Tag Archive for: racial disparity

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Race May Hinder Appropriate Diagnosis and Treatment for Early-Onset CRC

Systemic racism remains an impediment  for the progress of public health in the U.S. Racial disparities continue to reduce access to quality healthcare in the country, as was confirmed by a recently published study. 

The study, published in the Journal of Clinical Oncology (JCO), found that young Black individuals (18-49 years) in the U.S. diagnosed with colorectal cancer (CRC) have a higher death rate than their White counterparts. The authors suggest that young Black patients with CRC are less likely to receive timely and guideline-concordant care (guideline-concordant is the minimal treatment patients should receive according to the National Comprehensive Cancer Network standards), which may be responsible for the increased mortality in that population. Specifically, the study found that Black CRC patients had longer times to receive adjuvant chemotherapy for colon cancer and neoadjuvant chemoradiation for rectal cancer compared to White patients. 

Racial disparity has a long and profound history in the U.S., affecting everything from the housing sector to the criminal justice system to the healthcare system and the economy. But when it comes to healthcare, it becomes even more worrisome and disturbing because the system’s ongoing inequities are impeding the progress made through years of public health effort. As a national goal, the Agency for Healthcare Research and Quality is dedicated to reducing racial disparities in health outcomes across the country. 

Interestingly, the American Cancer Society reports that, with the exception of pancreatic and kidney cancer, Black people had lower survival rates than White people for all cancer types. 

Barriers to CRC Screening and Treatment

Back to the JCO study – the authors found that access to CRC screening is difficult for Black people in the U.S. for a number of reasons, including:

  • Health insurance coverage: Often your health insurance determines the type of healthcare you receive. However, obtaining quality private health insurance is primarily dependent on having a job. But when it comes to employment, a substantial percentage of Black people are disadvantaged. Compared to White people, Black people have the highest unemployment rate in the country and are more likely to work in blue-collar jobs. Consequently, Black individuals have lower rates of private insurance coverage. 
  • Facility type: Black people are more likely to receive treatment at facilities with limited resources and are less likely to have access to high-performing facilities like teaching hospitals and cancer centers with a National Cancer Institute designation. However, research indicates that there could be a 5% reduction in the disparity in the provision of guideline-concordant care if Black and White patients were treated in the same healthcare facilities. 
  • Access to specialists/Lack of diversity in the medical workforce: For Black patients with metastatic CRC, fewer consultations with specialists and subsequent multimodality therapy treatments are provided. Nonetheless, even in cases when the rates of specialist visits are comparable to those of White patients, Black people are less likely to undergo treatment for CRC. A lack of cultural sensitivity and diversity in the medical workforce erodes good patient-provider communication, including the kind and caliber of information that clinicians deliver to patients, and makes the health care system appear less trustworthy. Disparities in patients’ access to high-quality care can be made worse by this, which can result in clinicians making insufficient treatment recommendations and creating obstacles to treatment adherence for patients from marginalized populations.

Over the years, a lot of work has been done to boost access to healthcare and remove barriers that might prevent it. Despite that, racial disparities in healthcare in the U.S. remain. However, no one should be denied access to high-quality healthcare due to the color of their skin or race. More work is needed to eradicate the disparities that Black Americans and other minority races face throughout the country.

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

 

Photo credit: Nathan Dumlao on Unsplash

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Colorectal Cancer: New Data Suggest Rising Rates, More Advanced Disease in Young Adults 

On March 1, 2023, the first day of Colorectal Cancer Awareness Month, the American Cancer Society released some alarming new statistics regarding early-onset colorectal cancer (CRC) diagnoses: in the U.S. population, people are increasingly being diagnosed with CRC at a younger age and with more advanced disease stage. Advanced-stage CRC diagnoses have risen by eight percent in the past two decades. Additionally, early onset diagnoses rose from one in ten individuals in 1995 to one in five in 2019. While CRC in the general population is declining, rates in younger people are on the rise. 

