Race and Medicine

Race and Medicine

Disclosures: The authors report no relevant financial disclosures.
June 22, 2021
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Black veterans have a higher prevalence of colorectal cancer

Disclosures: The authors report no relevant financial disclosures.
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Black veterans had a higher prevalence of advanced colorectal neoplasia and colorectal cancer compared with white veterans, according to research published in the Journal of Clinical Gastroenterology.

“Information on prevalence of CRC and advanced, precancerous polyps among veterans has not been well-described. Among studies of colorectal neoplasia prevalence, the separate effects of age, sex and race or ethnicity are often not considered,” Thomas F. Imperiale, MD, Richard L. Roudebush VA Medical Center, told Healio. “We were interested in looking at the effect of all three demographic factors on the prevalence of both CRC and advanced neoplasia (AN) to identify patterns in the data that might allow us to tailor when to begin screening and how best to screen veterans.”

Thomas Imperiale

In a retrospective, cross-sectional study, researchers analyzed 90,598 veterans (mean age 61.7 years; 5.2% women) who underwent diagnostic or screening colonoscopy to quantify the effect of age, sex and race on the risk for CRC and AN; study results yielded a prevalence of 1.3% and 8.9%, respectively. The adjusted risk for CRC was higher in veterans who underwent diagnostic colonoscopy vs. screening colonoscopy (OR = 3.79; 95% CI, 3.19-4.5), increased with age, was higher in men overall (OR = 1.53; 95% CI, 0.97-2.39) as well as higher overall for Black and Hispanic veterans. Similarly, the risk for AN also increased with age, had a higher prevalence among men (9.2% vs. 3.9%; aOR = 1.9; 95% CI, 1.6-2.25) and was 11% higher in Black veterans compared with white veterans (OR = 1.11; 95% CI, 1.04-1.2).

“The reported differences in prevalence of CRC between Black and white individuals is likely not biological, but rather, in the uptake of screening. Other factors contributing to the difference in CRC prevalence between Black and white individuals are access to screening and in response to symptoms,” Imperiale said. “A message to Black people (veterans in particular, but these data are likely generalizable to non-veterans) is that their higher risk [for] CRC is not a 'done deal,' it is likely not due to biology. At the same time, they need screening at least as much as anyone else and should get screened for CRC.”