Disparities in Colorectal Cancer Screening by Time in the U.S. and Race/Ethnicity, 2010-2018

Shattering the monolith: burden of gastrointestinal cancer in Asian Americans, Native Hawaiians, and Pacific Islanders in the United States

Asian Americans remain the fastest-growing racial group in the United States, and are anticipated to double over the next few decades. Asian Americans are the only major racial-ethnic group for whom cancer remains the leading cause of death, and multiple gastrointestinal cancers rank among the top five incident and fatal cancers. Most research to date presents Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) in aggregate, overlooking their vast heterogeneity and hindering efforts to identify and address health disparities within AANHPI origin groups. Here, we present gastrointestinal cancer incidence and mortality in AANHPI, including disaggregated rates where feasible, and highlight gaps in current screening practices. We conclude with actionable suggestions to shift away from using broad racial categories to evaluate cancer disparities, towards high-quality, disaggregated data to better isolate and address factors driving the clear differential cancer risks among AANHPI.

Utilization of colorectal cancer screening tests: a systematic review and time trend analysis of nationally representative data

Background

The substantial and increasing global burden of colorectal cancer (CRC) underscores the imperative to enhance implementation and utilization of effective CRC screening offers. Therefore, we examined the lifetime and up-to-date use of CRC screening tests across various countries, and described utilization trends over time.

Methods

We conducted a systematic review on the extent and recent trends of utilization of CRC screening tests among people 45 years or older in different countries around the globe. PubMed/Medline, Web of Science, and Embase electronic databases were screened for eligible studies from inception to June 30, 2024. The study protocol was registered with international prospective register of systematic reviews (PROSPERO) (CRD42023391344).

Findings

A total of 50 studies, based on nationally-representative data, were finally included - 27 from the United States (US) and 23 from other countries. The overall utilization of CRC screening has steadily increased over time in many countries, reaching 74.9% in Denmark in 2018-2020, 64% in Korea in 2020, and 72% in the US in 2021. Nevertheless, the utilization rates remain far below the national or continental targets in most countries. In contrast to European and Asian countries, where screening was predominantly fecal test-based, the approach in the US was primarily driven by colonoscopy, and the uptake of fecal tests and sigmoidoscopy gradually declined in the past two decades.

Interpretation

Despite ongoing progress in CRC screening offers and utilization, there remains large potential for enhanced roll-out and utilization of effective CRC screening programs for enhanced control of CRC incidence and mortality in the years ahead.

Funding

There was no funding source for this study.

Identification of Priorities for Colorectal Cancer Screening Interventions Among US Hispanic/Latino Populations

Objectives. To identify nationwide census tract‒level areas where improving colorectal cancer (CRC) screening uptake via targeted local preventive intervention may benefit Hispanic or Latino/a (H/L) groups defined by region or country of origin. Methods. Using 2021 Centers for Disease Control and Prevention PLACES and American Community Survey data, we applied geographically weighted regression and Getis-Ord Gi* hot spot procedures to identify CRC screening priority zones for H/L groups in the United States. Priority zones can be conceptualized as census tracts with strong inverse associations between percentage of a particular H/L group in the population and CRC screening rate, after adjusting for socioeconomic deprivation and lack of insurance. Results. We identified 6519, 3477, 3522, 1069, and 1424 census tract CRC screening priority zones for H/L communities of Mexican, Puerto Rican, Central/South American, Dominican, and Cuban heritage, respectively. Priority zones for H/L groups had strong spatial heterogeneity, and overlap of geographic patterns among H/L groups varied by region. Conclusions. Our findings and interactive web map may serve as a translational tool for public health authorities, policymakers, clinicians, and other stakeholders to target investment and interventions to increase guideline-concordant CRC screening uptake benefitting specific H/L communities in the United States. (Am J Public Health. 2024;114(S6):S515-S524. https://doi.org/10.2105/AJPH.2024.307733) [Formula: see text].

Limited English proficiency and reported receipt of colorectal cancer screening among adults 45-75 in 2019 and 2021

Introduction

Substantial barriers to screening exist for medically underserved populations, especially adults with limited English proficiency (LEP). We examined the proportion of US adults aged 45-75 up-to-date with colorectal cancer (CRC) screening by LEP after 2018. The American Cancer Society began recommending CRC screening for adults 45-49 in 2018.

Methods

We analyzed cross-sectional data of adults 45-75 years old participating in the 2019 or 2021 National Health Interview Survey (N = 25,611). Adults were considered up-to-date with screening if they reported any stool test within 1 year, stool-DNA testing within 3 years, or colonoscopy within 10 years. Adults who interviewed in a language other than English were considered to have LEP. Adults not up-to-date with screening were asked if a healthcare professional (HCP) recommended screening, and if so which test(s). Regression models conducted in 2022-2023 evaluated receipt of screening, adjusting for sociodemographics, year, and healthcare access.

Results

Overall, 54.0 % (95 % CI 53.1-54.9 %) of participants were up-to-date with screening (9.4 % aged 45-49 vs 75.5 % aged 65-75); prevalence increased from 2019 (52.9 %) to 2021(55.2 %). Adults with LEP (vs English proficiency) were less likely to be up-to-date with screening (31.6 % vs. 56.8 %, [aPR 0.86 (0.77-0.96)]). Among adults not up-to-date, 15.0 % reported their HCP recommended screening (8.4 % among adults with LEP).

Conclusions

Nearly half of US adults were not up-to-date with CRC screening in 2019 and 2021 and few reported being recommended screening. Adults with LEP and those 45-49 were least likely to be screened suggesting targeted interventions are needed for these populations.

