Prevalence of Colon Polyps >9 mm Detected By Colonoscopy Screening in Asymptomatic Hispanic and...
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329 Disparities in Surveillance Colonoscopy Participation: Determining Gender- and Race-Specific Targets for Future Quality Improvement Interventions D. Eli Penn, Joseph Romagnuolo Background: In a recent study of patients undergoing screening colonoscopy, we found no significant differences in polyp prevalence or incidence between African Americans (AA) and Caucasians to help explain the higher mortality of colorectal cancer in AAs. There were, however, significant race- and gender-related differences in rates of surveillance colonoscopy participation, an important quality metric of a colon cancer screening program. The aim of the current study was to determine the race- and gender-specific barriers, to surveillance colonoscopy, in Charleston, SC after a polypectomy for adenoma(s). Methods: We identified 170 patients from our adenoma prevalence study who had an adenoma removed but did not return for surveillance colonoscopy within the expected timeframe. For each patient, the pathology was reviewed to confirm the need for surveillance. Patients were contacted by telephone and asked to rate their agreement (5-point Likert scale) with 14 statements, encompassing 4 dimensions of possible barriers: 1) financial (including lack or loss of insurance), 2) communication failures (including knowing how to set up the procedure), 3) compliance (including being too busy, or aversion to the procedure), and 4) understanding (of procedure’s importance). Results: 56 patients were able to be contacted and agreed to participate. Of those, 11 (20%) were AA and 26 (46%) were male. AAs were more likely than whites to cite "financial reasons" or "lack of insurance" for failure to return for surveillance (9% vs 2%). AAs were twice as likely to state they were unaware that they were supposed to come back (36% vs 16%), or claim that they had not been contacted (36% vs 16%) or re-referred (54% vs 23%). Women were five times more likely than men to "never want to have another colonoscopy’’ (20% vs 4%). AAs and women were more likely to agree that screening colonoscopy’s goal is ‘‘to remove polyps before they become cancer’’ and to agree that ‘‘colonoscopy after polyps are removed is important.’’ Conclusions: AAs who failed to return for surveillance colonoscopy in our study had a greater understanding of the purpose for surveillance than their white counterparts, but may have been more likely to expect to be contacted before returning; they were five times more likely to cite financial reasons for not returning. Women had a better understanding of the importance of surveillance colonoscopy than men, but 1 in 5 had an aversion to repeat procedures. These findings will help guide interventions aimed at improving adherence with surveillance colonoscopy after adenoma removal. Supported by a grant from The Center for Health Disparities Research 330 Prevalence of Colon Polyps O9 mm Detected By Colonoscopy Screening in Asymptomatic Hispanic and Asian/Pacific Islander Patients: Results from the National Endoscopic Database Brent Lee, David A. Lieberman, Jennifer L. Holub Compared to whites, Hispanics and Asian/Pacific Islanders have lower incidence and mortality from colorectal cancer (CRC). The purpose of this study was to determine if asymptomatic Hispanics and Asian/Pacific Islanders undergoing colonoscopy screening also have lower age-adjusted rates of polyps O9 mm. Such data could inform future screening guidelines. Aims: To measure and analyze the prevalence and location of polyps sized O 9 mm in diameter in asymptomatic white, Asian/Pacific Islander and Hispanic patients who receive colonoscopy screening. Methods: Colonoscopy data were prospectively collected from the Clinical Outcomes Research Initiative (CORI) database, which represents a consortium of 67 adult gastrointestinal practice sites in the United States. Asymptomatic white (n Z 146,798), Hispanic (n Z 7,654), and Asian/Pacific Islander (n Z 1,567) patients who received screening colonoscopy from 2004 - 2007 were identified. Main outcome measures included prevalence and location of polyps O9mm, adjusted for age, gender, and family history of colorectal cancer in a multivariate analysis. Prior work has shown that polyp(s) O9 mm are closely associated with rates of advanced neoplasia. Results: There was no significant difference in prevalence