.005), and associated with symptoms (15.8% vs 1.7%, P < 0.001), and IDA (14.6% vs 2.1%, P < 0.001). Multivariate analysis showed that IDA (odds ratio 7.68, P < 0.001) and symptoms (odds ratio 10.37, P < 0.001), but not age, were independent risk factors for CRC. Conclusion The presence of gastrointestinal symptoms or IDA, independent of age, is associated with an increased risk for CRC following a positive FIT.

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Section: Discussionmentioning

confidence: 96%

“…We did not, however, encounter any significant complications because of the colonoscopies, highlighting that the procedures are generally safe. In older patients, procedure risk–benefit analysis needs to be individualized and considered based on each patient's comorbidities, symptoms, colonoscopy interval, and CRC risk factors …”

Section: Discussionmentioning

confidence: 99%

Older age, symptoms, or anemia: Which factors increase colorectal cancer risk with a positive fecal immunochemical test?

Hamarneh

Symonds

Kholmurodova

et al. 2019

J of Gastro and Hepatol

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“…Hispanics comprise the largest growing ethnicity in the US, and are estimated to reach a population of greater than 100 million individuals by 2050 . There is emerging evidence that colorectal neoplasia rates among Hispanics are similar to or possibly greater than those of whites, although studies to date have been limited to sigmoidoscopy, did not include whites as a comparison group, did not include histology or were limited to symptomatic individuals …”

Section: Introductionmentioning

confidence: 99%

“…3 There is emerging evidence that colorectal neoplasia rates among Hispanics are similar to or possibly greater than those of whites, although studies to date have been limited to sigmoidoscopy, 4 did not include whites as a comparison group, 5 did not include histology 6 or were limited to symptomatic individuals. 7 We aimed to compare the prevalence of histologically confirmed adenomas and advanced colorectal neoplasia among Hispanics and blacks as compared to whites among individuals undergoing screening colonoscopy at an urban medical centre that serves a racially and ethnically diverse patient population.…”

Section: Introductionmentioning

confidence: 99%

Risk of colorectal adenomas and advanced neoplasia in Hispanic, black and white patients undergoing screening colonoscopy

Lebwohl

Capiak

Neugut

et al. 2012

Aliment Pharmacol Ther

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SUMMARY Background Racial and ethnic differences in the risk of premalignant colorectal neoplasia have not been extensively studied. Aim To measure adenoma prevalence among asymptomatic white, black and Hispanic patients undergoing screening colonoscopy. Methods In this cross sectional cohort study, data from individuals ≥50 years undergoing first-time colonoscopy since 2006 at a single tertiary-care medical centre were obtained from the electronic medical record. Adenoma prevalence among whites, blacks and Hispanics was calculated; multivariate Poisson and logistic regression were used to identify factors independently associated with adenoma rates and the presence of advanced adenomas. Results We identified 5075 eligible subjects: 3542 (70%) whites, 942 (18%) Hispanics and 591 (12%) blacks. The mean age was 62.2 years with 58% women. At least one adenoma was detected in 19%, 22% and 26% of whites, Hispanics and blacks respectively (Hispanics vs. whites P = 0.09; blacks vs. whites P = 0.0001). Isolated proximal adenomas were present in 9% of whites, 11% of Hispanics (P = 0.03) and 11% of blacks (P = 0.03). In multivariate analyses, a higher rate of adenomas was present in Hispanics (RR: 1.37, 95% CI: 1.20–1.57) and blacks (RR: 1.76, 95% CI: 1.52–2.04) than whites. Hispanics and blacks also had an increased risk of advanced adenomas compared to whites (ORHispanics: 2.25, 95% CI: 1.62–3.11; ORblacks: 1.91, 95% CI: 1.27–2.86). Conclusions Adenoma prevalence was higher in blacks and Hispanics than in whites. Both groups were at greater risk of having proximal adenomas in the absence of any distal pathology than whites, where these lesions would have only been detected by colonoscopy. Efforts to promote screening are necessary among diverse, under-represented populations.

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“…12 , 13 Singhal and colleagues found that although older adults, specifically African Americans and Hispanics, may have a previously normal colonoscopy, screening in ages 75 or older can still detect advanced CRC (19%). 14 About 5,200 middle-aged and older persons found a reduction of 65% in right-colon cancers and 75% in left-colon/rectal cancers after participating in CRC screening, specifically colonoscopy. 15 …”

Section: Introductionmentioning

confidence: 99%

Examining colorectal cancer screening uptake and health provider recommendations among underserved middle aged and older African Americans

Cobb

Ekwegh

Adinkrah³

et al. 2022

Health Promot Perspect

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Background: The purpose of this study is to determine whether underserved middle-aged and older African Americans are receiving a colorectal cancer (CRC) screening test (sigmoidoscopy or colonoscopy) and if recommended by their provider. Additionally, we examined correlates of both provider recommendation and uptake of CRC screening. Methods: Seven hundred forty African American individuals, aged 55 and older, participated in this local community cross-sectional survey. We used a multivariate technique of logistic regression. Results: One out of three participants reported that they never received a sigmoidoscopy or colonoscopy for CRC screening. More than 31% indicted that their providers never suggested CRC testing. However, participants who indicated that their providers recommended sigmoidoscopy/colonoscopy were almost 49 times (odds ratio [OR]: 48.9, 95% confidence interval [CI]: 29.5–81.2) more likely to obtain it compared to their counterparts who were not advised to have these procedures. Our data suggest that African American men were significantly less likely than women to receive recommendations from their providers (OR: 0.70, 95% CI: 0.50-0.91). Furthermore, controlling for other variables, the following factors: 1) living arrangement (OR: 1.44, 95% CI: 1.02–2.04), 2) health maintenance organization (HMO) membership (OR: 1.84, 95% CI: 1.28–2.67), 3) number of providers (OR: 1.15, 95% CI: 1.01–1.32), 4) satisfaction with access to and quality of care (OR: 1.24, 95% CI: 1.03–1.51), 5) depressive symptoms (OR: 0.92, 95% CI: 0.86–0.98), and 6) gastrointestinal conditions (OR: 1.73, 95% CI: 1.16–2.58) were associated with obtaining a sigmoidoscopy or colonoscopy test. Conclusion: Our findings suggest that the absence of a provider recommendation is the primary barrier preventing underserved older African Americans from obtaining CRC screening. In addition, our data revealed significant association between obtaining CRC screening and some of the predisposing characteristics of participants, satisfaction with access to and quality of care, and physical and mental health. These findings are consistent with this notion that disparities in health care for African Americans can be traced back to four primary factors: patients, healthcare providers, the healthcare system, and society as a whole, and emphasize the need for establishing theory-driven, culturally-sensitive, and cost-effective CRC screening interventions that recognize and address the constraints to cancer screening experienced by this segment of population.

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Colonoscopy for Colorectal Cancer Screening Above Age 75: Outcomes in Symptomatic African American and Hispanic Adults

Cited by 6 publications

References 17 publications

Older age, symptoms, or anemia: Which factors increase colorectal cancer risk with a positive fecal immunochemical test?

Older age, symptoms, or anemia: Which factors increase colorectal cancer risk with a positive fecal immunochemical test?

Risk of colorectal adenomas and advanced neoplasia in Hispanic, black and white patients undergoing screening colonoscopy

Examining colorectal cancer screening uptake and health provider recommendations among underserved middle aged and older African Americans

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