Inequality in colon cancer among different races: Reasons and strategies for intervention

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.