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PubMed1989

Cancer incidence among spouses of patients with colorectal cancer.

The risk of colorectal cancer was examined among spouses of approximately 10,000 colorectal cancer patients. A total of 8,095 spouses were identified, and cancer cases in this cohort were sought in the Danish Cancer Registry. No excess risk was found for colorectal cancer as such. The data were also analyzed by subsite of the large bowel for the index cases and for the spouses, respectively. The estimated relative risks were in general close to unity, the only exception being the risk of right-sided colon cancer among husbands of index cases with left-sided colon cancer, RR = 2.17 (p less than 0.05). The absence of excess risk was noted regardless of the duration of marriage. The risk of other cancers with a presumed etiology similar to that of colorectal cancer (cancer of the uterine corpus, breast, prostate and biliary tract) was also close to expected values.

Colorectal Neoplasms↗

PubMed2004

Prevention of colorectal cancer using COX-2 inhibitors: basic science and clinical applications.

Cyclooxygenase-2 (COX-2), an inducible prostaglandin G/H synthase, is overexpressed in pre-neoplastic tissues and several human cancers including colorectal cancer. Evidence linking COX-2 activity to carcinogenesis was derived from epidemiologic studies and animal models with defect adenomatous polyposis coli (APC) gene. PGE2 induced by COX-2 exerts several biological properties that may be advantageous for tumorigenesis: 1) Promoting angiogenesis (increased VEGF, bFGF, and PDGF production), 2) Anti-apoptosis mechanism (via increased bcl-2 and Akt activity), 3) Stimulating tumor metastasis (by increasing matrix metalloproteinases) and 4) Decreased immune surveillance (decreased cytokine production and NK activity). In addition, COX-2 reaction can cause DNA oxidation and induce mutations. Chemoprevention of colorectal cancer has attracted great attention in recent years. Epidemiologic data showed that chronic intake of traditional nonsteroidal anti-inflammatory drugs (NSAIDs) could reduce the incidence of colorectal cancer. Recent clinical trial studies showed that celecoxib, a selective COX-2 inhibitor, is equally effective in reducing colorectal adenomas in animal models and patients with familial adenomatous polyposis (FAP), yet with superior GI safety. Two COX-2 inhibitors (celecoxib and refocoxib) have been approved by FDA as adjuncts to usual care in FPA patients, and are currently being studied in patients with sporadic adenomas and other types of cancers. These studies are expected to generate evidence in favor of targeting COX-2 and its gene products as chemopreventive strategies, which may provide an alternative in current approach to reducing the morbidity and mortality of this disease.

Adenomatous Polyposis Coli↗

PubMed2002

Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer.

Concepts from the health belief, transtheoretical, and dual process models were used to examine how siblings of individuals diagnosed with colorectal cancer (CRC) before age 56 made decisions about CRC screening. Siblings (N = 504) were assessed for CRC screening practices and intentions, pros, cons, processes-of-change, perceived risk of CRC, perceived severity of CRC, preventability of CRC, cancer-related distress, and sibling relationship closeness. Physician and family recommendation and knowledge were also assessed. Fifty-seven percent of participants (n = 287) were compliant with CRC screening. Logistic regression indicated that perceived pros and cons, perceived risk, commitment to screening, health care avoidance, and sibling closeness were associated with screening compliance. Physician and family recommendation were also strong correlates. A similar set of factors was associated with stage of adoption of CRC screening.

Adoption↗

PubMed1986

[Prognostic significance of pathology in 3, 147 cases of colorectal cancer. National Cooperative Group on Pathology and Prognosis of Colorectal Cancer].

This paper analyses the pathological features and prognosis in 3,147 cases of colorectal carcinoma collected from thirteen colleges, institutes and hospitals. The results reveal: The mean 5 year survival rate of 3,147 cases of colorectal carcinoma is 50.21%. The age of patient, tumor location, size, gross typing, histologic classification, growth pattern, the depth of infiltration, the metastasis into lymph nodes, the lymphocyte infiltration and fibrous proliferation surrounding the cancer are all prognostic. The depth of infiltration and metastasis into lymph nodes are the chief determinant of prognosis. The prognosis is much better in cases without penetrating the musculature or prognosis. The prognosis is much better in cases without penetrating the musculature or metastasis into lymph nodes than otherwise. It is better in those with metastases into 1-2 2 lymph nodes than with 3 or more. The histological types reflect the biologic nature of the cancer, exercising the most decisive influence upon the prognosis. The various pathologic changes are all closely associated with it. There is much difference in prognosis among well, moderately and poorly differentiated adenocarcinomas (70.3%, 49.6% and 26.6%) whereas almost no difference exists among the different histologic types with the same degree of differentiation. This indicates that it is the cancer differentiation which plays the important role in the prognosis. 4. The immune response in the regional lymph nodes, the lymphocyte infiltration and fibrous proliferation surrounding the cancer reflect the immune status of the organism against the cancer and favorably affect the prognosis.

