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Earlier Colorectal Cancer Screening for Blacks Advised
 
 
  MedPage Today
Published: June 05, 2010
 
Action Points
 
* Explain to interested patients that the recommendation for blacks to begin screening for colorectal cancer screening at age 45 is consistent with existing guidelines from the American College of Gastroenterology but at odds with those from the American Cancer Society.
 
Black men and women should begin colorectal cancer screening at age 45 if they have an average level of risk, according to new guidelines from the American Society for Gastrointestinal Endoscopy (ASGE).
 
The guidance, which is consistent with recommendations from the American College of Gastroenterology, was issued by the ASGE's standards of practice committee in the June issue of GIE: Gastrointestinal Endoscopy.
 
Previous studies have shown that blacks have greater mortality risk from colorectal cancer, younger age at presentation, a higher proportion of cancers presenting before age 50, and lower screening rates than whites.
 
Black patients also have, in general, more advanced cancer at diagnosis.
 
"There are multiple possible explanations for this phenomenon, including societal issues (such as access to medical care and increased exposure to modifiable colon cancer risk factors), as well as possible inherent biologic differences resulting in more aggressive colon neoplasm behavior in African Americans than in European Americans," the guideline authors wrote.
 
In the new guidance, ASGE also recommended emphasizing colorectal cancer screening for other minority ethnic groups with low screening rates, but did not recommend an earlier age to start in other groups.
 
Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society, said the evidence is lacking to support an earlier start for colorectal screening among black individuals or those from other ethnic groups. ACS recommends that screening for average-risk individuals start at age 50.
 
"We do not support the guideline that's been published by the ASGE," he said. "In our opinion, at this point in time, the evidence is not sufficient to warrant sending a different message to different ethnic groups regarding the age or the type of tests that they should have."
 
ASGE issued the statement to highlight differences in GI disease patterns based on ethnicity, because such differences may affect how endoscopy is applied in these groups.
 
"Studies addressing the impact of modifying specific endoscopic standards of practice for conditions based on ethnicity are currently lacking," the authors wrote. "However, it is logical to assume that increased awareness of differences in disease patterns and management among different ethnic groups could have beneficial impacts on the health-related quality of life of these groups."
 
In addition to guidance regarding colorectal cancer screening, ASGE made the following recommendations, all based on low-quality evidence (meaning that further research is likely to have an important impact on the confidence in the effect estimates and is likely to change the estimates):
 
* Screening esophagogastroduodenoscopy for esophageal cancer should not be based on ethnicity, but on clinical considerations only.
 
* Further studies are needed before making ethnicity-based recommendations for screening for Helicobacter pylori to reduce risk of gastric cancer.
 
* in patients found to have gastric intestinal metaplasia, the authors suggest surveillance for those at increased risk of gastric cancer due to ethnic background or family history.
 
* Screening esophagogastroduodenoscopy for gastric cancer should be used in new U.S. immigrants from high-risk regions around the world, such as Korea, Japan, China, Russia, and South America, especially if there is a family history of gastric cancer in a first-degree relative.
 
The authors of the guidance did not make any financial disclosures.
 
Primary source: Gastrointestinal Endoscopy
Source reference:
Dominitz J, et al "Ethinc issues in endoscopy" Gastrointest Endosc 2010; 71: 1108-1112.
 
 
 
 
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