For African Americans Colo-Rectal Screening should begin at 45
Mar 21, 2005 - 6:08:38 PM

Physician experts from the American College of Gastroenterology have issued new recommendations to healthcare providers to begin colorectal cancer screening in African Americans at age 45 rather than 50 years. Colonoscopy is the preferred method of screening for colorectal cancer and data support the recommendation that African-Americans begin screening at a younger age because of the high incidence of colorectal cancer and a greater prevalence of proximal or right-sided polyps and cancerous lesions in this population.

The recommendations are published in the March issue of the American Journal of Gastroenterology. Overall, colorectal cancer is the second leading cause of cancer deaths in the United States. African Americans are diagnosed with colorectal cancer at a younger age than whites, and African Americans with colorectal cancer have decreased survival compared with whites. The article reviews the evidence why African Americans should have their colons screened for cancer at age 45 instead of age 50, five years earlier than the current recommendations. The article was drafted by the American College of Gastroenterology's Committee on Minority Affairs and Cultural Diversity.

The Committee recommends colonoscopy as a "first line" screening procedure for colorectal cancer for African Americans rather than flexible sigmoidoscopy because of the high overall risk and as well as some evidence that African Americans have more right-sided cancers and polyps. The right side of the colon includes the cecum, ascending colon and proximal transverse colon and cannot be reached by flexible sigmoidoscopy.

Clinical gastroenterologists play an important role in promoting colorectal cancer awareness and the need for screening in African Americans. Evidence suggests African Americans are more responsive to screening recommendations from their personal physicians than from other sources. The College urges physicians to provide culturally sensitive patient education on colorectal cancer to African Americans.

Reducing the high morbidity and mortality associated with colorectal cancer among African Americans continues to be a major healthcare challenge in the United States. In response to this challenge, the leadership of the American College of Gastroenterology asked the Committee on Minority Affairs and Cultural Diversity to develop a position paper on colorectal cancer in African Americans. The committee has done an extensive review of the literature on colorectal cancer screening and issues related to screening in African Americans to support their recommendations. One important goal was to improve awareness among primary care physicians and gastroenterologists of the important differences in colorectal cancer between African Americans and Caucasians.

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