Adenocarcinoma, Mucinous↗

PubMed2003

The epidemiology of colorectal cancer: what can we learn from the New Zealand Cancer Registry?

AIM: Colorectal cancer (CRC) is a major cause of cancer death in New Zealand. Incidence and mortality rates are regularly reported but more detailed information concerning the epidemiology of the disease is not readily available. The aim of this study is to describe the epidemiology of colorectal cancer, with particular reference to gender; subsite distribution; stage at diagnosis; tumour grade; the contribution of recognisable aetiological factors; and the resection rate and type of surgery performed for rectal cancer. METHODS: All 2272 pathology reports of colorectal cancer submitted to the National Cancer Registry for the year 2000 were reviewed and restaged according to the classical Dukes system. Age, gender, stage, subsite distribution, differentiation, tumour type, associated pathology and type of rectal cancer specimen were recorded. RESULTS: The gender ratio for all cases was equal. One third of resected cancers were in the rectum, one third in the left colon and one third were proximal to the splenic flexure. Men had more rectal cancer (M:F 1.6:1) and women more colon cancer (0.9:1). Right-sided cancers were of significantly higher grade than left-sided cancers. The proportion of right-sided cancers increased with advancing age in both men and women. Three per cent of patients had synchronous tumours and 0.2% of patients had phenotypic features of familial adenomatous polyposis (FAP). Fourteen per cent of patients were Dukes stage A at diagnosis, 43% stage B and 43% stage C. Rectal cancers were more likely to be stage A than colon cancers (odds ratio 1.6). Stage and grade of CRC were significantly associated. Ninety one per cent of cancers were resected; 29% of patients with rectal cancer had an abdominoperineal resection and 6% a local excision. CONCLUSIONS: The current stage distribution of CRC is in keeping with a predominantly unscreened population. The subsite distribution of cancer and its relationship to age and gender are similar to other high-risk countries; however, its relationship to grade of tumour has not previously been reported. An abdominoperineal resection rate of 29% reflects the mix of specialised colorectal and general surgical units treating rectal cancer in New Zealand and is in line with or better than recent overseas data that reflect national or regional practice.

Adenocarcinoma↗

PubMed2005

Possible participation of advanced glycation end products in the pathogenesis of colorectal cancer in diabetic patients.

Colorectal cancer is a major public health problem, being the second most common cause of cancer in developed countries. Several epidemiological studies have reported moderately increased risks of colorectal cancer in diabetic patients compared with general population. However, the underlying molecular link between diabetes and colorectal cancer remains to be elucidated. In diabetes mellitus, the formation and accumulation of advanced glycation end products (AGEs) progress. There is a growing body of evidence to show that AGEs-their receptor (RAGE) interactions are involved in the development of atherosclerosis and diabetic microangiopathy. AGEs-RAGE interactions stimulated the growth of human pancreatic cancer cells through the autocrine induction of platelet-derived growth factor-B. Furthermore, we have recently found that AGEs stimulated the growth and migration of cultured human melanoma cells and that anti-RAGE antibodies inhibited tumor formation and lung metastasis of melanoma cell xenografts and subsequently improved survival in athymic mice. These observations let us to hypothesize that AGEs could explain the molecular link between diabetes and colorectal cancer. In this paper, we would like to propose the possible ways of testing our hypotheses. Is elevation of serum AGE levels a risk factor for colorectal cancer in patients with diabetes? Does treatment with metformin, which has a potential effect on the inhibition of glycation reactions in vivo, decrease the risk for colorecetal cancer in diabetic patients? If the answer is yes, is this beneficial effect of metformin superior to that of other anti-diabetic agents with equihypoglycemic properties? Does treatment with pyridoxamine, a post-Amadori inhibitor (so-called Amadorins) of AGE formation, reduce the risk for colorectal cancer as well? Furthermore, are increased levels of AGEs and RAGE in colorectal cancer associated with poor prognosis in patients with diabetes? These clinical studies could clarify whether the AGEs-RAGE interactions serve as a causal link between diabetes and colorectal cancer.

