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February 25, 2009

Colonoscopy Screening in Black and White Patients

JAMA. 2009;301(8):827-829. doi:10.1001/jama.2009.164

To the Editor: Dr Lieberman and colleagues1 concluded that black individuals are at higher risk of having polyps larger than 9 mm compared with white individuals. However, this conclusion may be incomplete for several reasons.

Black individuals represented only 6.4% of the population studied. In contrast, black persons represent 13.4% of the US population.2 This raises the possibility of bias in the population examined, particularly if black individuals who underwent screening were at elevated risk for colorectal cancer or polyps compared with the general black population. Additionally, although the data were obtained from a national endoscopic database, the underrepresentation of black persons raises concern that they may not be receiving colon cancer screening in adequate numbers compared with white individuals. This leads to the question of what is different about the small number of black individuals who chose to have a colonoscopy vs those who did not. These issues are critical to both the interpretation of the findings of this study and to future policies regarding tailored colorectal cancer screening.