Decreased colorectal cancer incidence and mortality in a diverse urban population with increased colonoscopy screening

Jennifer J Brown,Jared Striplin,Ann Zauber,Sidney J Winawer,David Greenwald,Justin M List,Olivia Weng,Charles K Asumeng,Matthew Weissman,Shannon M Farley

doi:10.1186/s12889-021-11330-6

Abstract

BackgroundAlthough colorectal cancer screening has contributed to decreased incidence and mortality, disparities are present by race/ethnicity. The Citywide Colon Cancer Control Coalition (C5) and NYC Department of Health and Mental Hygiene (DOHMH) promoted screening colonoscopy from 2003 on, and hypothesized future reductions in CRC incidence, mortality and racial/ethnic disparities.MethodsWe assessed annual percent change (APC) in NYC CRC incidence, stage and mortality rates through 2016 in a longitudinal cross-sectional study of NY State Cancer Registry, NYC Vital Statistics, and NYC Community Health Survey (CHS) data. Linear regression tested associations between CRC mortality rates and risk factors.ResultsOverall CRC incidence rates from 2000 decreased 2.8% yearly from 54.1 to 37.3/100,000 population in 2016, and mortality rates from 2003 decreased 2.9% yearly from 21.0 to 13.9 in 2016 at similar rates for all racial/ethnic groups. Local stage disease decreased overall with a transient increase from 2002 to 2007. In 2016, CRC incidence was higher among Blacks (42.5 per 100,000) than Whites (38.0), Latinos (31.7) and Asians (30.0). In 2016, Blacks had higher mortality rates (17.9), than Whites (15.2), Latinos (10.4) and Asians (8.8). In 2016, colonoscopy rates among Blacks were 72.2%, Latinos 71.1%, Whites 67.2%, and Asians, 60.9%. CRC mortality rates varied by neighborhood and were independently associated with Black race, CRC risk factors and access to care.ConclusionsIn a diverse urban population, a citywide campaign to increase screening colonoscopy was associated with decreased incidence and mortality among all ethnic/racial groups. Higher CRC burden among the Black population demonstrate more interventions are needed to improve equity.

Highlights

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer death for men and women in the U.S [1] Incidence rates fell 2.4% yearly, as did mortality rates, 2.2% yearly over 2007– 2016 [2]
New York City (NYC) CRC incidence and stage at diagnosis trends Age-adjusted incidence of cases for all CRC stages combined in NYC declined significantly from 2000 to 2016, from 57.5 to 37.3 per 100,000 population, (APC = − 2.79, p < 0.0001; n = 65,550), Fig. 1
In 2016, CRC incidence per 100,000 was significantly higher among Blacks, at 42.5 than Whites 38.0, Latinos 31.7 and Asian/Pacific Islander (Asian) 30.0

Summary

Introduction

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer death for men and women in the U.S [1] Incidence rates fell 2.4% yearly, as did mortality rates, 2.2% yearly over 2007– 2016 [2]. Detection and prevention have contributed to decreases in CRC incidence and mortality. A community-based screening program in California, utilizing annual FIT and colonoscopy, achieved greater than 80% participation, with associated reductions in CRC incidence, mortality and advanced stage disease [16]. A population-based FIT screening program in Italy was associated with lower mortality rates, while incidence peaked during the introduction of the program and returned to baseline [9]. Colorectal cancer screening has contributed to decreased incidence and mortality, disparities are present by race/ethnicity. The Citywide Colon Cancer Control Coalition (C5) and NYC Department of Health and Mental Hygiene (DOHMH) promoted screening colonoscopy from 2003 on, and hypothesized future reductions in CRC incidence, mortality and racial/ethnic disparities

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Conclusion