is even more concerning in male population. Further targeted interventions are required tolower these differences.

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Ethnic Differences in Early-Onset Colorectal CancerMatthew Chin, Gurjot Singh, Fouzia Khan, Natalia Kouzminova, Albert Lin, AhmadKamal

BACKGROUND: The incidence of colorectal cancer (CRC) in persons under the age of 50is rising, and people of Hispanic ethnicity comprise a growing proportion of cases. Previousstudies have shown that Hispanics present at younger ages and at later stages, and havepoorer survival than non-Hispanic whites. However, little is known about differences inmethods of presentation, tumor location, and family history of these patients. METHODS:All CRC patients under the age of 50 diagnosed from 1990 onwards were ascertained throughour hospital's tumor registry. We reviewed endoscopy and surgery reports, clinic notes,laboratory results, radiology reports, pathology reports, and inpatient discharge summariesto determine key demographic and clinical features of these patients. RESULTS:We identified139 patients, of whom 58 (41.3%) were Hispanic and 81 (58.3%) were non-Hispanic.Hispanics had a lower mean age at diagnosis (39 years vs. 42 years, p=0.01), and had atrend towards higher BMI (26.7 vs. 25.1 kg/m2, p= NS), with 49% being overweight. Forboth groups, the most common symptoms were abdominal pain (59%) and bleeding (38%).Weight loss was a more common presenting symptom among Hispanics (19% vs. 7%, p =0.04). Most patients in both groups presented at late stage, with 72% having Stage III/IVdisease. Among Stage IV patients, 44% had multiple sites of metastasis. Thirty eight percentof cancers were diagnosed at surgery, with the remainder being found via diagnostic colonos-copy or flexible sigmoidoscopy. None of the tumors were found by screening, even amongpatients with elevated risk. Rectal cancer comprised 20-30 % of tumors in both groups,and Hispanic patients had more cancers in the sigmoid or descending colon (49% vs. 31%,p =0.04). Although the majority of cases were sporadic rather than familial, Hispanics weremore likely than non-Hispanics to have a family history of CRC (19% vs. 5%, p =0.009).CONCLUSIONS: Hispanics appear to be at high risk for early-onset CRC, possibly due toa higher prevalence of obesity. The majority of patients present at later stages. Presentingsymptoms are non-specific, although a fair number of Hispanic CRC patients had involuntaryweight loss prior to diagnosis. Although most cases of early-onset CRC are sporadic, a higherproportion of Hispanic patients reported a family history of colon cancer, suggesting thata thorough family history and possibly early screening colonoscopy is indicated in this popula-tion.Presenting Symptoms by Ethnicity

Percentages do not add to 100 because some patients had multiple symptomsTumor Location by Ethnicity

S-407 AGA Abstracts

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Body Mass Index and Risk of Colon Adenoma and Cancer: Results From anInner City HospitalFrances Charlene P. Briones, Saritha Gorantla, Yahuza Siba, Karina A. Auffant Caraballo,Joan A. Culpepper-Morgan

