Abstract Colorectal cancer (CRC) remains a significant public health concern, particularly among underserved populations. This study evaluated CRC risk factors and compared risk assessment models in a predominantly Hispanic cohort residing along the U.S.-Mexico border. We analyzed data from 4,202 CRC screening participants, mostly women (78.3%), with a mean age of 57.3 years (SD = 5.54). Most were born in Mexico (86.2%) and had resided in the U.S. for an average of 25 years (SD = 16.5). Risk was assessed using four models: Freedman, Wells, Kaminski, and Yeoh. We examined model concordance, risk distributions, and gender-specific trends. Freedman’s model showed that 41.1% of participants had a lifetime CRC risk above the national average. Men had a higher lifetime risk (51.3%) than women (38.3%), while more women had elevated 10-year risk (26.3% vs. 21.1%). Freedman and Wells models demonstrated a strong concordance correlation coefficient (CCC = 0.76), with an optimal Freedman cutoff of 0.97 (AUC = 87%). Kaminski and Yeoh identified more participants at above-average risk (27.8% and 35%) compared to Freedman (20.6%) and Wells (14.9%). Key contributors to elevated risk included smoking pack-years, obesity, and family history, with gender-specific variations. Freedman’s model, offering both lifetime and 10-year risk estimates, emerged as the most practical tool in this cohort. Custom thresholds (0.89 for women, 1.41 for men) improved risk stratification, aligning with validated polyp-detection rates. These findings support the use of tailored CRC risk models for Hispanic populations to enhance targeted screening and prevention efforts.
Molokwu et al. (Wed,) studied this question.