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Harvey J. Murff, MD, MPH; Neeraja B. Peterson, MD, MSc; Jay H. Fowke, PhD, MPH; Margaret Hargreaves, PhD; Lisa B. Signorello, ScD; Robert S. Dittus, MD, MPH; Wei Zheng, MD, PhD; William J. Blot, PhD

Arch Intern Med. 2008;168(6):625-631.

Background  Family history is a risk factor for colon cancer, and guidelines recommend initiating screening at age 40 years in individuals with affected relatives. Racial differences in colon cancer mortality could be related to variations in screening of increased-risk individuals.

Methods  Baseline data from 41 830 participants in the Southern Community Cohort Study were analyzed to determine the proportion of colonoscopy procedures in individuals with strong family histories of colon cancer, and whether differences existed based on race.

Results  In participants with multiple affected first-degree relatives (FDRs) or relatives diagnosed before age 50 years, 27.3% (95% confidence interval [CI], 23.5%-31.1%) of African Americans reported having a colonoscopy within the past 5 years compared with 43.1% (95% CI, 37.0%-49.2%) of white participants (P<.001). African Americans in this group had an odds ratio of 0.51 (95% CI, 0.38-0.68) of having undergone recommended screening procedures compared with white participants after adjusting for age, sex, educational status, annual income, insurance status, total number of affected and unaffected FDRs, and time since last medical visit. African Americans with multiple affected FDRs or relatives diagnosed before age 50 years and who had ever undergone endoscopy were less likely to report a personal history of colon polyps (odds ratio, 0.29; 95% CI, 0.20-0.42) when compared with whites with similar family histories.

Conclusions  African Americans who have FDRs with colon cancer are less likely to undergo colonoscopy screening compared with whites who have affected relatives. Increased efforts need to be directed at identifying and managing underserved populations at increased risk for colon cancer based on their family histories.

Author Affiliations: Vanderbilt Epidemiology Center (Drs Murff, Fowke, Zheng, and Blot) and Division of General Internal Medicine and Public Health, Department of Medicine (Drs Murff, Peterson, Fowke, Signorello, Dittus, Zheng, and Blot), Vanderbilt University, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville (Drs Murff, Peterson, Fowke, Signorello, Zheng, and Blot); Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville (Drs Murff and Dittus); and Meharry Medical College (Dr Hargreaves); and International Epidemiology Institute, Rockville, Maryland (Drs Signorello and Blot).

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