of polyps O9 mm in white and Hispanic patients (6.2% vs 5.8%; pZ0.11; adjusted OR 0.94; 95% CI 0.85-1.03). Asian/Pacific Islander men and women had a lower prevalence of polyps O9 mm compared to white men and women (4.1% vs 6.2%; pZ0.0004; adjusted OR 0.67; 95% CI 0.52-0.86). When analyzed by decade of age, 60-69 year-old Asians had similar rates of large polyps compared to 50-59 year-old whites (see Table). Conclusion: Compared to whites, Hispanic men and women undergoing screening colonoscopy have a similar risk of polyps O9 mm, whereas Asian/Pacific Islanders have a lower risk. These data suggest that screening colonoscopy might be deferred until age 60 years in average-risk Asian/ Pacific Islanders. Further study is needed to confirm this finding. Prevalence of polyp(s) O 9 mm stratified by race and age. Age(yrs) Whites Asians Hispanic !50 383/8724 (4.4%) 2/115 (1.7%) 17/506 (3.4%) 50-59 3678/69633 (5.3%) 25/799 (3.1%)) 190/3770 (5.0%) 60-69 3149/44225 (7.1%) 23/452 (5.1%) 162/2279 (7.1%) O70 1954/24216 (8.1%) 14/201 (7.0%) 74/1099 (6.7%) )Asian compared to Whites; p!0.01 331 The Effect of Acculturation On Colorectal Polyp Prevalence Among Hispanics Neal Joseph, Nora Muakkassa, Sergio Quijano, Martin J. Wolff, Fritz Francois Background: Acculturation, the change in behavior and values that occurs when an immigrant group comes into contact with another group, has been linked to important health outcomes such as coronary heart disease, and breast cancer. The association of acculturation with colon cancer risk is unknown. Our aim was to determine the risk of colonic lesions according to acculturation status among Hispanics. Methods: Consecutive patients referred for screening colonoscopy were prospectively enrolled. A detailed history was obtained, and a validated acculturation survey was administered along with a standardized dietary habit assessment to a subset of self-identified Hispanics. The number, size and location of each polyp were noted during endoscopy. The association between acculturation and adenomas of any size, including advanced neoplasms (adenomas R10mm or any adenoma with villous histology, high-grade dysplasia, or cancer) was assessed. Results: A total of 1,337 patients were enrolled of which 807 (58%) were Hispanic and served as the study cohort. The majority of these patients 749 (93%) were immigrants who had been in the US for 28 16 years. Mean age was significantly higher for immigrants compared to non-immigrants (58 9 vs 51 9; p!0.001), however BMI (27.9 5 vs. 28.1 6) and waist circumference (35 4 vs. 33 4) were comparable. The prevalence of colonic adenomas was higher but not significantly different between immigrants and non-immigrants (16% vs. 12%). In the subset of assessed immigrant Hispanics, age did not differ significantly between acculturated individuals and those who were not acculturated (59 8 vs. 59 9). However the prevalence of adenomas was significantly higher among the acculturated compared to the non-acculturated (25% vs. 11%, pZ0.046). Among the dietary factors assessed, acculturated Hispanics were more likely to consume pastries (72% vs. 55%; pZ0.047) and less likely to drink milk (69% vs. 86%; pZ0.036) compared to their non-acculturated counterparts. After controlling for age, gender, BMI, and number of years in the U.S., acculturation remained a significant predictor of colon pathology (ORZ4.5; 95% CI 1.2-18; pZ0.036). Conclusions: In this colon cancer screening population acculturation was a significant independent predictor of colon pathology among Hispanics, and was associated with a certain dietary profile. Further evaluation of acculturation-related risk factors may help address existing health disparities in colon cancer. 332 Time Trends and Racial Disparities in the Stage of Diagnosis of Esophageal Adenocarcinoma (EAC) in the United States Sachin B. Wani, Amit Rastogi, Mandeep Singh, Vikas Singh, John D. Keighley, Ajay Bansal, Prateek Sharma Background: The incidence of EAC continues to increase in US at an alarming rate. Overall 5-year survival rate for EAC is ~15% and is dependent on its stage of diagnosis. Aims: a)Study the trends in the stage of diagnosis of EACb)Assess racial disparities in the stage of diagnosis of EAC. Methods: The Surveillance Epidemiology and End Results (SEER) database of NCI was searched to identify all pts diagnosed with invasive EAC between January 1, 1976 and December 31, 2005. Data from 9 population-based registries were used to calculate