Blacks with family history less likely than whites to get colonoscopy

Mar 25 2008

African Americans who have multiple first-degree relatives with colon cancer are less likely than whites with affected relatives to undergo recommended screening procedures, according to a report in the March 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Family history increases risk for colon cancer, especially if multiple first-degree relatives develop the condition or if one immediate family member is diagnosed before age 60, according to background information in the article. Most clinical guidelines recommend that individuals with these family history factors begin undergoing screening for colorectal cancer at age 40 years, as opposed to age 50 for the general population. A colonoscopy every five years is the screening method of choice.

Harvey J. Murff, M.D., M.P.H., of Vanderbilt University, Nashville, Tenn., and colleagues analyzed screening behavior in 41,830 individuals (32,265 African Americans and 9,565 whites) age 40 to 79 years. Demographic characteristics, family cancer history, tobacco and alcohol use, medical history, physical activity level and medication use were assessed at initial interviews, conducted between 2002 and 2006. Participants were also asked whether they had undergone sigmoidoscopy or colonoscopy for colon cancer screening.

A total of 538 African Americans (1.7 percent) reported either multiple first-degree relatives with colon cancer or a first-degree relative diagnosed before age 50, compared with 255 whites (2.7 percent). Of those, 27.3 percent of African Americans and 43.1 percent of whites reported having a colonoscopy within the past five years, as recommended. Also in this group, African Americans were less likely than whites (19.7 percent vs. 46.9 percent) to report a personal diagnosis of colorectal polyps, precursors to colorectal cancer.

“For both African Americans and whites with family histories of colon cancer, the most common reason given for not having had a colonoscopy or flexible sigmoidoscopy was the lack of a recommendation from their health care provider, and this reason was more commonly reported by African Americans,” the authors write.

“In conclusion, in this disadvantaged population, colonoscopy procedures in individuals with family histories of colon cancer are underused,” they continue. “Physicians and other health care providers need to elicit family history information for all patients and ensure that African Americans with affected relatives appropriately receive colon cancer screening.”

Editor's Note: This article was supported in part by grants from the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.