Background: Colon cancer remains the third leading cause of cancer mortality in the UnitedStates in both men and women despite the availability of screening colonoscopy. This hasbeen linked to the rising obesity epidemic in this country, which is found to be moreprevalent in African Americans (AA). Harlem Hospital serves a demographically uniquepopulation which is 50% AA, 35% Hispanics and 10% White/Others. Our aim was toexamine the relationship of body mass index (BMI), race and gender to colon cancer andadenoma formation in a community of color. Methods: We performed a population-based,retrospective cohort analysis of all patients who underwent colonoscopy in Harlem HospitalCenter from 2006-2007. Our data included both screening and diagnostic colonoscopies.The patients were classified according to their reported race and country of origin. BMI wascomputed using the height and weight taken either on the day of outpatient visit prior toundergoing colonoscopy or on the day of procedure. The occurrence of adenoma or carcinomawas recorded. Results: A total of 1,898 patients underwent a colonoscopy and 636 wereexcluded because of incomplete data. The average age of the group was 58 and 45% weremen. The ethnic breakdown was as follows: 70% AA, 27% Hispanics and 3% Others. Themean BMI was 29. 254 patients were found to have adenomas with 74% being AA, 22%Hispanics, and 4% Others. 15 colorectal carcinoma were identified with 87% AA, 6.5%Hispanics, and 6.5% Others. The mean BMI for those with adenoma was 29.46 (SD±6.28)and for those without was 29.27 (SD±6.58). Of those without adenoma, 42% were menand 58% were women. For those with adenoma, 54% were men and 46% women, thisdifference with regards to adenoma formation between men and women was statisticallysignificant (P<0.001). In men, the mean BMI for those with adenoma was 28.91 (SD±5.70)and those without was 27.87 (SD±5.31), this difference in BMI in the two groups wasstatistically significant (P<0.05). In women, the mean BMI for those with adenoma was30.10 (SD±6.87) and those without was 30.31 (SD±7.20), this difference was not statisticallysignificant. Conclusions: In our cohort, men with adenomas had a higher BMI. Womenwere less likely to develop adenoma regardless of BMI. The study failed to demonstrate anysuch difference with cancer formation, probably due to the low number of cancers detectedin our cohort of patients. As has been suggested in other studies, our study suggests thatthe type of adiposity may have more importance than BMI alone. Men have more visceralor central adiposity, which is known to be more metabolically active than the peripheraltype that women have. Intensive weight reduction and lifestyle modifications may be morevaluable in men than women.

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Inaccuracy of Patient Recollection of Prior Colonoscopy in an Inner- CityPopulationMenachem Schechter, Israr A. Sheikh, Saritha Gorantla, Frances Charlene P. Briones,Anand Gupta, Elena Tsai, Joan A. Culpepper-Morgan

Introduction: Physicians must often rely on patient report in making health care decisions.Little data has been published studying the accuracy of patient recall, especially of remoteevents like screening colonoscopy, which often occurred several years prior. Reliability ofpatient memory presents a particular problem in providing care to an inner city populationwhere patients are often medically unsophisticated and visit multiple health care facilities.We aimed to assess the accuracy of patient recall of prior colonoscopy in our institutionand estimate the potential accrued error in colon cancer screening recommendations basedon reliance on memory. Methods: In October and November of 2011, we called by telephonepatients who had undergone colonoscopy from Jan 2004 -April 2007 for colon cancerscreening or polyp surveillance at Harlem Hospital and asked them a series of brief, scriptedquestions and compared the answers to the data in our Electronic Medical Record, includingthe endoscopy report and recommendations given to the patient the day of their procedure.The phone interview queried: “whether the patient had ever had a colonoscopy”, “when”,“what did it show”, “are you supposed to have another”, and if so, “when”. Interviews wereconducted in English, or with a proficient interpreter if the respondent was non-Englishspeaking. Patients with a more recent colonoscopy were excluded. Results: A total of 344patients were called, with 128 spoken to, of which 8 were disqualified as they were unableor unwilling to answer questions or had undergone recent colonoscopy at another institution,leaving 120 respondents, 30 per year of the 4 years studied. The cohort, whose average agewas 64.8, was 37.5% male and 62.5% female and contained 96 African American (80%),15 of them being West African immigrants, 23 Hispanics (19%) and 1 Caucasian. In total79 (65.8%) erred by >1 year in recalling when their last colonoscopy took place, with 31(39%) recalling having had colonoscopy earlier and 48 (61%) later than actually recorded.The total average error was 2.45 years with a median of 2 years, which would lead tosignificant error in screening recommendation.(see table). Gender, race, and age(<or> age65) were not statistically significant factors. Most respondents knew that another colonoscopyhad been recommended with only 34/120 (28.3%) unaware or unsure if future colonoscopywas recommended, though most did not know when a repeat was due. Conclusion: In ourpopulation, patient recall is unreliable in determining appropriate screening intervals andwould lead to >50% of patients having colonoscopy significantly earlier or later than recom-mended. Accuracy of recall declined consistently with the length of time from prior colonos-copy. Better education is needed in making patients more meaningful partners in their care.

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