Low Rate of Colon Cancer Screening Contributes to 1,500 Colon Cancer Deaths in New York City

NEW YORK CITY, March 18 ??? Colon cancer screening rates in New York City are disturbingly low, especially among African Americans, according to two new studies by The New York Academy of Medicine and the New York City Department of Health and Mental Hygiene (DOHMH). Colon cancer, which attacks the colon and/or rectum, is the second leading cause of cancer-related death in the United States. Even though the disease is preventable, colon cancer killed more than 1,500 New Yorkers in 2002 claiming the lives of more non-smokers than any other cancer.

These findings were presented today at Harlem Hospital by David Vlahov, Ph.D., Director of the Academy???s Center for Urban Epidemiologic Studies and Lorna Thorpe, Ph. D., an epidemiologist with the DOHMH. The researchers were joined by City Health Commissioner Dr. Thomas R. Frieden; Academy President Dr. Jeremiah Barondess; NYC Health and Hospitals President, Dr. Benjamin Chu; Ralph Lauren Center for Cancer Prevention and Care Medical Director, Dr. Harold Freeman; and President and CEO of AMDeC, Dr. Maria K. Mitchell.

Commissioner Frieden said, ???Colon cancer is a leading killer in NYC. This is why, after careful review of the efficacy of other colon cancer screening tools, we are recommending colonoscopy as the ???gold standard??? for New Yorkers to prevent colon cancer for most adults age 50 and older. Only half of the New Yorkers in this age group report ever getting a colonoscopy or sigmoidoscopy, leaving nearly 1 million adult New Yorkers at greater risk for undetected colon cancer. Every New Yorker age 50 and over should get a colonoscopy every 10 years to screen for colon cancer. People with a personal or family history of colorectal cancer or polyps ??? especially if family members were younger than 50 when diagnosed ??? are at higher risk and should be screened before age 50.???

Age-adjusted death rates for colon cancer are 24 people per 100,000 for African-Americans, 21 per 100,000 for Whites, 16 per 100,000 for Hispanics, and 14 per 100,000 for Asians.

???Colon cancer death rates are highest in African-Americans, followed by Whites, Hispanics and then Asians, yet the rates for colon cancer screening in African-Americans lag behind others,??? reported Dr. Vlahov, who was the lead investigator of the Academy-led research. ???These studies are wake-up calls for action.???

The DOHMH study
In 2002, the DOHMH conducted a health survey of nearly 10,000 New Yorkers from 33 communities, the largest health survey of its kind in New York City. One focus of this survey was to determine cancer-screening rates in New York City. The survey found a low rate of colon cancer screening for all groups, with screening disparities by race. Whites were more likely to be screened for colon cancer (53%) followed by Asians (51%), Hispanics (45%) and blacks (44%), DOHMH Vital Statistics data show that black and white New Yorkers are more likely to die from colon cancer than Hispanics or Asians. The study also found that while the risk of colorectal cancer increases with age, less than 60% of New Yorkers 65 years and older have been screened.

To address these findings, DOHMH recently issued a City Health Information alert to medical providers, and a Health Alert (http://www.nyc.gov/health) to the general public. The decision to recommend colonoscopy as the main tool for colon cancer prevention in New York City emerged from an expert advisory panel of colon cancer experts. These experts along with others from throughout New York City also met at a DOHMH-sponsored Colon Cancer Summit last week to discuss new strategies for preventing colon cancer in NYC.

The Academy study
The Academy (http://www.nyam.org) study was based on data collected for the New York Cancer Project by AMDeC, a consortium of medical schools, academic health centers and other research institutions in New York State. In the Academy study, which included 5,995 cancer-free adults ages 50 and older, 48% of Whites were screened for colon cancer, compared with 34% of African-Americans, 28% of Hispanics, 30% of Asians and 32% of others. In other words, African-Americans were only three-quarters as likely to have been screened as Whites, and Hispanics were only two-thirds as likely. Additionally, the Academy study found that women are less likely to be screened for colon cancer than men.

The results suggest that social or cultural factors may contribute to differences in screening rates, noted Dr. Vlahov, considering that the lower rates for colon cancer screening among African-Americans and Hispanics are not explained entirely by differences in income, insurance coverage, smoking habits or family history of cancer.

The AMDEC Project
The Academy???s analyses are among the first based on massive data collected for the New York Cancer Project by AMDeC. The Cancer Project is designed to assess the environmental and genetic causes of cancer and other diseases by monitoring over an extended period the health of tens of thousands of New Yorkers who volunteered to enroll in this study. (http://www.amdec.org).

???These findings support colon cancer screening as an important priority for public health intervention,??? said Dr. Harold Freeman, who guided the community recruitment effort for AMDeC???s New York Cancer Project. Dr. Freeman is also Director of the National Cancer Institute???s Center to Reduce Cancer Health Disparities (National Institutes of Health). ???Vastly improved rates for screening of breast and cervical cancer make us optimistic that communities can mobilize for effective colon cancer screening and control, which occurs less often than screening for other types of cancer. As a comparison, screening rates for breast and cervical cancer used to be much lower in New York City before successful education and outreach campaigns were conducted, and then regularly reinforced.???

Dr. Mitchell said ???These studies underscore AMDeC???s role in accelerating the progress of both basic and applied medical research. Through a unique, multi-institution collaboration, the Cancer Project achieved its initial goal of mobilizing thousands of New Yorkers to participate in medical research, creating both a massive database and the infrastructure to manage it for use by New York???s world-class scientists.???

The NYC Health and Hospitals Corporation (HHC) President, Dr. Benjamin Chu said, "HHC believes that early detection of colorectal cancer saves lives and we will be offering colonoscopy as the preferred screening method for our patients over age 50. We are committed to increasing these screenings in the communities we serve and will triple the number of screening colonoscopies in our facilities to meet the needs of our patients."

For more information about colon cancer, colon cancer screenings, and colonoscopy, New Yorkers should speak to their medical provider. Information is also available on the NYCDOH website and the American Cancer Society.

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  Posted on March 18, 2003

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