Disparities in colorectal cancer in African-Americans vs Whites: Before and after diagnosis

Disparities in treatment and survival of white and Native American patients with colorectal cancer: a SEER analysis

BACKGROUND

Minority groups with colorectal cancer have not experienced the decline in incidence and mortality that has been reported in whites. We sought to determine whether differences exist in treatment and survival between white and Native American patients with colorectal cancer because little has been written about this specific minority group.

STUDY DESIGN

The Surveillance Epidemiology and End Results (SEER) database for colorectal cancer was used to compare treatment and survival in whites (colon, n = 137,949; rectum, n = 46,843) and Native Americans (colon, n = 872; rectum, n = 316). Cox proportional hazards models were used to compare cancer-specific survival in Native Americans with whites, adjusted for stage, sex, age and year of diagnosis, socioeconomic status, and treatment.

RESULTS

Native Americans presented at younger ages than whites for both colon and rectal cancer (p < 0.001). They were diagnosed at more advanced stages of disease than whites for only colon cancer. No significant differences were detected in the proportion of patients recommended for surgery between the two groups, for either cancer at any stage (all p > 0.05). Native Americans with rectal cancer were more likely to receive radiation than whites (p < 0.001), but they received less sphincter-preserving surgery (60.0% vs 65.4%; p = 0.045). Native Americans with colon cancer fared significantly worse than whites (hazard ratio = 1.20; 95% CI = 1.08 to 1.34), but there is no difference in cancer-free survival between races for rectal cancer.

CONCLUSIONS

Compared with whites, Native Americans with colon cancer have worse cancer-specific survival.

Referrals among cancer services organizations serving underserved cancer patients in an urban area

Significant racial, socioeconomic, and geographic disparities exist nationwide in cancer screenings, treatments, and outcomes. Differences in health and social service provision and utilization may contribute to or exacerbate these disparities. We evaluated the composition and structure of a referral network of organizations providing services to underserved cancer patients in an urban area in 2007. We observed a need for increased awareness building among provider organizations, broader geographic coverage among organizations, and increased utilization of tobacco cessation and financial assistance services.

Impact of race on colorectal cancer

BACKGROUND

Several studies have shown that colorectal cancer runs a more severe course in blacks compared with whites. Black patients tend to have more advanced disease at diagnosis and are more likely to die of cancer than are white patients. The present study was carried out to compare the characteristics and outcomes of colon cancer in blacks and whites in a Veterans Affairs Medical Center, where patients are expected to receive similar treatment irrespective of race.

METHODS

The database of the Veterans Affairs Medical Center was searched for all patients with a histologic diagnosis of colon cancer diagnosed since 1996. Detailed information on patient and tumor characteristics was obtained. In addition the type of treatment and outcome was analyzed.

RESULTS

A total of 300 subjects were included in the study. They comprised 205 white and 95 black patients. There was no difference in age at presentation between the 2 groups. Blacks were more likely to have anemia (P = .005) and rectal bleeding (P < .001) than were whites. However there was no difference between the 2 groups with respect to the histologic grade of the tumor, the extent of disease at presentation, the proportion of patients receiving curative surgery, and the time to death after diagnosis.

CONCLUSIONS

There was no racial difference in the treatment outcome of colon cancer in patients treated at a Veterans Affairs Medical Center. These findings indicate that if patients receive similar treatment, the racial background of an individual does not have any impact on the severity of disease at presentation and the outcome of treatment.

Racial/ethnic patterns of uptake of colorectal screening, National Health Interview Survey 2000-2008

BACKGROUND

Lower access and/or utilization of colorectal screening are thought to be major contributors to the higher proportion of cancers among African Americans and Hispanics that are diagnosed at advanced stages of disease and the poorer outcomes observed among Hispanics and African Americans compared with non-Hispanic whites. We examine rates of initiation, utilization of specific screening modalities, adherence tocolorectal screening guidelines, and rate of uptake of colonoscopy among age-eligible African Americans, Hispanics and non-Hispanic whites.

METHODS

Data on 46145 African American, Hispanic, and non-Hispanic white survey respondents to the 2000 and 2005 Cancer Control Modules and the 2003 and 2008 Sample Adult Cores of the National Health Interview Surveys are examined in these analyses.

RESULTS

There was a modest increase in the initiation of colorectal screening among non-Hispanic whites, only and racial/ethnic disparities colorectal screening utilization persisted. The proportion of respondents for whom colonoscopy was the most complete guideline consistent exam received increased over time, while use of other modalities decreased among all racial/ethnic groups.

CONCLUSION

More effort must be made to increase colorectal screening among the U.S. population in general but particularly among racial/ethnic minority populations. With the increased attention on prevention, there is also a need to increase knowledge of the strengths and limitations of specific screening modalities and the need to receive screening exams within recommended time intervals among both patients and providers making screening recommendations.