Agrawal S et al. (2005) Colorectal cancer in African Americans. Am J Gastroenterol 100: 515–523

New recommendations from the American College of Gastroenterology have called for earlier screening for colorectal cancer in African Americans. Screening for average-risk individuals should begin at age 45 years, they say—five years earlier than has been recommended to date. This advice comes in response to evidence of a higher incidence of the disease in this population than among other racial or ethnic groups, and a lower mean age at presentation. Furthermore, since African American patients have a particularly high frequency of lesions in the proximal part of the large bowel, colonoscopy is preferred over sigmoidoscopy as a first-line screening procedure.

The College's Committee of Minority Affairs and Cultural Diversity has published the recommendations—along with information on colorectal cancer incidence, survival, tumor site distribution, diagnosis, and screening—in the American Journal of Gastroenterology. The paper draws attention to the specific issues of colorectal cancer in African Americans, and encourages the development of culturally-sensitive educational programs, both in the community and for physicians.

The authors note that survival in African Americans with colorectal cancer is lower than among whites and prognosis tends to be poorer. In the absence of any biological explanation for the higher incidence of colorectal cancer in African Americans, the authors suggest that better access to healthcare, increased awareness of screening, and improvements in socioeconomic status might help to close the gap between these two groups.