incidence rates of EAC. Age-adjusted incidence rates, using the 2000 US standard, and 95% confidence intervals (CI) were calculated by gender and race (whites, blacks, and others) using SAS. These were calculated in six discrete 5-year time periods (1976-1980 through 2001-2005). Tumor stage was defined as SEER Historic Stage (local - confined to the esophagus; regional - invaded adjacent tissues or spread to regional lymph nodes; distant - metastasized or with distant lymph node involvement; unstaged). To assess for an overall change in the stage of diagnosis, c2 test of equal proportions across time was performed. To assess for a change in the individual stage of diagnosis, Cochran-Armitage test for trend were performed. Results: Between 1976 and 2005, 10,596 cases of EAC were diagnosed. Incidence of EAC/100,000 person-yrs increased from 0.51 in 1976-80 (95% CI 0.47-0.57) to 2.54 2001-05 (95% CI 2.45-2.63), an increase of 400%. In 2001-2005 (compared to 1976-1980) significantly higher number of local and regional EACs were diagnosed [33% increase in local tumors,32% increase in regional]; p for trend for both !0.0001 whereas lower number of distant cancers were diagnosed;p for trend Z0.0002. Significantly less tumors were unstaged in 2001-05 compared with 1976-80 (decline of 57%, p for trend !0.001). Incidence of EAC among whites increased 4-fold with significantly more tumors diagnosed at a local and regional stage; (39% increase in local tumors, 32% increase in regional, p for trend for both !0.0001; 6% decrease in distant, p!0.0005). The incidence of EAC among blacks also increased 2-fold but no significant change in the stage of diagnosis was noted. Conclusions: Updated results (up to 2005) of this population-based study suggest that the incidence rates of EAC continue to rise in whites and blacks. Currently, significantly more EAC are diagnosed at the local and regional stage along with a significant decrease in the distant and unstaged cancers in whites; however, a similar trend was not seen among blacks. Determination of factors driving these racial disparities in EAC stage diagnosis need to be explored. Abstracts www.giejournal.org Volume 69, No. 5 : 2009 GASTROINTESTINAL ENDOSCOPY AB105
Transcript of Prevalence of Colon Polyps >9 mm Detected By Colonoscopy Screening in Asymptomatic Hispanic and...
Abstracts
329
Disparities in Surveillance Colonoscopy Participation:
Determining Gender- and Race-Specific Targets for Future
Quality Improvement InterventionsD. Eli Penn, Joseph RomagnuoloBackground: In a recent study of patients undergoing screening colonoscopy, wefound no significant differences in polyp prevalence or incidence between AfricanAmericans (AA) and Caucasians to help explain the higher mortality of colorectalcancer in AAs. There were, however, significant race- and gender-related differencesin rates of surveillance colonoscopy participation, an important quality metric ofa colon cancer screening program. The aim of the current study was to determine therace- and gender-specific barriers, to surveillance colonoscopy, in Charleston, SCafter a polypectomy for adenoma(s). Methods: We identified 170 patients from ouradenoma prevalence study who had an adenoma removed but did not return forsurveillance colonoscopy within the expected timeframe. For each patient, thepathology was reviewed to confirm the need for surveillance. Patients were contactedby telephone and asked to rate their agreement (5-point Likert scale) with 14statements, encompassing 4 dimensions of possible barriers: 1) financial (includinglack or loss of insurance), 2) communication failures (including knowing how to setup the procedure), 3) compliance (including being too busy, or aversion to theprocedure), and 4) understanding (of procedure’s importance). Results: 56 patientswere able to be contacted and agreed to participate. Of those, 11 (20%) were AA and26 (46%) were male. AAs were more likely than whites to cite "financial reasons" or"lack of insurance" for failure to return for surveillance (9% vs 2%). AAs were twice aslikely to state they were unaware that they were supposed to come back (36% vs16%), or claim that they had not been contacted (36% vs 16%) or re-referred (54% vs23%). Women were five times more likely than men to "never want to have anothercolonoscopy’’ (20% vs 4%). AAs and women were more likely to agree that screeningcolonoscopy’s goal is ‘‘to remove polyps before they become cancer’’ and to agreethat ‘‘colonoscopy after polyps are removed is important.’’ Conclusions: AAs whofailed to return for surveillance colonoscopy in our study had a greaterunderstanding of the purpose for surveillance than their white counterparts, but mayhave been more likely to expect to be contacted before returning; they were fivetimes more likely to cite financial reasons for not returning. Women had a betterunderstanding of the importance of surveillance colonoscopy than men, but 1 in 5had an aversion to repeat procedures. These findings will help guide interventionsaimed at improving adherence with surveillance colonoscopy after adenomaremoval. Supported by a grant from The Center for Health Disparities Research
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Prevalence of Colon Polyps O9 mm Detected By Colonoscopy
Screening in Asymptomatic Hispanic and Asian/Pacific Islander
Patients: Results from the National Endoscopic DatabaseBrent Lee, David A. Lieberman, Jennifer L. HolubCompared to whites, Hispanics and Asian/Pacific Islanders have lower incidence andmortality from colorectal cancer (CRC). The purpose of this study was to determine ifasymptomatic Hispanics and Asian/Pacific Islanders undergoing colonoscopyscreening also have lower age-adjusted rates of polyps O9 mm. Such data couldinform future screening guidelines. Aims: To measure and analyze the prevalence andlocation of polyps sized O 9 mm in diameter in asymptomatic white, Asian/PacificIslander and Hispanic patients who receive colonoscopy screening. Methods:Colonoscopy data were prospectively collected from the Clinical Outcomes ResearchInitiative (CORI) database, which represents a consortium of 67 adult gastrointestinalpractice sites in the United States. Asymptomatic white (n Z 146,798), Hispanic(n Z 7,654), and Asian/Pacific Islander (n Z 1,567) patients who received screeningcolonoscopy from 2004 - 2007 were identified. Main outcome measures includedprevalence and location of polyps O9mm, adjusted for age, gender, and family historyof colorectal cancer in a multivariate analysis. Prior work has shown that polyp(s)O9 mm are closely associated with rates of advanced neoplasia. Results: There was nosignificant difference in prevalence of polyps O9 mm in white and Hispanic patients(6.2% vs 5.8%; pZ0.11; adjusted OR 0.94; 95% CI 0.85-1.03). Asian/Pacific Islandermen and women had a lower prevalence of polyps O9 mm compared to white menand women (4.1% vs 6.2%; pZ0.0004; adjusted OR 0.67; 95% CI 0.52-0.86). Whenanalyzed by decade of age, 60-69 year-old Asians had similar rates of large polypscompared to 50-59 year-old whites (see Table). Conclusion: Compared to whites,Hispanic men and women undergoing screening colonoscopy have a similar risk ofpolyps O9 mm, whereas Asian/Pacific Islanders have a lower risk. These data suggestthat screening colonoscopy might be deferred until age 60 years in average-risk Asian/Pacific Islanders. Further study is needed to confirm this finding.Prevalence of polyp(s) O 9 mm stratified by race and age.
Age(yrs) Whites Asians Hispanic
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al.org!50
383/8724 (4.4%) 2/115 (1.7%) 17/506 (3.4%) 50-59 3678/69633 (5.3%) 25/799 (3.1%)) 190/3770 (5.0%) 60-69 3149/44225 (7.1%) 23/452 (5.1%) 162/2279 (7.1%) O70 1954/24216 (8.1%) 14/201 (7.0%) 74/1099 (6.7%))Asian compared to Whites; p!0.01
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The Effect of Acculturation On Colorectal Polyp Prevalence
Among HispanicsNeal Joseph, Nora Muakkassa, Sergio Quijano, Martin J. Wolff,Fritz FrancoisBackground: Acculturation, the change in behavior and values that occurs when animmigrant group comes into contact with another group, has been linked toimportant health outcomes such as coronary heart disease, and breast cancer. Theassociation of acculturation with colon cancer risk is unknown. Our aim was todetermine the risk of colonic lesions according to acculturation status amongHispanics. Methods: Consecutive patients referred for screening colonoscopy wereprospectively enrolled. A detailed history was obtained, and a validatedacculturation survey was administered along with a standardized dietary habitassessment to a subset of self-identified Hispanics. The number, size and location ofeach polyp were noted during endoscopy. The association between acculturationand adenomas of any size, including advanced neoplasms (adenomas R10mm orany adenoma with villous histology, high-grade dysplasia, or cancer) was assessed.Results: A total of 