African Americans Have Fewer Colorectal Cancer Specialists

Ruzanna Harutyunyan's picture

The higher the number of African Americans in a U.S. county, the lower the number of specialists who diagnose and treat colorectal cancer.

That’s according to University of Michigan’s Awori J. Hayanga, M.D., M.P.H., who, with colleagues, analyzed data from the 2004 version of the Area Resource File, a nationwide database of health care, economic and demographic information.

The database is derived from a variety of sources and comprises data from all 3,219 counties in the United States.

“What is significant about this is that the Federal government has set out a plan to eliminate disparities in healthcare access by 2010,” Hayanga says, noting that it would realistically take much longer. “The structure of healthcare varies from county to county. Some counties have much more than they need and others have much less than they need. There is a geographical hurdle that has to be overcome and it has to do with the way racial groups are clustered.”

The report, which appears in the June issue of Archives of Surgery, one of the Journal of the American Medical Association/Archives journals, shows that each percentage point increase in the African American population in a county appears to be associated with a decrease in the number of specialists within that county who diagnose and treat the condition.

In contrast, counties with a higher percentage of Asian Americans appear to have more colorectal cancer specialists.

Despite overall declines in incidence of and death from colorectal cancer in the general U.S. population, African Americans are more likely than other patients to die of the disease, according researchers.

“Minority groups have poor access to quality health care services,” according to the report. “This is true of colorectal cancer care and may be related to both geographical proximity and use of surgical, gastroenterology and radiation oncology services.”


Without suitable access, many minority patients may have advanced colorectal cancer and be less likely to receive appropriate drug therapies used to prevent cancer recurrence.

Analysis by researchers showed a statistically significant decrease in the number of gastroenterologists and radiation oncologists with each percent increase in African American population and a decrease in colorectal surgeons in a given county.

Previous research indicates that African Americans are about 20 percent less likely to undergo colonoscopy compared with other races, and even those who have first-degree relatives with colorectal cancer have a decreased likelihood of undergoing recommended screenings.

Disparities have also been reported in the receipt of drug therapies, including radiotherapy and chemotherapy, the researchers say.

Not using diagnostic and drug therapies could be connected to the significant distances that African Americans must travel to seek these services, plausibly outside their residential counties. This may serve as an impediment to seeking these services despite the best intentions of referring physicians and surgeons, according to the report.

Access to diagnostic and to drug therapies is central to timely screening, diagnosis, follow-up therapy and surveillance. Without it, longer-term survival may never be improved and disparities never equalized.

Separate research by Hayanga, published in the June issue of the Journal of the American College of Surgeons, reveals that segregation decreases access to surgical care in African Americans and Hispanics.

This study looked at data from 3,219 U.S. counties categorized as least segregated, moderately segregated or most segregated. In counties with the highest levels of segregation, an increase in the African-American or Hispanic population was associated with a decrease in the availability and use of surgical services and an increase in the number of emergency room visits.

In the most segregated counties, each percentage point increase in Hispanic or African-American population was associated with a decrease in outpatient surgery volume, ambulatory surgical facilities and number of general surgeons.