Carcinoma in situ of the colorectum: SEER trends by race, gender, and total colorectal cancer

Background and Objectives: To determine if Americans of African origin (bla cks) have less access to colonoscopic polypectomy than Americans of Europea n origin (whites), the rate of carcinoma in situ of the colorectum (CIS), a disease more similar to benign adenoma of the colorectum than invasive can cer in its symptomatology, discovery, and treatment, was determined in the United States from 1973 to 1994. The hypothesis being tested is that CIS wi ll be far less common in blacks than in whites and that rates of CIS should be increasing in whites from 1973 to 1994. Methods: CIS and invasive carcinoma of the colorectum incidence data were o btained from Surveillance, Epidemiology, and End Results (SEER) Public Use Files from 1973 through 1994. Rates were age adjusted and proportions deter mined by division of CIS rates for each subsite by total carcinoma rates, f or each year, race, and gender. The colorectum was divided anatomically in this analysis at the junction of the descending and sigmoid colon. Results: The relationships between male/female and black/white CIS incidenc e rates were broadly similar to invasive cancer rates over the 21 years of SEER, demonstrating a white male predominance for distal disease, a black m ale predominance for proximal disease, and a decline in incidence since 198 8. CIS as a proportion of total colorectal cancer increased in all races an d genders from 1973 to 1987, but then declined in all groups. Conclusions: The majority of CIS is excised by endoscopic resection. Theref ore, this might be considered a surrogate population for those individuals who have colonoscopic resection of benign adenomas. It is this latter treat ment that has been hypothesized to be the cause for the declining incidence of invasive colorectal cancer. However, data presented herein do not suppo rt this hypothesis. J. Surg. Oncol. 1999;71:123-129. (C) 1999 Wiley-Liss, I nc.