Ethnic Disparities in Colonoscopy Use Among Colorectal Cancer Survivors: A Systematic Review

After curative treatment for colorectal cancer (CRC), routine surveillance using colonoscopy may improve patient outcomes by detecting local recurrences and new onsets of CRC early enough to treat. Although some studies have directly addressed ethnic disparities in receipt of surveillance colonoscopy, the results are mixed and inconclusive. We aimed to identify all relevant studies of ethnic disparities in colorectal cancer surveillance and understand the association between race/ethnicity and colonoscopy use. We conducted a systematic review of literature which addressed the association between race/ethnicity and colonoscopy utilization among CRC survivors. We searched Medline for relevant articles. Two authors reviewed and subsequently eliminated or approved titles, abstracts, and full texts based on pre-determined inclusion/ exclusion criteria. Our decision for inclusion or exclusion was based on the relevancy of each paper, specifically in terms of data originality and the analysis of race/ethnicity in relation to colonoscopy use. Of the 1544 titles reviewed, only 8 studies investigated racial and ethnic disparities in the context of survivorship care. Half of the articles showed a small but significant ethnic disparity in the receipt of timely colonoscopy, and the other half showed a nonsignificant trend in the same direction. The effect did not appear to vary by time of diagnosis or proportion of minorities in each study, though larger studies showed a somewhat greater racial/ ethnic disparity in colonoscopy use. Despite evidence of widespread disparities in colorectal cancer prevention, detection, treatment, and outcomes, we found few studies that investigated racial and ethnic disparities in the context of survivorship care. Although our review found a limited number of studies addressing this issue, at least a small disparity has been acknowledged regarding the use of colonoscopy among colorectal cancer survivors.