BACKGROUND: Black Americans experience higher colorectal cancer (CRC) incidence than Whites, despite undergoing prevention screenings similar to Whites since 2010. We compared Black and White patients' colorectal adenoma status at screening colonoscopy, a measure of CRC risk. METHODS: Using cross-sectional, observational data, we studied colorectal adenomas at first-time screening colonoscopy of average risk patients aged 40-89 years, screened between September 2001 and July 2016 in South Carolina. We studied age-adjusted odds of Black men and women (vs White), of having adenoma, advanced adenoma, ≥3 non-advanced adenomas, and right hyperplastic polyp, and compared their total polyp burden (sum of diameters of all adenomas and right polyps detected) Results: Among 28,100 patients, 58.4% Black, 53.8% women, we found that Black patients had lower age- and gender-adjusted odds vs. Whites to have adenoma (OR=0.88, p<
0.01), and right hyperplastic polyp (OR=0.74, p<
0.01), with similar pattern within gender groups. Black and White patients were similar on advanced adenoma, and 3+ non-advanced adenoma. Among patients with lesions, mean polyp burden ranged from 8.5mm(±7.2) for Black women aged 40-49 years, to 12.3mm (±7.4) for Black men aged over 70. Age-adjusted polyp burden was 0.4mm higher for Black men than White men, and 0.3 mm lower for Black women than White women patient groups (p<
0.01). CONCLUSIONS: In a large, racially balanced patient sample, Black and White patients showed similar polyp profiles. IMPACT: Given similar adenoma status, other evidence-supported clinical factors associated with suboptimal polyp detection should be explored to understand the continuing CRC disparities affecting Black Americans.