Risk of Interval Colorectal Cancer Higher in Blacks Than Whites

MedicalResearch.com Interview with:

Stacey Fedewa PhD Strategic Director, Risk Factors & Screening Surveillance American Cancer Society, Inc. Atlanta, GA 30303

Dr. Fedewa

Stacey Fedewa PhD
Strategic Director, Risk Factors & Screening Surveillance
American Cancer Society, Inc.
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Screening for colorectal cancer is effective in reducing incidence and mortality by detecting precancerous lesions or cancer at more curable stages. But colorectal cancers can still develop in screened populations, some are missed at the time of screening; others can develop between recommended screenings. Patterns of risk for interval colorectal cancer, defined as cancers that develop after a negative result on colonoscopy, by race/ethnicity are not well known.

The risk for blacks was of interest to us because colorectal incidence and mortality rates in blacks are the highest among any race or ethnicity in the United States. We were also interested to see if quality of colonoscopy, measured by physician’s polyp detection rate, could account for differences.

MedicalResearch.com: What is the background for this study?

Response: In our population-based study of Medicare enrollees, the probability of interval colorectal cancer by the end of follow-up was 7.1% in blacks and 5.8% in whites. Blacks (52.8%) were more likely than whites (46.2%) to have received colonoscopy from physicians with a lower polyp detection rate (our surrogate measure of quality with lower detection rates representing poorer quality), polyp detection rate was significantly associated with the risk of an interval cancer. Nonetheless, the higher risk of interval cancers among blacks remained after adjusting for polyp detection rate.

MedicalResearch.com: What should readers take away from your report?

Response: The overall risk of interval colorectal cancers in elderly blacks was higher than whites.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our study was one of the first to examine the issue of racial/ethnic disparities in interval colorectal, so I think before recommending any changes in guidelines or clinical practice, we need to dig a little deeper into some our findings with more detailed investigation. For example, our study did not directly assess whether the higher interval colorectal cancers in blacks was due to higher “de novo” cancers (ie those growing in between recommended screening intervals), though our results, along with others, provide some evidence that this might not be case.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study identified disparities in interval colorectal cancer as well as quality of colonoscopy, the most common test used for colorectal cancer screening. However, I think it’s important to relay the message that screening for colorectal as well as leading a healthy life (ie being physically activity, maintaining a healthy body weight, having a healthy diet) are important ways that people can reduce their risk of colorectal cancer. I have no disclosures.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


Fedewa SA, Flanders WD, Ward KC, Lin CC, Jemal A, Sauer AG, et al. Racial and Ethnic Disparities in Interval Colorectal Cancer Incidence: A Population-Based Cohort Study. Ann Intern Med. [Epub ahead of print 23 May 2017] doi: 10.7326/M16-1154
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