Author(s)

Yakira David^1,2*, Lorenzo Ottaviano³, Jihye Park⁴, Sadat Iqbal¹, Michelle Likhtshteyn¹, Samir Kumar¹, Helen Lyo¹, Ayanna E. Lewis³, Brandon E. Lung³, Jesse T. Frye³, Li Huang³, Ellen Li³, Jie Yang⁵, Laura Martello¹, Shivakumar Vignesh¹, Joshua D. Miller³, Michele Follen⁶, Evan B. Grossman^1,7

¹Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
²Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
³Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
⁴Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
⁵Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA.
⁶Department of Obstetrics and Gynecology, NYC HNC/Kings County, Brooklyn, NY, USA.
⁷Department of Medicine, Division of Gastroenterology, NYC Health and Hospitals/Kings County, Brooklyn, NY, USA.

Background and Aims: The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there in increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. Methods: A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45 - 75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Results: Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance was associated with adenoma detection. Conclusion: In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.

Colorectal, Cancer, Screening, Adenoma, Quality

David, Y. , Ottaviano, L. , Park, J. , Iqbal, S. , Likhtshteyn, M. , Kumar, S. , Lyo, H. , Lewis, A. , Lung, B. , Frye, J. , Huang, L. , Li, E. , Yang, J. , Martello, L. , Vignesh, S. , Miller, J. , Follen, M. and Grossman, E. (2019) Confounders in Adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer. Journal of Cancer Therapy, 10, 269-289. doi: 10.4236/jct.2019.104022.