EP813 - Concrete Divisions: The Lasting Effects of Residential Segregation on Colorectal Cancer Detection in Buffalo, NY

Purpose/Background: Colorectal cancer is the third leading cause of cancer-related death in the United States. Its incidence and mortality rate has been shown to be significantly higher in Black Americans. Adenoma detection is a quality metric in colonoscopy screening, but the impact of patient demographics and residential segregation on adenoma and cancer detection remain largely unstudied. Buffalo, New York is one of the most segregated cities in the United States, with residential segregation contributing to continued health inequities within our communities and hospital systems. Main Street is a concrete dividing line in Buffalo. Redlining and racially restrictive covenants forced the Black community to the East of Main Street while the West side remained majority White. Our study compared colorectal adenoma and cancer detection among East and West Buffalo residents undergoing initial screening colonoscopies to gain greater insight on the impact of segregation on disparities in colorectal cancer risk. We believe this data will be applicable to health inequities affecting marginalized populations nationwide.

Methods/Interventions: We retrospectively reviewed 210 screening colonoscopies performed by eight colorectal surgeons from July - October 2025 within the Department of Surgery at the University at Buffalo at three major teaching hospitals and two ambulatory surgery centers. The number of non-advanced and advanced adenomas, and malignant tumors were analyzed by patient addresses East and West of the Main Street line. Socioeconomic factors including race, Medicaid status, and family history were also studied. Data analysis was performed with R software using Fisher's t test, Pearson's Chi-squared test, and Wilcoxon rank sum test.

Results/Outcomes: Of 210 colonoscopies reviewed during the 3-month period, 97 (46%) were first time screening colonoscopies, and of those 35 patients (36%) lived within Buffalo city limits. Of these patients, 60% lived East of Main Street while 40% lived West of Main Street, and 66% were female. The average age of first colonoscopy was 55.0 in East side patients and 53.2 in West side patients. Among East side patients, 62% were Black and 33% are covered by Medicaid. 9% of East side patients reported a family history of colorectal cancer. East side patients had greater numbers of small ( < 6 mm) and sigmoid polyps detected on colonoscopy. However, none of these differences were statistically significant.

Conclusion/Discussion: While there were no statistically significant differences identified in the East side patients compared to the West side patients of Buffalo at this time, we anticipate that with continued data collection our project will be a major step in understanding the health inequities that have burdened Buffalo for so long. Our lack of power could be attributed to sample size or current data skew towards East side residents. In our patient cohort, there is an 8-10 year lag behind national screening colonoscopy guidelines, further justifying the importance of targeted improvements in screening access, colonoscopy scheduling, and patient education. In the future, we anticipate that this data will allow us to understand barriers to screening and adenoma detection.

Table 1 - Polyp characteristics among East and West side patients
Figure 1 - Patient distribution East and West of Main Street, Buffalo, NY
Address distribution of patients East and West of Main Street (represented by red line). Black line represents Buffalo city limits.