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Distribution of colorectal cancer in young African Americans: implications for the choice of screening test

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

We recently reported on a left-sided predominance of colorectal cancers in the young (under age 50). Given the predilection of young African Americans for the disease, we wondered if there may be a difference in the biology of colorectal carcinogenesis between this group and Caucasians.

Objective

Compare the distribution of colorectal cancer in African American patients and Caucasians under age 50, and describe implications for screening in these groups.

Patients

Colorectal cancer patients diagnosed under the age of 50 between the years 2000 and 2016. All races other than African American and Caucasian and all patients with hereditary colon cancer or inflammatory bowel disease were excluded. Outcome measures: race, age at diagnosis (5 subgroups: < 20, 20–29, 30–39, 40–44, and 45–49 years) and cancer location; right (cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure), left (descending colon and sigmoid colon), or rectal.

Results

759 patients were included; 695 (91.6%) were Caucasian and 64 (8.4%) were African American. Most cases were diagnosed between ages 40 and 49 (African American = 75%, Caucasian = 69.5%). Rectal cancer was most common in both races, although significantly more common in Caucasian than in African American patients (64.2% vs 39.1%). Right colon cancer was more commonly found in African Americans (37.5%) compared with Caucasians (18%) (p = 0.0002). The ratio of rectal to right-sided colon cancer in African Americans was 1:1 compared with 3.6:1 in Caucasians.

Limitations

Relatively low number of African American patients

Conclusion

The high rate of right-sided cancer in young African American patients means that they should be screened with colonoscopy. The increased incidence of right-sided cancers may represent a different biology of carcinogenesis in African Americans and deserves further study.

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Tarek H. Hassab, Matthew F. Kalady & James M. Church

  2. Medical Research Institute, University Of Alexandria, Alexandria, Egypt

    Tarek H. Hassab

  3. Sackler Faculty Of Medicine, Tel Aviv University, Tel Aviv, Israel

    Lior Segev

  4. Sanford R. Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA

    Matthew F. Kalady & James M. Church

Authors
  1. Tarek H. Hassab
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  2. Lior Segev
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  3. Matthew F. Kalady
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  4. James M. Church
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Contributions

• Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

• Drafting the work or revising it critically for important intellectual content; AND

• Final approval of the version to be published; AND

• Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to James M. Church.

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The authors declare that they have no conflict of interest.

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The data in this manuscript were presented as a poster presentation in ASCRS Annual scientific meeting, Nashville, TN, May 19–23, 2018.

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Hassab, T.H., Segev, L., Kalady, M.F. et al. Distribution of colorectal cancer in young African Americans: implications for the choice of screening test. Int J Colorectal Dis 34, 1477–1482 (2019). https://doi.org/10.1007/s00384-019-03338-7

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  • DOI: https://doi.org/10.1007/s00384-019-03338-7

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