Minority patients prefer optical colonoscopy for colorectal cancer screening

The clinical importance of colorectal cancer screening is well established, however the majority of eligible people do not undergo screening tests.

It is important to identify which tests may encourage individuals to be screened in order to help increase the survival rate of the disease. Individuals of racial/ethnic minorities strongly prefer and better tolerate optical colonoscopy (OC) versus white patients who prefer computed tomographic (CT) colonography for the evaluation of the colon, according to a new study published in Clinical Gastroenterology and Hepatolog y. Additionally, patients who had a prior history of polyps preferred undergoing OC, most likely since they were aware of their increased risk of polyps which would necessitate removal using colonoscopy.

“We were somewhat surprised at the results of our study as we had assumed that racial/ethnic minorities would have preferred CT colonography as the less invasive screening test,” said Edmund J. Bini, MD, MPH, of the VA New York Harbor Healthcare System and lead investigator of the study. “These findings have important clinical implications for the development of programs that will encourage racial and ethnic minorities in the U.S. to be screened for colorectal cancer.”

The study found that if recommended by their physicians, significantly more study participants would be willing to undergo OC versus those who would undergo CT colonography. Overall, patients in the study felt OC was more painful than CT colonography, however they experienced more bloating and embarrassment during CT colonography than during OC.

Black patients were the most satisfied with OC as opposed to white participants who were the least satisfied during this procedure. White patients experienced more abdominal pain, discomfort and bloating during OC. Patients who identified their race/ethnicity as “other” experienced the greatest embarrassment and anxiety scores.

During the CT colonography, white patients experienced the least severity of abdominal pain while Hispanic participants experienced the greatest pain. Black and Hispanic patients felt significantly more embarrassed during CT colonography than did white patients or participants from other racial/ethnic minorities. White participants were significantly more satisfied with CT colonography than other study participants.

The study included 272 participants from diverse racial/ethnic backgrounds including non-Hispanic whites, non-Hispanic blacks, Hispanic individuals and those who self-identified as “other.” All participants completed both OC and CT colonography. The most common reason participants who were white or who designated their race/ethnicity as “other” were undergoing colonoscopy was screening. In participants who were black, the most common indication for colonoscopy was a positive fecal occult blood test (FOBT) and in patients who were Hispanic, the most common reasons were hematochezia (blood in the stool) or iron deficiency anemia.

Guidelines from multiple agencies and professional societies, including the AGA Institute, underscore the importance of colorectal cancer screening for all individuals 50 years of age and older (younger for certain groups known to be at higher risk). The U.S. Preventive Services Task Force, the U.S. Multi-Specialty Task Force and others have published recommendations for screening for colorectal cancer, the second-leading cause of cancer deaths in the United States. Currently, recommended screening tests include colonoscopy, flexible sigmoidoscopy, barium enema and fecal occult blood tests.

In September, the AGA Institute issued standards for performance of virtual, or CT, colonography. The AGA Institute will hold a course of CT Colonography on March 7 – 8, 2008, in Washington, DC. To learn more about AGA Institute initiatives on CTC, please visit the AGA Web site at www.gastro.org.

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