Adenocarcinoma↗

PubMed2003

Association of the CpG island methylator phenotype with family history of cancer in patients with colorectal cancer.

Methylation of promoter CpG islands in colorectal cancer (CRC) falls into two categories: age related and cancer specific. Most cancer-specific methylation at CpG islands occurs in a subset of cases that display the CpG island methylator phenotype (CIMP). The underlying cause of CIMP is not known. Using methylation-specific PCR, we studied 47 CRC patients for methylation at five loci to determine whether the methylation status of CpG islands is associated with family history of cancer. Four of the loci were differentially methylated between the CRC cases with a family history and those with no family history. Patients with methylation at all four loci were 14 times more likely to have a family history of cancer than patients with methylation at none of the four loci. These findings suggest that there may be a genetic component to CIMP in CRC.

Chromosome Mapping↗

PubMed1995

Decreased expression of DCC mRNA in gastric and colorectal cancer.

The deleted-in-colorectal-cancer (DCC) gene, located on chromosome 18q 21.3, is considered to be a tumor suppressor gene related to cellular adhesion receptors. A loss of heterozygosity (LOH) on chromosome 18q is frequently observed in adenomatous polyposis coli, as well as in sporadic colon carcinoma and its liver metastatic loci. In this study, we investigated the expression of DCC mRNA in the resected specimens of 38 gastric cancers and 28 colorectal cancers by a reverse transcription-polymerase chain reaction method. In the gastric cancer patients, the mean expression level of DCC mRNA in the tumors was significantly lower than that in normal tissues (p = 0.009), but no difference was observed in the colorectal cancer patients. DCC mRNA expression was decreased in 15 gastric cancers (40%) and 10 colorectal cancers (36%), and there was a significant correlation between the decreased expression of DCC mRNA and nodal metastasis in colorectal cancer (chi 2 = 7.049, DF = 1, P = 0.0079). Two of four gastric cancer patients and none of seven colorectal cancer patients whose cancers were confined to the muscularis propria without metastasis showed decreased expression of DCC mRNA. These findings demonstrate that decreased expression of DCC mRNA may occur at an early stage in gastric cancer and at a late stage in colorectal cancer and that this decreased expression correlates with the potential to develop nodal metastasis.

Cell Adhesion Molecules↗

PubMed2006

The diagnostic value of G-CSF measurement in the sera of colorectal cancer and adenoma patients.

BACKGROUND: Granulocyte-colony stimulating factor (G-CSF) regulates the growth of hematopoietic progenitor cells. Cancer cells, including colorectal cancer, can produce this cytokine. The aim of this study was to compare the diagnostic value of measurement of G-CSF and classic tumor markers--carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) in the sera of colorectal cancer with adenoma patients and to determine its usefulness in the diagnosis of colorectal cancer and polyps. PATIENTS AND METHODS: The serum levels of G-CSF and tumor markers were assayed in 76 colorectal cancer, 35 colorectal adenoma patients and in 65 healthy subjects. We defined the diagnostic sensitivity, specificity and areas under ROC curves for the measurands. RESULTS: Median values of G-CSF and tumor markers were significantly higher in colorectal cancer patients than those in healthy subjects. There were significant differences in the serum levels of G-CSF between adenoma patients and healthy subjects. The concentrations of tumor markers in colorectal cancer patients were higher than those in polyps. Combined use of G-CSF with CEA improved their diagnostic sensitivity in colorectal cancer. CONCLUSIONS: Measurement of G-CSF might be useful in the diagnosis of colorectal cancer patients, but not in the differentiation between colorectal cancer and polyps.

Adenoma↗

PubMed2004

Deleted in colon cancer protein expression in colorectal cancer metastases: a major predictor of survival in patients with unresectable metastatic disease receiving palliative fluorouracil-based chemotherapy.

