Colorectal cancer in young African Americans: clinical characteristics and presentations

Lapumnuaypol, Kamolyut; Mahmood, Ejaz; Chaiwatcharayut, Wikrom; Bandres, Maria V.; Goyal, Abhinav; Djibo, Djeneba Audrey; Tiu, Andrew

doi:10.1097/meg.0000000000001205

Cited by 6 publications

(15 citation statements)

References 39 publications

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Section: Resultsmentioning

confidence: 99%

“…Of the 12 859 unique articles retrieved, 699 full texts were reviewed, and 81 studies were included (Figure 1 and Table). There were 76 cross-sectional studies, 4 case-control studies, and 1 cohort study . Studies were performed in Africa (5 studies), Asia or the Middle East (26 studies), Europe (19 studies), North America (23 studies), South America (5 studies), and Oceania (2 studies) .…”

Section: Resultsmentioning

confidence: 99%

“…There were 76 cross-sectional studies, 4 case-control studies, and 1 cohort study . Studies were performed in Africa (5 studies), Asia or the Middle East (26 studies), Europe (19 studies), North America (23 studies), South America (5 studies), and Oceania (2 studies) . There were 67 studies deemed to have low risk of bias, 10 studies with moderate risk of bias, and 4 studies with high risk of bias, based on JBI checklists.…”

Section: Resultsmentioning

confidence: 99%

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Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

Demb,

Kolb,

Dounel

et al. 2024

JAMA Netw Open

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ImportanceEarly-onset colorectal cancer (EOCRC), defined as a diagnosis at younger than age 50 years, is increasing, and so-called red flag signs and symptoms among these individuals are often missed, leading to diagnostic delays. Improved recognition of presenting signs and symptoms associated with EOCRC could facilitate more timely diagnosis and impact clinical outcomes.ObjectiveTo report the frequency of presenting red flag signs and symptoms among individuals with EOCRC, to examine their association with EOCRC risk, and to measure variation in time to diagnosis from sign or symptom presentation.Data SourcesPubMed/MEDLINE, Embase, CINAHL, and Web of Science were searched from database inception through May 2023.Study SelectionStudies that reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis for patients younger than age 50 years diagnosed with nonhereditary CRC were included.Data Extraction and SynthesisData extraction and quality assessment were performed independently in duplicate for all included studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Joanna Briggs Institute Critical Appraisal tools were used to measure risk of bias. Data on frequency of signs and symptoms were pooled using a random-effects model.Main Outcomes and MeasuresOutcomes of interest were pooled proportions of signs and symptoms in patients with EOCRC, estimates for association of signs and symptoms with EOCRC risk, and time from sign or symptom presentation to EOCRC diagnosis.ResultsOf the 12 859 unique articles initially retrieved, 81 studies with 24 908 126 patients younger than 50 years were included. The most common presenting signs and symptoms, reported by 78 included studies, were hematochezia (pooled prevalence, 45% [95% CI, 40%-50%]), abdominal pain (pooled prevalence, 40% [95% CI, 35%-45%]), and altered bowel habits (pooled prevalence, 27% [95% CI, 22%-33%]). Hematochezia (estimate range, 5.2-54.0), abdominal pain (estimate range, 1.3-6.0), and anemia (estimate range, 2.1-10.8) were associated with higher EOCRC likelihood. Time from signs and symptoms presentation to EOCRC diagnosis was a mean (range) of 6.4 (1.8-13.7) months (23 studies) and a median (range) of 4 (2.0-8.7) months (16 studies).Conclusions and RelevanceIn this systematic review and meta-analysis of patients with EOCRC, nearly half of individuals presented with hematochezia and abdominal pain and one-quarter with altered bowel habits. Hematochezia was associated with at least 5-fold increased EOCRC risk. Delays in diagnosis of 4 to 6 months were common. These findings highlight the need to identify concerning EOCRC signs and symptoms and complete timely diagnostic workup, particularly for individuals without an alternative diagnosis or sign or symptom resolution.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

Demb,

Kolb,

Dounel

et al. 2024

JAMA Netw Open

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“… 79 Additionally, there is a sharp increase in middle-aged African Americans presenting with higher suspicions of CRC, which may include unusual symptoms, which should prompt providers to recommend CRC screening at younger ages below the guidelines. 80 , 81 African Americans with multiple chronic conditions should be prompted by providers for timely CRC screening since it is linked poorer outcomes, including death, in this population. 82 , 83 Due to African Americans being less likely to get screened for CRC, appropriate CRC education and culturally tailored strategies are needed to increase awareness of the value of CRC screenings.…”

Section: Discussionmentioning

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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“…A 2018 retrospective cohort study of 109 patients from a single medical center examined the clinical characteristics of African Americans with early-onset colorectal cancer (younger than 50 years old). 2 Patients with recurrent colorectal cancer were excluded while patients with hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis, and inflammatory bowel disease were included. Ethnicity data were based on self-report in congruence with the US Census definitions and included 75 African Americans and 34 non-African Americans.…”

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confidence: 99%

Is there evidence to start colorectal cancer screening in African Americans before the standard guideline age?

Robinson

Hill-Daniel

2022

EBPR

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Colorectal cancer in young African Americans: clinical characteristics and presentations

Abstract: There should be a higher index of suspicion for CRC in young AA adults presenting with anemia, abdominal pain, and weight loss. Early screening colonoscopy should be advocated in AAs because of the predominance of proximal disease.

Cited by 6 publications

References 39 publications

Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

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

Is there evidence to start colorectal cancer screening in African Americans before the standard guideline age?

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