Pathogenic germline variants in patients with endometrial cancer of diverse ancestry

BACKGROUND

Racial disparities in outcomes exist in endometrial cancer (EC). The contribution of ancestry-based variations in germline pathogenic variants (gPVs) is unknown.

METHODS

Germline assessment of ≥76 cancer predisposition genes was performed in patients with EC undergoing tumor-normal Memorial Sloan Kettering Cancer Center Integrated Mutation Profiling of Actionable Cancer Targets sequencing from January 1, 2015 through June 30, 2021. Self-reported race/ethnicity and Ashkenazi Jewish ancestry data classified patients into groups. Genetic ancestry was inferred from Memorial Sloan Kettering Cancer Center Integrated Mutation Profiling of Actionable Cancer Targets. Rates of gPV and genetic counseling were compared by ancestry.

RESULTS

Among 1625 patients with EC, 216 (13%) had gPVs; 15 had >1 gPV. Rates of gPV varied by self-reported ancestry (Ashkenazi Jewish, 40/202 [20%]; Asian, 15/124 [12%]; Black/African American (AA), 12/171 [7.0%]; Hispanic, 15/124 [12%]; non-Hispanic (NH) White, 129/927 [14%]; missing, 5/77 [6.5%]; p = .009], with similar findings by genetic ancestry (p < .001). We observed a lower likelihood of gPVs in patients of Black/AA (odds ratio [OR], 0.44; 95% CI, 0.22-0.81) and African (AFR) ancestry (OR, 0.42; 95% CI, 0.18-0.85) and a higher likelihood in patients of Ashkenazi Jewish genetic ancestry (OR, 1.62; 95% CI; 1.11-2.34) compared with patients of non-Hispanic White/European ancestry, even after adjustment for age and molecular subtype. Somatic landscape influenced gPVs with lower rates of microsatellite instability-high tumors in patients of Black/AA and AFR ancestry. Among those with newly identified gPVs (n = 114), 102 (89%) were seen for genetic counseling, with lowest rates among Black/AA (75%) and AFR patients (67%).

CONCLUSIONS

In those with EC, gPV and genetic counseling varied by ancestry, with lowest rates among Black/AA and AFR patients, potentially contributing to disparities in outcomes given implications for treatment and cancer prevention.

PLAIN LANGUAGE SUMMARY

Black women with endometrial cancer do worse than White women, and there are many reasons for this disparity. Certain genetic changes from birth (mutations) can increase the risk of cancer, and it is unknown if rates of these changes are different between different ancestry groups. Genetic mutations in 1625 diverse women with endometrial cancer were studied and the lowest rates of mutations and genetic counseling were found in Black and African ancestry women. This could affect their treatment options as well as their families and may make disparities worse.

Delays in Colorectal Cancer Screening for Latino Patients: The Role of Immigrant Healthcare in Stemming the Rising Global Incidence of Colorectal Cancer

The significant global burden of colorectal cancer accentuates disparities in access to preventive healthcare in most low- and middle-income countries (LMICs) as well as large sections of underserved populations within high-income countries. The barriers to colorectal cancer screening in economically transitioning Latin America are multiple. At the same time, immigration from these countries to the USA continues to increase. This case highlights the delays in diagnosis experienced by a recent immigrant from a country with no established colorectal cancer screening program, to an immigrant population in the USA with similar poor screening coverage. We discuss common challenges faced by Latinos in their home countries and the USA, as well as strategies that could be implemented to improve screening coverage in US immigrant populations.

Publication trends and hotspots of colorectal adenoma during 2002-2022: a bibliometric and visualized analysis

Background

Prevention and treatment of colorectal adenoma (CRA) are great significant to reduce morbidity and mortality of colorectal cancer. Although there have been numerous studies on CRA recently, few publications utilized the bibliometrics to evaluate this field. The objective of current study was to provide a comprehensive analysis of the current state and frontier progress of CRA over the past 20 years.

Methods

The Web of Science Core Collection was utilized to extracted all studies of CRA during 2002-2022. Bibliometric tools including CiteSpace, VOSviewer, and the Online Analysis Platform of Literature Metrology were used for statistical analysis. CiteSpace and the Online Analysis Platform were used to evaluate the contributions of various countries/regions, institutions, authors, and journals in this field. Research hotspots and trends were identified through keywords and references analysis by VOSviewer and CiteSpace.

Results

2,268 publications from 2002 to 2022 in total were identified. The number of global publications in this field has increased annually. The USA was the most productive country, contributing nearly 30% of global publications. But in recent years, China's publications grew rapidly and had the highest citation strength. The most productive institutions was the National Cancer Institute. Baron JA from the USA was the most productive and the one of most co-cited authors. Cancer Epidemiology Biomarkers & Prevention had the highest number of publications and Gastroenterology was the most co-cited journals. Analysis of keywords clusters showed that "mechanism/pathophysiology", "risk factors and prevention", "colonoscopy screening and treatment", "metabolism", and "microbiota" were the major frontier topics and the main research directions.

Conclusions

CRA publications have shown a gradual upward trend in recent years, most of which have been published by developed countries. Developing countries should further focus on CRA research and transnational cooperation with developed countries in the future, in order to better improve the situation of the increasing morbidity and mortality of CRC. Baron JA was the most outstanding researcher in this field. More attention should be devoted to "pathogenesis of CRA", "less invasive diagnostic methods", "chemoprevention", and "screening and risk prediction of CRA including gut microbiome and metabolism", which will be frontiers in the future.