Lesions in the Proximal Colon in African-American and Hispanic Women: A Case for Complete Colonoscopy as the Screening Modality of Choice

Purpose: Recent literature indicates that women have a significant risk in developing proximal lesions (cecum, ascending and transverse colon) without a distal lesion (rectum, sigmoid and descending colon). However, information on the distribution of colonic lesions in African- American (AA) and Hispanic (H) women is limited. The aim of this study is to characterize the location and histopathology of colonic lesions in this subgroup. Methods: Retrospective data analysis on a screening colonoscopy data base was performed. 328 female patients between the ages of 50-80 years were studied. 62.8% were AA and 29.3% were Hispanic; 7.9% belonged to other subgroups and were excluded. Distal lesions were defined as rectum, sigmoid and descending colon, which can be visualized using the flexible sigmoidocope. Proximal lesions were defined as cecum, ascending colon and transverse colon, which are beyond the reach of the flexible sigmoidoscope. Results: In the African-American subgroup, 44.7% had polyps. 30.4% had proximal lesions, and of these, 17.4% were proximal to the transverse colon. 68.5% had distal lesions. 1.1% had both proximal and distal lesions. In the Hispanic subgroup, 38.5% had polyps. 48.6% had proximal lesions, and of these, 35.1% were proximal to the transverse colon. 51.4% had distal lesions. 53.4% of the polyps in both subgroups were 0.5-1 cm in size. 3.1% of the polyps were malignant and 6.2% were advanced adenomas. Conclusion: Close to one-third of all polyps in the AA subgroup and close to one-half of all polyps in the Hispanic subgroup were found in the proximal colon. African-American and Hispanic women appear to have a significant number of proximal lesions without concomitant distal lesions. We reinforce the case for complete screening colonoscopy as the screening modality of choice in these subgroups of minority women.