A Jemal

CA Doubeni

Cassandra Gulden

G Matanoski

Olufunmilayo I Olopade

Sonia Kupfer

TL Fairley

Tovah Moss

English

PubMed

Gulden Cassandra

Moss Tovah

Olopade Olufunmilayo I

Kupfer Sonia

Directory of Open Access Journals

Hereditary Cancer in Clinical Practice

Racial differences in a high-risk colorectal cancer referral population: a single-center experience

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POSTER PRESENTATION Open Access
Racial differences in a high-risk colorectal cancer
referral population: a single-center experience
Cassandra Gulden MS1*, Tovah Moss BA2, Olufunmilayo I Olopade MD1, Sonia Kupfer MD1,2
From 14th Annual Meeting of the Collaborative Group of the Americas on Inherited Colorectal Cancer
Dallas, TX, USA. 12-13 October 2010
Background
Multiple studies have shown that colorectal cancer
(CRC) disparities exist between African Americans and
Caucasians. African Americans have higher CRC inci-
dence and mortality than Caucasians [1,2]. Furthermore,
African Americans present with more advanced CRC [3]
and at younger ages [4]. However, little is known about
the impact of hereditary CRC syndromes in African
Americans on these disparities. In the University of Chi-
cago Cancer Risk Clinic, we see a diverse referral popu-
lation for evaluation of hereditary syndromes based on
personal or family history of CRC. We sought to com-
pare clinical characteristics of our African American and
Caucasian patients to determine if differences exist in a
high-risk CRC referral population.
Method
We retrospectively collected data on self-reported Afri-
can American and Caucasian individuals who were
referred for a personal or family history of CRC from
1992-2010. Available clinical characteristics including
number of individuals, number of families (probands
with family members who followed-up in our clinic),
personal or family history of CRC, age at cancer onset,
and number of individuals who underwent genetic test-
ing for APC or mismatch repair genes were collected.
Pedigrees were reviewed to determine Revised Bethesda,
Amsterdam II and PREMM1,2 scores. Statistical analysis
included Student’s t-test for continuous variables and
Pearson’s chi-square for categorical variables. Compari-
son of independent proportions was done using z-ratios.
Results
A total of 949 Caucasian and 254 African American
individuals were referred to the Cancer Risk Clinic for a
personal or family history of CRC. The average age of
CRC diagnosis, number of family members with CRC,
and those meeting Bethesda and Amsterdam criteria
were similar between populations (Table 1). Fewer
family members of African American probands were
seen compared to Caucasians (p =0.002). More African
American females with CRC were seen in our clinic
(p=0.04). Importantly, despite overall similar clinical
characteristics, fewer African Americans had genetic
testing compared to Caucasians (p = 0.02).
Conclusion
Despite many similarities between our high-risk CRC
populations, there exists a difference in the number of
family members of African American probands seen in
our clinic and the number of African Americans who
had genetic testing when compared to Caucasians. Less
genetic testing may mean African American mutation
carriers are not being identified. This can significantly
impact appropriate cancer screening recommendations
and knowledge about hereditary CRC syndromes in this
population. Future collaborative studies are needed to
address why these differences may exist.
Author details
1Cancer Risk Clinic, Section of Hematology/Oncology, University of Chicago
Medical Center, Chicago, IL, 60637, USA. 2Section of Gastroenterology,
University of Chicago Medical Center, Chicago, IL, 60637, USA.
* Correspondence: cgulden@medicine.bsd.uchicago.edu
1Cancer Risk Clinic, Section of Hematology/Oncology, University of Chicago
Medical Center, Chicago, IL, 60637, USA
Full list of author information is available at the end of the article
Gulden et al. Hereditary Cancer in Clinical Practice 2011, 9(Suppl 1):P15
http://www.hccpjournal.com/content/9/S1/P15
© 2011 Gulden et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Published: 10 March 2011
References
1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ: Cancer statistics,
2008. CA Cancer J Clin 2008, 58:71-96.
2. Matanoski G, Tao XG, Almon L, Adada AA, Davies-Cole JO: Demographics
and tumor characteristics of colorectal cancers in the United States,
1998-2001. Cancer 2006, 71:3819-3826.
3. Doubeni CA, Field TS, Buist DS, Korner EJ, Bigelow C, Lamerato L,
Herrinton L, Quinn VP, Hart G, Hornbrook MC, Gurwitz JH, Wagner EH:
Racial differences in tumor stage and survival for colorectal cancer in an
insured population. Cancer 2007, 109:612-620.
4. Fairley TL, Cardinez CJ, Martin J, Alley L, Friedman C, Edwards B, Jamison P:
Colorectal cancer in U.S. adults younger than 50 years of age, 1998-
2001. Cancer 2006, 107:1153-1161.
doi:10.1186/1897-4287-9-S1-P15
Cite this article as: Gulden et al.: Racial differences in a high-risk
colorectal cancer referral population: a single-center experience.
Hereditary Cancer in Clinical Practice 2011 9(Suppl 1):P15.
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Table 1 Clinical characteristics of individuals referred for personal and/or family history of CRC by race
AA Caucasian p-value
Personal and/or family history of CRC
Total number of individuals 254 949
Total number families (% of total individuals) 68 (26.8) 617 (65.0) 0.002
Median # CRC affected family members (range) 1 (1-7) 1 (1-14)
Average number CRC affected family members < 50 years 0.35 0.46
Number with polyps (%) 6 (2.4) 43 (4.5) 0.12
Genetic testing (%) 16 (6.3) 106 (11.2) 0.02
Personal History of CRC
Total number (% of total) 32 (12.6) 86 (9.1) 0.09
Age years (mean) 48.6 49.9 0.65
% female 82.1 60.5 0.04
Revised Bethesda + (%) 22 (68.8) 49 (57.0) 0.25
Amsterdam II + (%) 5 (15.6) 17 (19.8) 0.61
PREMM1,2 score 17.06 16.12 0.81
Genetic testing (%) 10 (31.2) 42 (48.8) 0.09
CRC, colorectal cancer; AA, African American; Genetic testing category includes mismatch repair genes and APC; PREMM1,2 score obtained using publicly
available calculator.
Gulden et al. Hereditary Cancer in Clinical Practice 2011, 9(Suppl 1):P15
http://www.hccpjournal.com/content/9/S1/P15
Page 2 of 2


Colorectal cancer in U.S. adults younger than 50 years of age,

Demographics and tumor characteristics of colorectal cancers in the United States,

EH: Racial differences in tumor stage and survival for colorectal cancer in an insured population. Cancer

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3288932

Racial differences in a high-risk colorectal cancer referral population: a single-center experience

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