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Study: Screening rates affect racial disparity in CRC

Monday May 7, 2012
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Differences in screening account for more than 40% of the racial disparity in colorectal cancer incidence and nearly 20% of the disparity in colorectal cancer mortality, according to a study.

Differences in stage-specific survival, which likely reflect differences in treatment, account for an additional 35% of the black-white disparity in colorectal cancer mortality rates, the study found.

The study, which appeared April 18 on the website of Cancer Epidemiology, Biomarkers and Prevention, concluded that equal access to care could substantially reduce the racial disparities in CRC rates.

Previous studies have identified considerable disparities in CRC incidence and mortality rates between blacks and whites in the United States. For the new study, researchers led by Iris Lansdorp-Vogelaar, PhD, a visiting scientist at the American Cancer Society during the project and now with Erasmus Medical Center in The Netherlands, used a computer simulation model to apply the screening and survival rates seen among whites to the population of black Americans ages 50 and older. They compared those rates to actual, "observed" incidence and mortality rates in blacks to calculate how much of the existing racial disparities in CRC rates are attributable to differences in screening and/or stage-specific relative survival.

The researchers found that applying the screening pattern observed among whites to blacks would close the disparity gap in CRC incidence rates in people ages 50 and older from 28.2 to 16.4 cases per 100,000. Screening would decrease the mortality gap from 26.8 to 21.6 deaths per 100,000. If blacks had the stage-specific relative survival of whites, the disparity in CRC mortality rates would decrease even further, to 17.2 deaths per 100,000. When combined, the screening pattern and stage-specific relative CRC survival of whites would decrease disparity in CRC mortality to 12.4 deaths per 100,000.

The report found that differences in CRC screening explained 42% of the observed disparity in CRC incidence between blacks and whites and 19% of the disparity in CRC mortality. Stage-specific relative CRC survival differences explained 36% of the disparity in CRC mortality. Together, according to the study, differences in screening and survival explained 54% of disparity in CRC mortality. Equalizing access to care could substantially reduce the racial disparities in CRC burden, the authors concluded.

As for the remaining 46% to 58% of the disparity in CRC incidence and mortality, known or unknown lifestyle factors are the most likely candidates for the gap, according to the authors. Such factors include alcohol, smoking, obesity and meat consumption, which increase the risk of CRC, according to previous research, as well as physical activity and postmenopausal hormone replacement therapy (in women), which have been linked to a decreased risk.

To view the study data and access the study via subscription or purchase, visit http://bit.ly/IJqRYG.

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