The higher incidence and mortality from colorectal cancer among African Americans compared with Whites may be due to differences in health care utilization rather than differences in susceptibility to cancer, according to a study published in the Journal of the National Cancer Institute.
Despite an overall decrease in colorectal cancer incidence and death in recent decades, disease rates in African Americans have remained high compared with Whites. Incidence rates of colorectal cancer are almost 20% higher among African Americans, and death rates are 50% higher. These racial disparities raise two major questions: Are African Americans genetically predisposed to greater risk for the disease? Or are differences in healthcare access and utilization of services responsible?
To explore the possible causes of racial disparity in colorectal cancer incidence and mortality, researchers evaluated colorectal cancer screening outcomes and follow-up diagnostic testing among 57,561 White patients and 3,011 African-American patients. All patients underwent screening for colorectal cancer with flexible sigmoidoscopy (FSG).
- Among the patients who had abnormal results with FSG screening, more White patients than African-American patients (72% versus 63%) had a follow-up diagnostic colonoscopy within one year of the FSG screening.
- Rates of FSG-detected colorectal abnormalities did not differ significantly by race.
The researchers concluded that, given the disparities observed between Whites and African Americans in follow-up testing but not in rates of colorectal abnormalities, it appears that use of healthcare servicesâand not biological differencesâmay explain the higher rates of colorectal cancer incidence and mortality among African Americans. Further understanding and resolution of racial disparities in healthcare access and utilization are an important step in reducing disease rates; such measures can make way for effective, widespread screening and treatment of abnormalities.
Ayanian JZ. Racial Disparities in Outcomes of Colorectal Cancer Screening: Biology or Barriers to Optimal Care? Journal of the National Cancer Institute [early online publication]. March 31, 2010.
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