PURPOSE: To determine whether deleted in colon cancer (DCC) protein expression in colorectal cancer (CRC) metastases could predict outcome to palliative fluorouracil (FU)-based chemotherapy and to assess whether it is similar to that observed in the corresponding primary tumors. PATIENTS AND METHODS: DCC protein expression was assessed immunohistochemically on archival specimens of CRC metastases from 42 patients homogeneously treated by methotrexate-modulated bolus FU alternated to 6-S-leucovorin-modulated infused FU and was retrospectively correlated with patient characteristics and clinical outcome. In a subset analysis, DCC immunoreactivity was compared between metastatic CRC and the corresponding primary tumors and regional lymph node metastases. RESULTS: Positive immunoreactivity for DCC was found in 45% of patients. Eighteen (78%) of 23 patients for whom multiple samples were available displayed a similar pattern of expression in distant metastases and primary tumors. The median survival time was 14.3 months in patients without DCC expression and 21.4 months in patients with DCC-positive tumors (log-rank test, P =.04); the 2-year survival rates were 8.5% and 42.5%, respectively. Response rates to chemotherapy were not significantly different between the two groups. By multivariate analysis, DCC protein expression maintained its prognostic value and showed to be the single best predictor of survival, with a relative risk of 2.16. CONCLUSION: Our results indicate that expression of the DCC protein in CRC metastases is similar to that observed in the corresponding primary tumors and represents a dominant predictor of survival in patients with unresectable, advanced CRC who are undergoing palliative FU-based chemotherapy.

Adult↗

PubMed2004

Survival after adjuvant 5-FU treatment for stage III colon cancer in hereditary nonpolyposis colorectal cancer.

In vitro studies suggest that a deficient mismatch repair (MMR) system reduces 5-Fluorouracil cytotoxicity. Colon cancer (CC) in hereditary nonpolyposis colorectal cancer (HNPCC) is due to a dysfunctioning MMR gene that leads to microsatellite instability (MSI). Clinical studies on the efficacy of 5-Fluorouracil (5-FU) in MSI high tumours are contradictory. In a retrospective study, we compared the survival of subjects with stage III CC from HNPCC families that were treated with and without adjuvant 5-FU. The Dutch HNPCC family registry was used. Information on adjuvant chemotherapy for stage III CC was obtained from subjects of families with a mutation and/or who fulfilled the AMS criteria or who were strongly suspicious for HNPCC. CC specific survival was calculated. Observation time was measured either until the date of death, date of a second primary CC or until the closing date of the study, i.e., June 1, 2001. Statistical analysis was done by Kaplan-Meier survival analysis. A total of 92 subjects with stage III CC were included. Twenty-eight of them (17 males) had adjuvant treatment with 5-FU. The median follow-up was 4 (range: 1-17) years; 8 subjects died of CC. The 5-year survival was 70% (95% Cl: 49-90). Sixty-four subjects (36 males) did not have adjuvant therapy. Their median follow-up was 6 (range: 0-23) years. Twenty of them died of CC. The 5-year survival in this group was also 70% (95% Cl: 59-83). To date, the selection of patients with CC for 5-FU treatment is based on the stage rather than the biology of the tumour. In our study, the 5-year survival of subjects treated with and without adjuvant 5-FU did not differ. Further studies are necessary to elucidate the role of MSI in 5-FU treatment of MSI-H tumours in HNPCC.

Adult↗

PubMed1988

[A cooperative study of surgical adjuvant chemotherapy of colorectal cancer (second report): 3-year survival rate. Cooperative Study Group of Surgical Adjuvant Chemotherapy of Colorectal Cancer in Japan].

To evaluate the efficacy of surgical adjuvant chemotherapy for patients with curatively resected colorectal cancer (excluding m and sm cancer), a randomized controlled study was performed from January 1982 to October 1983. The schedules for drug administration were different in four districts, and four randomly assigned protocols were studied using tegafur (FT), ACNU, MMC and ADM. A total of 4,906 cases from 491 institutions were entered and 4,206 cases were varied for the study. There were no significant differences in 3-year survival rate in each district protocol. According to Dukes C for rectal cancer patients, ADM + FT group was higher than the FT only group in 3-year survival rate (p = 0.092) and had a significantly longer survival than FT only group in 3-year disease-free rate (p = 0.011). The rate of local recidivation in colon cancer resected curatively was higher in ACNU + FT group than in FT only group (p less than 0.05). A tendency for decreased liver metastasis was observed in FT group compared with the control group, and liver metastasis of ADM + FT group was lower than that of FT only group. No serious adverse effects were observed in any protocol.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1996

Oral adjuvant chemotherapy with carmofur (HCFU) for colorectal cancer: five-year follow-up. Tokai HCFU Study Group--third study on colorectal cancer.

