Bridging Behavior and Biology to Reduce Socioeconomic Disparities in Colorectal Cancer Risk

Abstract

During the last quarter of the 20th century, the incidence of colorectal cancer in the United States declined by 22%. Half of this decline has been attributed to changes in health behaviors, such as red meat consumption and physical activity, and the other half has been ascribed to increased screening with fecal occult blood testing, sigmoidoscopy, and colonoscopy (1). The declining incidence of colorectal cancer accelerated from 1999 to 2008 with average annual reductions of 2%–3% for both men and women (2), representing a shared accomplishment of public health and health care. These improvements, however, have been disproportionately concentrated among more educated and affluent Americans. In 2000, rates of obesity were higher and rates of colorectal cancer screening were substantially lower among adults with less education, as reported in the National Health Interview Survey (3). As a result, even though the overall incidence of colorectal cancer has declined in recent decades, socioeconomic disparities in colorectal cancer incidence remain substantial (4). Moreover, disparities in colorectal cancer mortality by education and race have actually increased since 1993 and thus represent a growing concern (5).