Early Colorectal Cancer Screening in African Americans: High Uptake and High Yield

Early Colorectal Cancer Screening in African Americans: High Uptake and High Yield

Douglas K. Rex, MD, MASGE, reviewing Levin TR, et al. Gastroenterology 2020 Jul 20.

Recommendations from GI societies to screen African Americans for colorectal cancer (CRC) starting at age 45 were based largely on age-related incidence and mortality data by race. The recommendation from the American Cancer Society to begin CRC screening in all Americans at age 45 is based largely on incidence data and modeling. Few data on the actual uptake and yield of screening in persons younger than age 50 years are available. 

The Kaiser Permanente Northern California health plan utilizes an organized CRC screening program based on mailed fecal immunochemical tests (FITs). In 2018, the plan piloted mailed FIT screening of African-American members ages 45 to 50 years. Completion of FIT screening in younger African Americans was 33.1%, with a positive test rate of 4% and a colonoscopy completion rate of 85.3% after a positive FIT. Among the patients who underwent colonoscopy, 57.8% had any adenoma, 33.6% had advanced adenoma, and 2.6% had cancer (3 individuals). Results were similar in all categories for unscreened 51- to 56-year-old African Americans, whites, Hispanics, and Asians/Pacific Islanders compared to African Americans who were screened earlier. In addition, the completion rate for colonoscopy after a positive test and the percentage of patients with an advanced adenoma at colonoscopy were numerically higher in younger African Americans than any of the older groups.

Douglas K. Rex, MD, FASGE


Screening recommendations that are based on cancer incidence data and modeling studies are often criticized because there is little empirical evidence as to whether younger patients will actually undergo screening and what the yield of screening is. These results indicate that an actual screening program in African Americans aged 45 to 50 years is well received and utilized and has a comparable yield of positive tests and a high yield of important findings at colonoscopy. For the movement toward earlier screening, there are no barriers presented by these data.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Levin TR, Jensen CD, Chawla NM, et al. Early screening of African Americans (45-50 years old) in a fecal immunochemical test-based colorectal cancer screening program. Gastroenterology 2020 Jul 20. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2020.07.011)

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