African-Americans with colorectal cancer have poorer outcomes, lower survival rates

New research published in the November issue of the Journal of the American College of Surgeons shows that African-American patients with colorectal cancer are more likely to be diagnosed with advanced disease and are less likely to undergo surgical procedures compared with Caucasians, suggesting that improvements in screening and rates of operation may reduce differences in colorectal cancer outcomes for African-Americans.

Racial disparities previously have been demonstrated in numerous studies for a number of cancers, typically due to unequal access to care. As a result, the identification and elimination of these disparities has become a national public health priority.

"Colorectal cancer is the only gastrointestinal cancer that is routinely screened for and can be effectively treated, yet African-Americans still have a profoundly lower survival rate than Caucasians," said Timothy L. Fitzgerald, MD, FACS, associate professor, department of surgery, division of surgical oncology, East Carolina University in Greenville, NC. "Our analysis suggests that these disparities may be attributable to a lack of access to or use of care. It is imperative that screening and treatment are delivered equally to all patients."

East Carolina researchers used four years of population-based Medicare and Medicaid administrative claims merged with the Michigan Tumor Registry and identified data for 18,260 patients (≥66 years) with colorectal (n=13,001; 11.31 percent African-American), pancreatic (n=2,427; 14.38 percent African-American), gastric (n=1,739; 17.49 percent African-American) and esophageal (n=1,093; 13.50 percent African-American) cancer. Key data used in the analysis included likelihood of late-stage diagnosis, likelihood of surgical treatment after diagnosis, and survival.

In evaluating an unadjusted analyses, researchers discovered that African-American patients with colorectal cancer were more likely to present with metastatic disease (23.17 percent versus 14.75 percent Caucasians; p<0.05) and less likely to undergo operations (71.25 percent versus 79.05 percent; p<0.05), regardless of socioeconomic factors. This finding was the case even when the analysis was confined to patients with localized, surgically treatable diseases.

The median survival of African-Americans with colorectal cancer (39 months versus 56 months) and esophageal cancer (5 months versus 9 months) in the study was significantly less than that for Caucasians (p < 0.05). Survival was similarly poor for pancreatic and gastric cancer patients regardless of race.

In conducting a multivariate analysis, the research team found that African-American patients had a higher likelihood of dying from colorectal cancer than Caucasian patients did. However, this difference did not persist when adjustments were made for disease stage and presence or absence of a surgical procedure (hazard ratio = 1.15, 95% CI = 1.06 – 1.24). There was no association between survival and race for patients with esophagus, gastric or pancreatic cancer. Other variables of interest and statistical significance were median household income below $35,000, a dual eligibility insurance status and older age, all of which were negatively associated with colorectal cancer survival.