Table 2.
Evidence for Racial Differences in Screening Outcomes
| Unadjusted Percentag With the Screening Outcome | Odds Ratios and Risk Ratios*Black Relative to White With 95% Confidence Intervals |
||||||||
|---|---|---|---|---|---|---|---|---|---|
| Black |
White |
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| Outcome/data source | Data Type | Data Collection Years | Age Range (Years) | % | N | % | N | Unadjusted | Adjusted** |
| Adenoma Prevalence | |||||||||
| At Screening Colonoscopy | |||||||||
| National Colonoscopy Study (Mendelsohn, 2017)32¶ | RCT | 2000–2002 2004–2007 |
40–69 | 25.1 | 191 | 26.1 | 199 | 0.93 (0.67,1.28) | 0.86 (0.60,1.25) |
| Stony Brook University (Stein, 2010)57 | Survey, Chart Review | 2006–2007 | >=40 | 35.8 | 356 | 35.7 | 67 | ||
| Kaiser (Corely, 2013)38 | EHR | 2006–2008 | >=50 | 27 | 892 | 24 | 13,266 | — | 1.15 (0.98,1.35) |
| Columbia University (Lebwohl, 2012)54 | EHR | 2006–2010 | >=50 | 25.9 | 591 | 19.1 | 3542 | 1.76 (1.52.2.04) | |
| Columbia University (Lebwohl, 2012)54 | EHR | 2006–2010 | 50–59 | 19.4 | 288 | 16.7 | 1494 | ||
| Columbia University (Lebwohl, 2012)54 | EHR | 2006–2010 | 60–69 | 28.0 | 186 | 17.2 | 1168 | ||
| Columbia University (Lebwohl, 2012)54 | EHR | 2006–2010 | >=70 | 38.5 | 117 | 24.9 | 880 | ||
| Temple University (Friedenberg, 2012)55 | Chart Review | 2007–2010 | 50–59 | 42.9 | 669 | 38.5 | 258 | ||
| Nassau University Medical Center (Zheng, 2014)58 | Chart Review | 2007–2011 | — | 21.8 | 635 | 24.0 | 283 | — | 0.86 (0.60,1.22) |
| Multitarget Stool DNA (Cooper, 2018)56 | Accuracy Study | 2012–2015 | 40–80 | 38.9 | 265 | 33.9 | 495 | ||
| CCPN (Eberth, 2018)59 | EHR | 2014–2016 | 45–64 | 32.2 | 483 | 39.5 | 335 | 0.73 (0.54,0.99) | 0.76 (0.54,1.06) |
| At Follow-up Colonoscopy | |||||||||
| PLCO, 1st screening (Laiyemo, 2010)31† | RCT | 1993–2001 | 55–74 | 50.8 | 480 | 54.2 | 9944 | — | 1.01 (0.92,1.11) |
| PLCO, 2nd screening (Laiyemo, 2015)51‡ | RCT | 2009–2011 | 58–79 | 37.3 | 233 | 41.9 | 3,477 | — | 1.06 (0.89,1.26) |
| At Surveillance Colonoscopy | |||||||||
| Pooled Chemoprevention Study Results (Wallace, 2015)60 | Meta-Analysis of RCTs | 1984–1998 | >50 | 47.7 | 172 | 47.4 | 2,022 | — | 1.08 (0.92,1.27) |
| Advanced Adenoma Prevalence | |||||||||
| At Screening Colonoscopy | |||||||||
| National Colonoscopy Study (Mendelsohn, 2017)32¶ | RCT | 2000–2002 2004–2007 |
40–69 | 7.3 | 191 | 5.5 | 199 | 1.19 (0.56,2.52) | 1.04 (0.39,2.74) |
| Stony Brook University (Stein, 2010)57 | Survey, Chart Review | 2006–2007 | >=40 | 6.0 | 356 | 7.3 | 67 | ||
| Columbia University (Lebwohl, 2012)54 | EHR | 2006–2010 | >=50 | 5.4 | 591 | 3.7 | 3542 | 1.91 (1.27,2.86) | |
| Temple University (Friedenberg, 2012)55 | Chart Review | 2007–2010 | 50–59 | 6.4 | 669 | 7.0 | 257 | ||
| Boston Medical Center (Schroy, 2013)61 | Survey, Chart Review | 2005–2012 | 50–79 | 5.0 | 1,681 | 6.8 | 1,172 | Women: | |
| 1.23 (0.70,2.18) | 1.32 (0.73,2.40) | ||||||||
| Men: | |||||||||
| 0.59 (0.40,0.88) | 0.59 (0.39,0.89) | ||||||||
| Multitarget Stool DNA (Cooper, 2018)56 | Accuracy Study | 2012–2015 | 40–80 | 6.8 | 265 | 6.7 | 495 | ||
| CCPN (Eberth, 2018)59 | EHR | 2014–2016 | 45–64 | 10.9 | 483 | 15.5 | 335 | ||
| At Follow-up Colonoscopy | |||||||||
| PLCO, 1st screening (Laiyemo, 2010)31† | RCT | 1993–2001 | 55–74 | 23.1 | 480 | 22.3 | 9,944 | — | 1.11 (0.94,1.30) |
| PLCO, 2nd screening (Laiyemo, 2015)51‡ | RCT | 1996–2006 | 58–79 | 11.6 | 233 | 13.7 | 3,477 | — | 1.27 (0.90,1.79) |
| At Surveillance Colonoscopy | |||||||||
| Pooled Chemoprevention Study Results (Wallace, 2015)60 | Meta-Analysis of RCTs | 1984–1998 | >50 | 13.4 | 172 | 14.2 | 2,022 | — | 1.05 (0.71,1.56) |
| Boston Medical Center (Kwah, 2014)62 | EHR | 2005–2012 | >=50 | 41.9 | 203 | 47.4 | 246 | 1.18 (0.65,2.16) | 1.30 (0.69,2.40) |
| Prevalence of Proximal Adenomas | |||||||||
| At Screening Colonoscopy | |||||||||
| Kaiser (Corley, 2013)38 | EHR | 2006–2008 | >=50 | 17.0 | 892 | 14.1 | 13,266 | — | 1.26 (1.04,1.54) |
| Temple University (Friedenberg, 2012)55 | Chart Review | 2007–2010 | 50–59 | 24.2 | 669 | 23.7 | 258 | ||
