Oprah and Dr. Oz Highlight Lifesaving Potential of Colon Cancer Screening

Physician experts from the American College of Gastroenterology (ACG) applaud Oprah and Dr. Mehmet Oz for bringing attention to the lifesaving potential of colorectal cancer screening in today’s “The Oprah Winfrey Show.” By featuring the experience of a young African American firefighter from Chicago, Dr. Oz highlights the importance of screening for African Americans, who should begin colorectal cancer screening at age 45 rather than the current recommendation of age 50 according to the ACG. Colonoscopy is the preferred method of screening for colorectal cancer and data support the recommendation that African-Americans begin screening at a younger age because of the high incidence of colorectal cancer and a greater prevalence of proximal or right-sided polyps and cancerous lesions in this population.Overall, colorectal cancer is the second leading cause of cancer deaths in the United States. African Americans are diagnosed with colorectal cancer at a younger age than whites, and African Americans with colorectal cancer have decreased survival compared with whites. In 2005, the ACG published recommendations which reviewed the evidence why African Americans should have their colons screened for cancer at age 45 instead of age 50, five years earlier than the current recommendations. The ACG recommends colonoscopy as a “first line” screening procedure for colorectal cancer for African Americans rather than flexible sigmoidoscopy because of the high overall risk and as well as some evidence that African Americans have more right-sided cancers and polyps. The right side of the colon includes the cecum, ascending colon and proximal transverse colon and cannot be reached by flexible sigmoidoscopy. Facts about Colorectal Cancer in African Americans — African Americans have the highest incidence of colorectal cancer of any racial or ethnic group. Data from the population-based cancer registries that constitute the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute show that during 1975-2000 colorectal incidence rates in White men and women peaked in 1985 and have declined since.

— In 2000 the incidence rates in White men and women were 20-25 percent lower than peak rates in 1985 and 10-15 percent lower than the rates in 1975. During this same interval, incidence rates in African American men increased, and the rates were stable in African American women. — From 1996 to 2000, incidence rates in African Americans as a group were 12.3 percent higher than those in Caucasians, 9.5 percent higher in African American men when compared to Caucasian men, and 17.5 percent higher in African American women when compared to Caucasian women.

— The reasons for higher incidence rates in African Americans are unclear; however, dietary, nutritional factors, rates of physical inactivity, variability in screening rates, lower use of diagnostic testing, and increasing smoking rates have been most commonly implicated. — African Americans with colorectal cancer have decreased survival compared with whites. From 1992-1999, the five-year survival rate in African Americans was 53 percent, and 63 percent in whites. Part of the explanation for the decreased survival of African Americans with colorectal cancer is that a great proportion present with Stage IV disease. This effect has been ascribed to lower screening rates, less use of diagnostic tests, and less access to health care. — For African Americans and whites with the same stage disease (Stage II or III), survival is lower for African Americans, except in the Veterans Administration system, where access to care is equal.

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