Whites and Blacks Have Similar Risk of Metachronous Advanced Colorectal Neoplasia

Background: Current guidelines for surveillance of colonic neoplasia are based on data from predominantly white populations, yet whether these recommendations are applicable to blacks is unknown. Aim: To define the prevalence of advanced colorectal neoplasia (ACN) among whites and blacks undergoing surveillance colonoscopy. Methods: This was a retrospective, cross-sectional analysis of asymptomatic, average-risk non-Hispanic white (N = 246) and non-Hispanic black (N = 203) patients with colorectal neoplasia who underwent baseline screening colonoscopy between January 1, 2000, and December 31, 2007, and a surveillance colonoscopy before December 31, 2010, at an academic safety-net hospital. The main outcome measure was the prevalence of ACN, defined as a tubular adenoma or sessile serrated adenoma (SSA) ≥10 mm, any adenoma with villous histology or high-grade dysplasia, any serrated lesion with dysplasia, or invasive cancer at surveillance. Results: During a median follow-up of 4.3 years, the overall prevalence of ACN at surveillance was similar among blacks and whites (11.3 vs. 9.8 %; P = 0.59) with an odds ratio of 1.18 (95 % CI 0.65–2.26). Blacks and whites with non-advanced neoplasia had similar rates of ACN at the 1–3, 4–5, and >5 year follow-up intervals. Blacks with ACN or multiplicity at baseline had higher rates of ACN at the 1- to 3-year interval compared with whites, but the difference was non-significant (26.7 vs. 12.5 %; P = 0.32). No interval cancers were observed for either group. Conclusions: The overall prevalence of ACN was similar between non-Hispanic blacks and non-Hispanic whites undergoing surveillance in a safety-net healthcare setting suggesting that current surveillance guidelines are appropriate for both blacks and whites.