Inequalities in colorectal cancer among racial groups: Insights and actions for support
In the United States, racial disparities in colorectal cancer (CRC) incidence and mortality persist among Black Americans, Native Americans, and other racial groups. These disparities are primarily driven by a combination of socioeconomic factors, healthcare access barriers, systemic racism, and differences in cancer screening rates.
Limited Access to Healthcare and Screening
Barriers such as lack of insurance, fewer healthcare resources in communities, and logistical challenges in accessing care result in lower rates of CRC screening among Black Americans and Native Americans. Studies show that increasing screening rates, especially through programs like fecal immunochemical tests (FIT), significantly reduces incidence, mortality, and disparities by enabling early detection and removal of precancerous polyps.
Socioeconomic and Environmental Factors
Economic deprivation, lower educational attainment, and neighborhood-level disparities lead to poorer baseline health and delayed diagnosis. These factors correlate strongly with worse CRC survival outcomes among Black patients, as seen across different U.S. regions.
Systemic Racism and Discrimination
Long-standing racism contributes to chronic stress, mistrust in healthcare systems, and inequities in treatment quality, further exacerbating poor outcomes in Black and Native American populations beyond what genetics alone would explain.
Differences in Comorbidities
Higher prevalence of conditions like hypertension and chronic kidney disease in Black populations can complicate cancer treatment and survivorship, leading to worse CRC outcomes.
Regional Variations
Survival disparities vary geographically among Black patients, indicating that localized social determinants and healthcare infrastructure also play roles.
Impact of Comprehensive Screening Programs
Integrated and comprehensive screening initiatives that remove barriers such as in-person visits and proactively send screening kits have demonstrated drastic reductions in racial disparity, cutting incidence by about 30% and deaths by half among all racial groups.
Research Efforts and Screening Guidelines
Researchers are continuing to study factors affecting CRC mortality rates, particularly among Black Americans and Native Americans, to identify modifiable risk factors that may help reduce the burden of CRC among these groups. The U.S. Preventive Services Task Force has recently updated CRC screening guidelines to suggest that screening should begin at the age of 45 for everyone.
The American Cancer Society already advocates for earlier screening among people with an average risk of developing CRC, but this may not be sufficient for people at high risk. Researchers need to conduct further research into the exact causes of earlier CRC incidence and increased mortality among different races.
Raising Awareness and Addressing Factors
It is necessary to increase awareness of racial disparities in CRC within communities to encourage people to communicate their concerns to their doctors and undergo earlier screening. Tobacco use, alcohol use, and poor nutrition may be factors that contribute to the development of CRC in certain racial groups.
Black Americans have a higher incidence rate of CRC compared to White Americans, with the difference being at least 20%. The proximal colon, which refers to the beginning and middle sections of the colon, is disproportionately affected by CRC in Black Americans, making it harder for doctors to detect tumors.
Native Americans have the second highest rates of CRC incidence and mortality among U.S. racial groups, after Black Americans. Rates of CRC are rising, but fatality rates appear to be falling slightly. Around 65% of the racial disparities in CRC are due to environmental factors, with the remaining 35% being attributable to genetic factors.
In 2023, it is estimated that there will be more than 153,000 new cases of CRC and approximately 52,550 deaths. Black Americans are typically younger at the time of CRC diagnosis compared to White Americans, with median ages at diagnosis being 70 years for Black American females and 77 years for White American females, and 66 years for Black American males and 72 years for White American males.
CC rates are highest among Black Americans and Native Americans and are lowest among Asian and Pacific Islanders and Hispanic Americans. Earlier and more frequent screening may be necessary for people at high risk of developing CRC. Black Americans are twice as likely to receive a CRC diagnosis before the age of 50 compared to White Americans.
In conclusion, while genetic factors contribute minimally, it is the interplay of social determinants of health, inequitable access to CRC screening and quality treatment, and structural racism that largely drive the observed racial disparities in CRC incidence and mortality in the U.S. Efforts focusing on equitable access to preventive screening, addressing social determinants, and eliminating systemic barriers are critical to reducing these disparities.
- These disparities in colorectal cancer (CRC) among Black Americans, Native Americans, and other racial groups persist even in the American scientific community.
- Sleep patterns and sleep disorders might also have an impact on CRC incidence, given their connection to various biological processes.
- Workplace wellness programs can promote early detection and prevention by offering educational resources about CRC symptoms and screening methods.
- Medical conditions like diabetes and cardiovascular diseases could potentially be linked to an increased risk of CRC, making it essential to address chronic diseases and comorbidities.
- Respiratory conditions, such as chronic obstructive pulmonary disease (COPD) and asthma, might interfere with accurate CRC screening, necessitating supervision by healthcare professionals.
- Digestive health is closely related to CRC incidence, and certain digestive disorders may serve as indicators of CRC risk.
- Regular eye exams can help detect Early warning signs of CRC, emphasizing the importance of eye-health checks and screening programs.
- Hearing loss can lead to missed communication about CRC symptoms or screening opportunities, necessitating frequent hearing checks in the older population.
- Health and wellness encompasses various aspects of life, including physical health, mental health, and social support networks, all of which play a role in CRC outcomes.
- Fitness and exercise are key components of overall health and can reduce the risk of developing numerous medical conditions, including CRC.
- Sexual health matters can lead to late detection or impede communication about CRC symptoms, making it crucial to address barriers in accessing sexual healthcare services.
- Autoimmune disorders, like inflammatory bowel disease (IBD), might contribute to CRC development, highlighting the need for better understanding and treatment of these conditions.
- Climate change can indirectly affect CRC incidence by negatively impacting air quality, dietary choices, and access to healthcare resources.
- Mental health is an important aspect of overall well-being and can influence CRC outcomes through stress-related physiological responses and adherence to treatment regimens.
- Mens' health initiatives should focus on CRC prevention, early detection, and education to reduce racial disparities among men.
- Skin care is crucial for maintaining health and reducing the risk of various skin conditions that might serve as indicators of underlying medical issues, such as CRC.
- Therapies and treatments for CRC should prioritize minimally invasive, personalized, and effective approaches that cater to individual patients' needs.
- Nutrition is vital for maintaining good health, and certain dietary choices can influence the risk of CRC development.
- Aging is associated with an increased risk of CRC, and it is essential to address the unique healthcare needs of the aging population.
- Women's health includes various health issues specific to women, such as gynecological cancers and breast cancer, in addition to CRC.
- Parenting can sometimes interfere with CRC screenings due to logistic and emotional challenges, necessitating support and resources for parents.
- Weight management is crucial for maintaining overall health and can reduce the risk of CRC development for some racial groups.
- Cardiovascular health is vital for ensuring optimal CRC treatment outcomes, as heart disease can complicate cancer surgery and recovery.
- The healthcare and pharmaceutical industry play a significant role in CRC screening, treatment, and research efforts.
- Medicare should prioritize addressing racial disparities in CRC by providing equitable access to screening, treatment, and support services.
- CBD (cannabidiol) has shown potential in managing symptoms of CRC and other medical conditions, but more research is required.
- Neurological disorders, such as Alzheimer's disease and Parkinson's disease, could potentially affect CRC incidence and treatment outcomes due to their impact on cognitive function and mobility.
- Environmental science is vital for understanding and addressing factors contributing to CRC incidence, as environmental toxins and pollution can increase the risk.
- Financial management, including investments, wealth management, and personal finance, is essential for ensuring access to quality healthcare, treatments, and preventive screenings for all racial groups.
