NEW YORK (Reuters Health) – On screening colonoscopy, polyps greater than 9 mm in diameter are more likely to be detected in black individuals than in their white counterparts, according to a report in the Journal of the American Medical Association for September 24.

Moreover, in subjects over 60 years, larger polyps in the proximal colon were more often seen in black than in white individuals, the report indicates.

Dr. David A. Lieberman, from the Portland VA Medical Center in Oregon, and colleagues note that black men and women have a high incidence and mortality from colorectal cancer than white individuals. To see if there are racial differences in the prevalence and location of precursor lesions, the researcher analyzed data from 80,061 white patients and 5464 black patients who were evaluated by screening colonoscopy at 67 gastrointestinal practice sites in the US from 2004 to 2005.

Nearly 8% of black patients had polyps greater than 9 mm in diameter compared with 6.2% of white subjects (p < 0.001). Relative to their white counterparts, black men and black women were 16% and 62% more likely, respectively, to have larger polyps detected. In the overall analysis, proximal polyps greater than 9 mm occurred with similar frequency in each racial group. When the analysis was limited to subjects older than 60 years, however, these polyps were more prevalent in black subjects. “These findings emphasize the importance of encouraging all black men and women to be screened,” the authors state. “Further study is needed to determine how customized screening (based on race and age) would affect adherence and key outcomes, such as incidence and mortality of colorectal cancer.” In an accompanying editorial, Dr. Hemant K. Roy and Dr. Laura K. Bianchi, from Evanston Northwestern Healthcare in Illinois, write: “It is becoming clear that as physicians and patients enter the era of personalized medicine, colorectal cancer screening will evolve from simply dichotomizing patients into average or increased risk to assigning more precise gradations.” Reference:
JAMA 2008;300:1417-1422,1459-1461.