Health-care delivery contributes to racial disparity in colorectal cancer
Colorectal Cancer Treatment and Race
African-Americans with health insurance still face worse outcomes in colorectal cancer than Caucasians, Hispanics, and Asians, according to a new study. Published in the February 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that differences in utilization of screening tests and surgical treatment may contribute to poorer colorectal cancer survival rates in African-Americans.
Colorectal cancer is preventable and even curable. Improvements in the sensitivity and specificity of screening tests and in treatment protocols have resulted in overall declines in mortality rates for colorectal cancer. However, studies have demonstrated and continue to show clear ethnic/racial differences in survival. African-Americans have the worst outcome of any ethnic/racial group, while Caucasians tend to fare worse than Asians. Access to healthcare is often cited as the cause of these disparities. In fact, studies show that, in general, people with health insurance are more likely to access preventive care than those without. However, the impact of health insurance and potential access has on colorectal cancer mortality by race has not been explored to date.
Led by Chyke A. Doubeni, M.D., M.P.H. of the University of Massachusetts Medical School and the Meyers Primary Care Institute in Worcester, MA, researchers from the National Cancer Institute-funded Cancer Research Network investigated the association between tumor stage and risk of death by race in colorectal cancer and factors related to ethnic/racial differences in a population of insured persons.
The authors found that African-Americans were more likely to have advanced disease and were at greatest risk of death compared to other ethnicities/races. Caucasians and Hispanics had similar cancer mortality risks, and Asians and Pacific Islanders were least likely to die of the cancer. In addition, African-Americans were less likely to receive surgical treatment for their tumors compared to Caucasians. The analysis demonstrated that earlier detection and higher utilization of surgery would each, independently, improve mortality risk.
"Despite the availability of health care insurance," the authors identified significant "racial differences in survival from colorectal cancer among patients receiving care from integrated health care systems." That the authors found earlier detection and surgery would improve African-American outcomes suggests "disparities may be due to racial differences in the receipt of cancer prevention, detection and treatment services." The authors recommended the implementation of standardized protocols for the delivery of cancer care services to vulnerable populations to reduce disparities.