BACKGROUND: A joint study was performed by the Tokai HCFU study group, which included seven institutions, to examine the value of oral administration of Carmofur (HCFU), a 5-fluorouracil (5-FU) derivative, for postoperative adjuvant chemotherapy in patients with colorectal cancer undergoing curative resection. METHODS: The patients were divided into two groups, a control group receiving no HCFU and a group administered HCFU for 1 year, using a centralized registration system by telephone. Among 173 patients entered into this study, 159 evaluable cases were analyzed for evaluation of the drug. RESULTS: The cumulative 5-year disease-free rate of patients who received HCFU was significantly increased compared with the control group. In particular, the rate was much higher in patients with colon cancer. No severe side effects arose from adjuvant chemotherapy with HCFU. CONCLUSION: Adjuvant chemotherapy with oral HCFU appears to provide a useful and safe postoperative treatment.

Administration, Oral↗

PubMed2002

Adenoma prevalence and cancer risk in familial non-polyposis colorectal cancer.

BACKGROUND AND AIMS: Polypectomy in the colon has been shown to prevent colorectal cancer in both the general population and in familial colorectal cancer. Individuals with a family history of colorectal cancer have an increased risk of the disease. Over a period of 10 years, 304 subjects at risk were included in ongoing surveillance with regular colonoscopies. To compile the medical findings and experience generated during this period, a retrospective cross sectional study was performed. SUBJECTS: Subjects were classified into three family groups: families with hereditary non-polyposis colorectal cancer (HNPCC); families with hereditary colorectal cancer (HCC, non-Lynch syndrome); and a third group of families with only empirical risk estimates based on a family history of two close relatives (TCR) with colorectal cancer. METHODS: The risk population was studied with regard to age at onset, prevalence, number, cancer risk, size, dysplasia, and distribution of adenomas. A comparison was made within the family groups and with a reference group representing the general population. RESULTS: In total, 195 adenomas and six cancers were detected among 85 individuals. The relative risk of having an adenoma in the whole risk population compared with the general population was 2.6. Subjects from TCR families had most adenomas and HNPCC subjects had the least. A shift from proximal adenomas to distal carcinomas in families with HCC and TCR suggested a higher cancer risk in distal adenomas in these syndromes. HNPCC families showed a younger age at onset and adenomas with a higher degree of dysplasia. In HNPCC, there was a similar localisation of adenomas and carcinomas, suggesting a high risk of cancer in all adenomas. CONCLUSIONS: There was clear overrepresentation of adenomas in all three family types compared with the reference population. In HNPCC, we found earlier onset of adenomas and faster progression to cancer. Families with HCC, and even more so TCR subjects, had a later onset and lower risk of cancer from proximal adenomas. Based on these results, surveillance protocols in Sweden have been revised.

Adenoma↗

PubMed2003

Multiple primary cancer: an experience at the Cancer Institute Hospital with special reference to colorectal cancer.

BACKGROUND: Cancer patients are at high risk of developing a second cancer after the treatment of initial cancers. Understanding the characteristics of multiple primary cancer is important to establish an effective surveillance program for the early detection of second cancers. METHODS: We analyzed the cancer registry records from 1986 to 1995 at the Cancer Institute Hospital. The combination of the sites of the index and second cancers and the time intervals between the two cancers were examined. For colorectal cancer, another database of patients between 1946 and 1991 was analyzed, with special reference to synchronous and metachronous cancers. RESULTS: Out of 24,498 registered cases, there were 1281 (5.2%) multiple cancers, of which 464 (1.9%) were in the same organs and 817 (3.3%) were in other organs. Gastric or colorectal cancer frequently developed as the second cancer regardless of the site of the index cancer. Although the majority of the second cancers developed within 3 years after the index cancer, some developed 5 years or more after the index cancer. In colorectal cancer, the cases with metachronous cancer were similar to those with hereditary nonpolyposis colon cancer. The frequent combination of an advanced index cancer and an advanced second cancer and relatively poor survival after the second cancers in the metachronous cases may reflect delayed diagnosis of the second colorectal cancer. CONCLUSION: Careful attention should always be paid to the second cancer in treating cancer patients. Further analysis by individual site of the index cancers is needed to construct an effective surveillance for second cancers.

