Andrew J. Beamish

Su1043 Prognostic Significance of Socio-Economic Deprivation in Upper Gastrointestinal Cancer

Background: Blacks suffer a disproportionately higher incidence of and mortality from colorectal cancer in the United States. It is unclear if this public health problem is due to an increased biological susceptibility. No prospective study has evaluated differences in postpolypectomy recurrence risk by race. Aim: To examine the prevalence, recurrence and the location of colorectal neoplasia by race during a four-year follow-up in the Polyp Prevention Trial (PPT). Methods: The PPT was a 4-year, multicenter, randomized controlled trial which evaluated the effect of a low fat, high fiber, fruits and vegetable diet on the risk of colorectal adenoma recurrence. A total of 1,821 participants, which included 1,668 (91.6%) whites and 153 (8.4%) blacks, had information on location of colorectal adenoma at baseline and underwent end-of-trial colonoscopy 4 years later. We used Poisson regression models to evaluate the association between race and advanced adenoma (defined as an adenoma that is 1 cm or more in size, or with villous component or high grade dysplasia) at baseline and recurrent adenoma and advanced adenoma at 4 years. Results: Black and white participants did not differ on mean age (60.8 versus 61.3 years; P value = 0.53) or sex (66.7% versus 64.0% male; P value = 0.52). At baseline, blacks had higher prevalence of any advanced adenoma compared to whites (44.4% versus 37.0%; P value = 0.07) and proximal advanced adenoma (14.4% versus 8.8%; P value = 0.02); but not distal advanced adenoma (32.0% versus 29.9%, P value = 0.58). At the year 4 examination, 717 (39.4%) had adenoma recurrence and 120 (6.6%) had advanced adenoma recurrence. Blacks were as likely as whites to have any adenoma and advanced adenoma recurrence after adjusting for age, sex, body mass index, use of non steroidal anti-inflammatory drugs, smoking and family history of colorectal cancer (Table). There was no difference in adenoma recurrence by location. Conclusions: Despite higher prevalence of advanced adenoma at baseline, blacks have similar colorectal neoplasia recurrence risk as whites. Our study does not provide any evidence to support more frequent surveillance for blacks with personal history of adenoma as an intervention to reduce colorectal cancer disparity. The risk of adenoma and advanced adenoma recurrence by race