The complete report contains CRC incidence, mortality, and screening prevalence data that were derived from multiple national databases, including: 

  • National Cancer Institute
    • Surveillance, Epidemiology, and End Results (SEER) program
  • Center for Disease Control
    • National Program of Cancer Registries
    • Behavioral Risk Factor Surveillance System
    • National Center for Health Statistics
      • National Health Interview Survey
  • North American Association of Central Cancer Registries

The report projects that of the 153,020 expected CRC cases in 2023, 13% (nearly 20,000) will be in individuals younger than 50. Seven percent of projected CRC mortality will also be in individuals younger than 50. CRC mortality in individuals under the age of 50 is also on the rise, as the mortality rate in this population has risen one percent every year since 2004. 

Rising cancer trends in the younger U.S. population point to increased exposures to causal agents, and indicate the need for research that identifies newfound risk factors. The data from this report highlights the growing concern that is early-onset CRC incidence and mortality, pointing to a portion of the population that will need more research and funding in the CRC space. 

Efforts to improve screening rates at a health care center in New York City

Racial Disparity in CRC Incidence and Mortality

Racial disparities continue to exist in CRC incidence, mortality, and survival rates. Both incidence and mortality rates in the U.S. are highest among American Indian/Alaskan Native and non-Hispanic Black individuals. Alaskan Native individuals face the highest burden of CRC incidence than any other group (88.5 per 100,000 individuals). Risk factors that contribute to disparities in the Alaskan Native population are likely a combination of environmental factors (low sun exposure, diet low in fiber, smoking, and obesity) and low access to colon health care services. Alaskan Native individuals have the lowest screening rate in the U.S. 

Black Americans are more likely to be diagnosed with metastatic CRC than any other racial or ethnic group in the nation. Black patients also experience significant disparities in care, and are 21% less likely to receive colon cancer surgery and 28% less likely to receive rectal cancer surgery. Additionally, Black patients are more likely to develop right-sided tumors, which are correlated with a poorer prognosis. 

These updated data from the American Cancer Society point to the need for future research in early-onset incidence, racial disparities, and general risk factors for CRC. Scientists should aim to identify newfound risk factors that are contributing to the trend of CRC diagnoses under 50, and to identify factors specific to high-risk racial and ethnic groups as well.

You can learn more about the signs and symptoms of colorectal cancer on this page.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Early-Age Onset Colorectal Cancer: Health Disparities in the Black Population

Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the U.S., and the incidence of early-age onset CRC (EAO-CRC)—when the disease is diagnosed in those younger than 50 years—is rising. In the Black population, EAO-CRC makes up nearly 10% of all new diagnoses. The incidence of EAO-CRC in the Black population (8.4 cases per 100,000 people in 2019) is slightly lower than that of the White population (8.9 cases per 100,000 people in 2019), but this is reversed when it comes to the mortality rate. The mortality rate of EAO-CRC in the Black population is 2.4 deaths per 100,000 people, while it is 1.8 deaths per 100,000 people in the White population. Between 2015-2019, 5,329 new EAO-CRC cases were diagnosed among Black Americans.

Studies have shown that Black individuals are more likely to be diagnosed with EAO-CRC at a younger age and a more advanced stage than White individuals: 22% of White Americans receive a metastatic diagnosis compared with 26% of Black Americans. 

 

 

While additional research is needed to discern the higher incidence of EAO-CRC in the Black population, certain socioeconomic and environmental factors likely play an important role. These include limited access to proper healthcare services, the prevalence of food deserts leading to poor nutrition, and living in areas with high pollution rates. Additional resources to support research, prevention, and treatment efforts of EAO-CRC in this population are critical.  

Empowering the population via awareness and education campaigns around the early warning signs of CRC and the importance of screening in the Black community would also go a long way. Early warning signs of CRC include changes in bowel movements, blood in stool, unexpected weight loss, and continuous abdominal discomfort. If you are experiencing these symptoms, speak with your doctor. 

Additional information on prevention, symptoms, and diagnosis of CRC can be found under ‘Resources’ on the Colon Cancer Foundation’s website.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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