Addressing Racial Disparity in Colorectal Cancer Screening With CT Colonography: Experience in an African-American Cohort

Colorectal cancer incidence and mortality are higher in African Americans as compared to non-Hispanic whites, and screening rates are lower in African Americans. We evaluated the African-American cohort (n = 2490) of the computed tomographic (CT) colonography screening program at the Atlanta VA Medical Center. The yield of cancer (0.7%; 18/2490) was higher as compared with a previously published predominantly white CT colonography cohort, and the overall colonographic prevalence of polyps and masses >= 10 mm (8.5%) was within the range observed among African Americans undergoing screening optical colonoscopy. The addition of CT colonography to the colorectal cancer screening armamentarium could improve colorectal cancer detection and prevention in African Americans. Background: Incidence and mortality from colorectal cancer (CRC) are higher among African Americans where CRC screening rates lag behind non-Hispanic whites. The purpose of this investigation was to evaluate CT colonography (CTC) performance and outcome measures in an African-American cohort. Materials and Methods: This study is an institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study. Retrospective evaluation of the African-American cohort from the Atlanta VA Medical Center (Decatur, Georgia) CTC screening program. Colonoscopy referral rates and histologic diagnoses were evaluated. Results: CTC studies (n = 2490; mean age, 59.5 years [range, 50-80 years]; 85.5% male; all African American) were performed between 2007 and 2016. The per-patient CTC positive rate was 9.8% for polyps from 6 to 9 mm, 5.4% for polyps from 10 to 29 mm, and 1.3% for masses >= 30 mm. Based on CTC findings and patient preference, 13.9% of patients were referred to optical colonoscopy and 2.9% were referred to CTC follow-up. Of patients recommended to undergo colonoscopy, 80.6% completed the procedure and colonic pathology was confirmed in 83.2% thereof. Histologic diagnoses were 221 tubular adenomas (161 6-9 mm; 60 >= 10 mm), 59 tubulovillous adenomas/villous adenomas (14 6-9 mm; 45 >= 10 mm), 34 hyperplastic-serrated polyps (27 6-9 mm; 7 >= 10 mm), 18 adenocarcinomas (all >= 10 mm), and 11 adenomas with high-grade dysplasia (all >= 10 mm). The per-patient positivity rate for patients who had optical colonoscopy (n = 279) was 71.3% for adenoma, 9.7% for hyperplastic polyp, and 6.1% for adenocarcinoma. Conclusions: CTC is an effective screening modality for African-American adults and could potentially improve rates of colorectal screening in this underserved population. (C) 2018 Elsevier Inc. All rights reserved.