Archives in Cancer Research

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Asymptomatic Hispanic

Colorectal cancer is the third most commonly diagnosed malignancy, and is second in cancer- related deaths. An estimated 141,210 people will be diagnosed with colon or rectal cancer in the US in 2011, and there will be an estimated 49,380 cancer-related deaths. Race and ethnicity seem to affect colorectal cancer incidence and mortality. Between 2003 and 2007, incidence and mortality among blacks were highest among the different races and ethnicities in the United States. Black individuals who receive colonoscopy screening are at higher risk of advanced neoplastic lesions than white patients, which may contribute to the greater prevalence. Racial differences have also been observed for Hispanics. Data suggest that colorectal cancer incidence and mortality are lower in Hispanic patients. Compared with whites, from 2003 to 2007 incidence was 13–17% lower in Hispanics. Previous studies suggest that Hispanics may have a higher likelihood of distal polyps and tumors than white patients, which may support sigmoidoscopy as an acceptable screening modality.

Colon screening guidelines in 2008 emphasize the importance of screening for cancer prevention, by detection and removal of pre-cancerous lesions. Colon cancer screening may be less effective if there are racial differences in age-adjusted prevalence and location of these lesions. Current colorectal cancer screening guidelines from the American Cancer Society, the Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology recommend initiation of screening at age 50 years for all races. The decline in colorectal cancer mortality in white patients has been ascribed to early detection and treatment; the same decline has not been observed among other racial minority groups, however. Although the prevalence of colorectal cancers is lower for Hispanics, they also undergo less colorectal cancer screening. This may affect the prevalence of colorectal cancer because less screening may result in less cancer detection. On the other hand, if Hispanics are a lower risk population, screening at age 50 may be of less benefit and be less cost-effective than screening white patients. There have been few studies of the prevalence of cancer precursor lesions in these populations, which could affect screening recommendations.

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