Colorectal Cancer on the U.S.-Mexico Border: An Epidemiological Study in an Indigent Hispanic Population

Abstract

Introduction: The incidence of colorectal cancer (CRC) in the US has declined, largely attributed to the advent of CRC screening programs. The decreasing trend is observed in Non-Hispanic Whites, Blacks, and Hispanics. However, close analysis of the trends demonstrates that the decline in CRC rate among Hispanics is less than other races / ethnicities. The burden of CRC in Hispanics deserves further attention to better understand the disease and explore strategies to change future trends. We conducted the current study to investigate the patterns of CRC incidence at University Medical Center (UMC), a public hospital that serves the indigent population of El Paso, Texas - a city on the US-Mexico border with a population of 840,410 and composed of 82.2 % Hispanics. Furthermore, we analyzed cancer databases, Texas Cancer Registry (TCR) and Surveillance, Epidemiology, and End Results (SEER), to detect disparities in CRC incidence. Methods: Medical records of patients diagnosed with CRC between January 1, 2000, to December 31, 2016, at UMC were analyzed. Furthermore, we performed a retrospective analysis of TCR and SEER to detect disparities in CRC incidence. Results: From 2000 to 2016, 911 patients with colon cancer were treated at UMC. Mean age at the time of diagnosis was 59.7 [Range 17 - 96 years old]. Of these, 804 (88.3%) were Hispanic. At the time of diagnosis, 157 (19.5 %) Hispanic patients were < 50 years of age. In Hispanics, < 50 years of age, the overall trend of CRC incidence rate per 100,000 county population remained stable, while there was an upward trend in those ≥ 50 years (Figure 1). Based on cancer databases, there was an increase in CRC rate among Hispanic males in El Paso, TX (Table 1). Also, Hispanic males ≥ 50 years in El Paso, TX have a higher rate of CRC than Hispanics residing elsewhere in the US (Table 2). TCR data demonstrates that 9.2 %, 13.8 %, and 16.7 % of Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics, respectively, were < 50 years of age at the time of diagnoses (p < 0.05).311_A Figure 1 No Caption available.Conclusion: Our study unveils a significant disparity in CRC incidence among Hispanics living in El Paso, TX. While the incidence of CRC is decreasing in the US, there is an upward trend in CRC incidence rate among Hispanic males in El Paso TX. Moreover, there is a higher rate of CRC in Hispanics < 50 years of age treated at UMC as compared to the rest of the state. Socioeconomic, genetic, and cultural / lifestyle factors are likely contributing to these disparities.311_B Figure 2 No Caption available.