Adult↗

PubMed2006

The impact of cancer coalitions on the dissemination of colorectal cancer materials to community organizations in rural Appalachia.

INTRODUCTION: The incidence of colorectal cancer in portions of rural Appalachia is higher than in much of the United States. To reduce this disparity, cancer-control strategies could be adapted to and implemented in rural Appalachian communities. The objectives of this pilot study were to develop and test community-based participatory research methods to examine whether cancer coalitions in Appalachia could effectively disseminate print materials from a national media campaign intended to promote colorectal cancer awareness to their rural communities. METHODS: This pilot study used a two-arm intervention design with random selection of 450 community organizations from nine counties with cancer coalitions (the coalition arm) and 450 organizations from nine matched counties without a cancer coalition (the noncoalition arm) in northern Appalachia. The primary outcome measures were participation by and interest of community organizations in dissemination of materials from Screen for Life: National Colorectal Cancer Action Campaign, a national campaign to promote colorectal cancer education and screening. The data were collected with prestudy and poststudy surveys. RESULTS: One-hundred thirty (29%) organizations participated in the coalition arm, and 38 (8%) participated in the noncoalition arm (P < .001). Within the coalition arm, 86 of the 119 (66%) organizations that responded to the question about influence reported being influenced to participate by the local coalition. Initial interest in dissemination was high in each of the study arms but remained higher throughout the study in the coalition arm than the noncoalition arm. CONCLUSION: Community cancer coalitions can increase the local dissemination of material from a national media campaign in rural Appalachia. Continued development and study of methods for coalitions to translate and implement cancer-control strategies at a local level in Appalachia is warranted.

Appalachian Region↗

PubMed2004

Prognostic significance of microsatellite instability in sporadic colorectal cancer.

BACKGROUND AND AIMS: Colorectal cancers exhibiting microsatellite instability (MSI) appear to have unique biological behavior. The influence of MSI on the prognosis of sporadic colorectal cancers is controversial and requires further investigation. The aim of this study was to analyze the association between MSI status and clinicopathological features and prognosis in sporadic colorectal cancer patients. PATIENTS AND METHODS: Of the 322 consecutive colorectal cancer patients operated upon at the Seoul National University Hospital between January and December 1998, we examined the clinicopathological features and prognosis of 248 patients with sporadic primary colorectal cancer. The MSI status of these 248 patients has been reported in a previous study. Of the 248 patients, 23 (9.3%) had MSI+ tumors. The patients' clinicopathological parameters were obtained from their medical records, and follow-up and survival data were obtained from medical records and phone calls. RESULTS: MSI+ sporadic colorectal cancers were found predominantly in the proximal colon ( p<0.001) and were associated with poor differentiation ( p=0.030), a lower preoperative serum carcinoembryonic antigen (CEA) level ( p=0.012), and less frequent systemic metastasis ( p=0.034) than MSI- tumors. Low tumor grade ( p=0.022), low tumor T-stage ( p=0.002), no lymph node metastasis ( p<0.001), no systemic metastasis ( p<0.001), adjuvant chemotherapy ( p<0.001) and MSI+ status ( p=0.038) were independent favorable prognostic factors for survival in sporadic colorectal cancer patients. CONCLUSION: MSI status was an independent favorable prognostic factor for survival in sporadic primary colorectal cancer patients.

Adult↗

PubMed2005

Colorectal cancer in African Americans.

Colorectal cancer in African Americans has an increased incidence and mortality relative to Whites. The mean age of CRC development in African Americans is younger than that of Whites. There is also evidence for a more proximal colonic distribution of cancers and adenomas in African Americans. African Americans are less likely to have undergone diagnostic testing and screening for colorectal cancer. Special efforts are needed to improve colorectal cancer screening participation rates in African Americans. Clinical gastroenterologists should play an active role in educating the public and primary care physicians about special issues surrounding colorectal cancer in African Americans. Community healthcare groups and gastrointestinal specialists should develop culturally sensitive health education programs for African Americans regarding colorectal cancer. The high incidence and younger age at presentation of colorectal cancer in African Americans warrant initiation of colorectal cancer screening at the age 45 yr rather than 50 yr.

Black or African American↗