1,337 patients were enrolled of which 807 (58%) were Hispanicand served as the study cohort. The majority of these patients 749 (93%) wereimmigrants who had been in the US for 28 � 16 years. Mean age was significantlyhigher for immigrants compared to non-immigrants (58 � 9 vs 51 � 9; p!0.001),however BMI (27.9 � 5 vs. 28.1 � 6) and waist circumference (35 � 4 vs. 33 � 4)were comparable. The prevalence of colonic adenomas was higher but notsignificantly different between immigrants and non-immigrants (16% vs. 12%). Inthe subset of assessed immigrant Hispanics, age did not differ significantly betweenacculturated individuals and those who were not acculturated (59 � 8 vs. 59 � 9).However the prevalence of adenomas was significantly higher among theacculturated compared to the non-acculturated (25% vs. 11%, pZ0.046). Amongthe dietary factors assessed, acculturated Hispanics were more likely to consumepastries (72% vs. 55%; pZ0.047) and less likely to drink milk (69% vs. 86%;pZ0.036) compared to their non-acculturated counterparts. After controlling forage, gender, BMI, and number of years in the U.S., acculturation remaineda significant predictor of colon pathology (ORZ4.5; 95% CI 1.2-18; pZ0.036).Conclusions: In this colon cancer screening population acculturation wasa significant independent predictor of colon pathology among Hispanics, and wasassociated with a certain dietary profile. Further evaluation of acculturation-relatedrisk factors may help address existing health disparities in colon cancer.
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Time Trends and Racial Disparities in the Stage of Diagnosis of
Esophageal Adenocarcinoma (EAC) in the United StatesSachin B. Wani, Amit Rastogi, Mandeep Singh, Vikas Singh, JohnD. Keighley, Ajay Bansal, Prateek SharmaBackground: The incidence of EAC continues to increase in US at an alarming rate.Overall 5-year survival rate for EAC is ~15% and is dependent on its stage ofdiagnosis. Aims: a)Study the trends in the stage of diagnosis of EACb)Assess racialdisparities in the stage of diagnosis of EAC. Methods: The SurveillanceEpidemiology and End Results (SEER) database of NCI was searched to identify allpts diagnosed with invasive EAC between January 1, 1976 and December 31, 2005.Data from 9 population-based registries were used to calculate incidence rates ofEAC. Age-adjusted incidence rates, using the 2000 US standard, and 95% confidenceintervals (CI) were calculated by gender and race (whites, blacks, and others) usingSAS. These were calculated in six discrete 5-year time periods (1976-1980 through2001-2005). Tumor stage was defined as SEER Historic Stage (local - confined to theesophagus; regional - invaded adjacent tissues or spread to regional lymph nodes;distant - metastasized or with distant lymph node involvement; unstaged). To assessfor an overall change in the stage of diagnosis, c2 test of equal proportions acrosstime was performed. To assess for a change in the individual stage of diagnosis,Cochran-Armitage test for trend were performed. Results: Between 1976 and 2005,10,596 cases of EAC were diagnosed. Incidence of EAC/100,000 person-yrs increasedfrom 0.51 in 1976-80 (95% CI 0.47-0.57) to 2.54 2001-05 (95% CI 2.45-2.63), anincrease of 400%. In 2001-2005 (compared to 1976-1980) significantly highernumber of local and regional EACs were diagnosed [33% increase in localtumors,32% increase in regional]; p for trend for both !0.0001 whereas lowernumber of distant cancers were diagnosed;p for trend Z0.0002. Significantly lesstumors were unstaged in 2001-05 compared with 1976-80 (decline of 57%, p fortrend !0.001). Incidence of EAC among whites increased 4-fold with significantlymore tumors diagnosed at a local and regional stage; (39% increase in local tumors,32% increase in regional, p for trend for both !0.0001; 6% decrease in distant,p!0.0005). The incidence of EAC among blacks also increased 2-fold but nosignificant change in the stage of diagnosis was noted. Conclusions: Updatedresults (up to 2005) of this population-based study suggest that the incidence ratesof EAC continue to rise in whites and blacks. Currently, significantly more EAC arediagnosed at the local and regional stage along with a significant decrease in thedistant and unstaged cancers in whites; however, a similar trend was not seenamong blacks. Determination of factors driving these racial disparities in EAC stagediagnosis need to be explored.
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