A decade of improved access to screening is associated with fewer colorectal cancer deaths in African Americans: a single-center retrospective study

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Φορέας Ελληνική Γαστροεντερολογική Εταιρία
Συλλογή Annals of Gastroenterology A decade of improved access to screening
is associated with fewer colorectal cancer deaths in African
Americans: a single-center retrospective study
Επιμέρους συλλογή Original Articles
ΠεριγραφήBackground Controversy exists as to whether disparities in colorectal cancer (CRC) outcomes in African Americans (AAs) are best resolved by screening at age 45 or by proper use of existing guidelines. In 2004, an aggressive colonoscopy-based CRC screening program was implemented throughout New York City. Our goal was to determine the effect of that program on CRC outcomes in our mostly AA population.Methods CRC cases entered into Harlem Hospital’s tumor registry from January 1992 to December 2011 were divided into two cohorts: 1992-2003, the pre-intensive screening era (PSE), and 2004-2011, the intensive screening era (ISE). Each cohort was reviewed for demographics, indication for colonoscopy, tumor location, tumor stage, and mortality. Multivariate analysis was applied to the pooled cohorts to determine factors associated with survival.Results Inclusion criteria were met by 379 patients: 207 PSE and 172 ISE. Racial distribution, gender, age at presentation, and tumor location were not different during the two eras. Over 75% of patients were AA. During the ISE, 84% were insured compared to 34% in the PSE (P<0.0001). Fewer patients died during the ISE (21%) than during the PSE (67%) (P<0.0001). The ISE patients were diagnosed with earlier stages of CRC compared to the PSE. Increased survival was associated with being insured (hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.30-2.81), distal tumors (HR 1.43, 95%CI 1.05-1.95), and being female (HR 1.36, 95%CI 1.01-1.850).Conclusions A multifaceted program reduced CRC outcome disparities in a poor AA community. Aggressive implementation of current colonoscopy screening guidelines still has unrealized potential to reduce CRC mortality disparities in AAs.Keywords Colorectal cancer, screening, colorectal cancer deaths, African AmericansAnn Gastroenterol 2017; 30 (5): 518-525
Δημιουργοί Siba, Yahuza Culpepper-Morgan, Joan Schechter, Menachem Alatevi, Eric Jallow, Sainabou Onaghise, Jude Sey, Albert Ozick, Lisa Sabbagh, Raja
Συνεργάτης NONE
ΕκδότηςAnnals of Gastroenterology
Ημερομηνία2017-08-26
Μορφότυποςapplication/pdf
Μορφότυποςtext/html
ΠηγήAnnals of Gastroenterology; Volume 30, No 5 (2017); 518
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