Colorectal Cancer in African Americans 2016

Introduction to Colorectal Cancer in African Americans

Prepared by the Committee on Minority Affairs and Cultural Diversity, American College of Gastroenterology
Renee Williams, MD1, Pascale White, MD2, Jose Nieto, DO3, Dorice Vieira, MLS, MA, MPH1, Fritz Francois, MD, MSc1 and Frank Hamilton, MD, MPH4

Colorectal cancer (CRC) remains the thirdmost common cause of malignancy-related death in men and women in the United States. It is estimated that 134,490 new cases and 49,190 deaths will occur in 2016.1 Among all racial and ethnic groups, African-Americanmen and women continue to have the highest rate of death and shortest survival for CRC.Currently, multiple medical societies recommend CRC screening in average risk asymptomatic individuals to begin at age 50.3,4 In 2005, the American College of Gastroenterology (ACG) published new guidelines for the screening of African Americans for CRC to begin at age 45.5 This was based on a systematic literature review on the issues relating specifically to this racial group and the health disparities that continue to exist. The goals of this update are to further explore the important epidemiology of CRC in African Americans, discuss aggregated differences, and to highlight patient as well as physician-related barriers to screening in addition to proposing strategies to diminish those barriers.

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American College of Gastroenterology (ACG) published new guidelines for the screening of African Americans for CRC to begin at age 45.5

Search methods. A medical librarian conducted a comprehensive literature search in the following databases: Biological Abstracts (1946–present), Biosis Citation Index (BCI) (1926–present), the Cumulative Index to Nursing and Allied Health (CINAHL) (1937–present), the Cochrane Library, Embase Classic (Ovid) (1947–present), PubMed/ Medline (1946–present), and Web of Science (1900–present). The Grey literature was also searched using the NY Academy of Medicine Grey Literature database, OIASter and Open Grey. The search strategy was constructed using a combination of Medical Subject Headings (MeSH) as well as additional relevant subject headings from the other databases. Relevant keywords/text words were also included. The primary strategy is provided below and was adapted appropriately when searching the unique databases. (Blacks or Black Americans OR African Americans OR West Indian American OR Caribbean Americans) AND (Mass screening OR Screening OR prevention) AND (Colon cancer OR colon neoplasms OR Colonic Cancer OR Colonic Neoplasms OR CRC OR colorectal carcinoma OR colon carcinogenesis OR sigmoid carcinoma OR colon adenocarcinoma OR colon carcinogenesis). The following limits were applied: English Language and publication years 2005 to the present.

Current screening guidelines. The United States Preventative Services Task Force, American Cancer Society, American Gastroenterological Association, and the American Society of Colon and Rectal Surgeons currently recommend CRC screening in asymptomatic and average risk individuals to begin at age 50.3,4,6 A few societies have adopted an earlier screening protocol, namely the ACG and American Society of Gastrointestinal Endoscopists (ASGE), both of whom recommend CRC screening in African Americans to begin at age 45. As a part of their best practice advice, the American College of Physicians has recommended the screening age of 40 years for African Americans.7 Different screening modalities include annual fecal occult blood tests, fecal DNA testing every 3 years, annual fecal immunochemical testing (FIT), colonoscopy every 10 years, CT colonography every 5 years, and flexible sigmoidoscopy every 5 years.8

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Citation: Clinical and Translational Gastroenterology (2016) 7, e185; doi:10.1038/ctg.2016.36 & 2016 the American College of Gastroenterology All rights reserved 2155-384X/16