| Nassau University Medical Center (Zheng, 2014)58 | Chart Review | 2007–2011 | — | 16.8 | 635 | 20.5 | 283 | — | — |
| At Follow-up Colonoscopy | |||||||||
| PLCO, 1st screening (Laiyemo, 2010)31 | RCT | 1993–2001 | 55–74 | 21.0 | 480 | 19.0 | 9944 | — | 1.09 (0.91,1.29) |
| PLCO, 2nd screening (Laiyemo, 2015)51 | RCT | 1996–2006 | 58–79 | 18.8 | 233 | 18.9 | 3,477 | — | 1.11 (0.84,1.47) |
| Prevalence of Advanced Proximal Adenomas | |||||||||
| At Screening Colonoscopy | |||||||||
| Boston Medical Center (Schroy, 2013)61 | Survey, Chart Review | 2005–2012 | 50–79 | 2.6 | 1,681 | 2.6 | 1,172 | — | — |
| At Follow-up Colonoscopy | |||||||||
| PLCO, 1st screening (Laiyemo, 2010)31† | RCT | 1993–2001 | 55–74 | 8.5 | 480 | 5.5 | 9,944 | — | 1.56 (1.13,2.14) |
| PLCO, 2nd screening (Laiyemo, 2015)51‡ | RCT | 1996–2006 | 58–79 | 4.4 | 233 | 6.4 | 3,477 | — | 1.44 (0.84,2.48) |
| Screen Detected CRC | |||||||||
| At Screening Colonoscopy | |||||||||
| Boston Medical Center (Schroy, 2013)61 | Survey, Chart Review | 2005–2012 | 50–79 | 0.4 | 1,681 | 0.4 | 1,172 | — | — |
| At Follow-up Colonoscopy | |||||||||
| PLCO, 1st screening (Laiyemo, 2010)31† | RCT | 1993–2001 | 55–74 | 2.1 | 480 | 1.5 | 9,944 | 1.58 (0.80,3.12) | — |
| PLCO, 2nd screening (Laiyemo, 2015)51‡ | RCT | 1996–2006 | 58–79 | 1.3 | 233 | 0.5 | 3,477 | — | — |
| Interval CRC | |||||||||
| SEER-Medicare (Fedewa, 2017)67 | Claims | 2002–2013 | 66–75 | — | 4,196 | — | 51,313 | — | 1.31 (1.13,1.15)§ |
Abbreviations: BRFSS: Behavioral Risk Factors Surveillance System; CCPN: Colorectal Cancer Prevention Network; EHR: Electronic Health Record; NHIS: National Health Interview Survey; PLCO: Prostate, Lung, Colorectal and Ovarian; PROSPR: Population-based Research to Optimize the Screening Process; RCT: Randomized Controlled Trial; SEER: Surveillance, Epidemiology, and End Results; VA: Veterans Health Administration.
Risk ratios are provided in italics to distinguish them from odds ratios.
Characteristics adjusted for in aOR and aRR estimates: Columbia University54: age, sex, family history of CRC, insurance status (Medicaid vs. other), participation of a trainee in exam; Nassau University Medical Center58: age, sex, tobacco use, body mass index (BMI), indication for colonoscopy, alcohol use, dyslipidemia, hypertension; National Colonoscopy Study32: age, sex, and education; Kaiser38: age, family history of CRC; CCPN59: age, sex, education, rural residence, physician, language spoken; PLCO, first screening31: age, sex, smoking status, family history of CRC, BMI, education, history of CRC within 3 years of enrollment, history of colon polyps, and screening center; PLCO, second screening51: age, sex, smoking status, family history of CRC, BMI, education, year of repeat flexible sigmoidoscopy and screening center; Boston Medical Center61: age, smoking status, BMI, alcohol use, education, insurance type, NSAID use, aspirin use, use of birth control pills, use of hormone replacement therapy, red meat intake, multivitamin use, calcium intake, physical activity, diabetes, previous colonoscopy. Pooled Chemoprevention Studies60: age, sex, study treatment assignment, and follow-up time; SEER-Medicare67: age, sex, state of residence, poverty level, urban–rural classification, Charlson comorbidity score, diverticulitis, polyp removal at index colonoscopy, physician specialty, and physician polyp detection rate quartile;
People of Hispanic ethnicity were included in both black and white groups.
The PLCO study used flexible sigmoidoscopy as the reference screening test. During the first screening, the percentage of participants with a polyp detected at flexible sigmoidoscopy was 25.5% (N=3,011) and 23.9% (N=57,561) in black and white participants, respectively.
The PLCO study used flexible sigmoidoscopy as the reference screening test. During the second screening, the percentage of participants with a polyp detected at flexible sigmoidoscopy was 31.2% (N=975) and 19.4% (N=21,550) in black and white participants, respectively.
Estimated hazard ratio for interval CRC up to 59 months after colonoscopy.