M1033 Colorectal Neoplasia in Young African Americans, Could Race Be a Risk Factor? a 40 Years Experience in An Inner City Teaching Hospital

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer, and survival in African Americans (AAs) is worse than Caucasians. Some studies suggest that the incidence of CRC is higher in AA patients below the age of 50 when compared to Caucasians. This study aims to confirm the higher prevalence of CRC in an AA population within the age groups of 40-49, and its implications to the screening guidelines. METHOD: In a retrospective study demographic data, indication and outcome of colonoscopy, and biopsy data were collected at Howard University Hospital over a period of 38 years (1970-2007). All of the study patients were (AA), and cases were classified either symptomatic average risk, 692 (91%); or high risk (family history, IBD), 69 (9%). Distribution of variables were studied by mean (standard deviation) or number (%) . RESULTS: A total of 8851 patients who had colonoscopy were analyzed. Female comprise 56%, and the mean (SD) for age was 60.3 (14.9). Out of the total, 965 (11%) were in the age group of 40-49, of which 409 (42%) had adenoma, and 45 (4.8%) had CRC. The location of 86% of the 409 adenomas were obtained. Two-hundred six (59%) adenomas were on the left side, and 144 (41%) were right sided. The histology of the adenomas included, 264 tubular adenomas (64.5%), 83 hyperplastic lesions (0.3%), 44 villous adenomas (10.8%), and 18 other histology (4.4%). When patients from age 40-44 (378) were compared for the prevalence of adenoma and CRC to those age 45-49 (587), the 40-44 age group had 148 (39.2%) adenomas and 18 (4.8%) CRC, vs. the 45-49 age group had 349 (59.4%) adenomas and 28.1(4.8%) CRC. Twenty four (68.5%) cancers were on the left side, and 11(31.5%) were right sided. Females had higher CRC rates 27 (61%), compared to males 18(39%). CONCLUSION: Our data showed a very high burden of colorectal adenoma and CRC in young AAs (<45). CRC rate of (4.8%) was seen for both the age group of 40-44, and 45-49, which indicates cancer in AAs may starts at younger age than predicted (<45). The American College of Gastroenterology recommends to start screening of AAs at age of 45, but this may not cover many high risk people who are younger than 45. Further study is needed on AAs to confirm these findings.