Colorectal Cancer Disparities Research Articles

Disentangling Racial, Ethnic, and Socioeconomic Disparities in Treatment for Colorectal Cancer.

Colorectal cancer is curable if diagnosed early and treated properly. Black and Hispanic patients with colorectal cancer are more likely to experience treatment delays and/or receive lower standards of care. Socioeconomic deprivation may contribute to these disparities, but this has not been extensively quantified. We studied the interrelationship between patient race/ethnicity and neighborhood socioeconomic status (nSES) on receipt of timely appropriate treatment among patients with colorectal cancer in California. White, Black, and Hispanic patients (26,870) diagnosed with stage I-III colorectal cancer (2009-2013) in the California Cancer Registry were included. Logistic regression models were used to examine the association of race/ethnicity and nSES with three outcomes: undertreatment, >60-day treatment delay, and >90-day treatment delay. Joint effect models and mediation analysis were used to explore the interrelationships between race/ethnicity and nSES. Hispanics and Blacks were at increased risk for undertreatment [Black OR = 1.39; 95% confidence interval (CI) = 1.23-1.57; Hispanic OR = 1.17; 95% CI = 1.08-1.27] and treatment delay (Black/60-day OR = 1.78; 95% CI = 1.57-2.02; Hispanic/60-day OR = 1.50; 95% CI = 1.38-1.64) compared with Whites. Of the total effect (OR = 1.15; 95% CI = 1.07-1.24) of non-white race on undertreatment, 45.71% was explained by nSES. Lower nSES patients of any race were at substantially higher risk for undertreatment and treatment delay, and racial/ethnic disparities are reduced or eliminated among non-white patients living in the highest SES neighborhoods. Racial and ethnic disparities persisted after accounting for neighborhood socioeconomic status, and between the two, race/ethnicity explained a larger portion of the total effects. This research improves our understanding of how socioeconomic deprivation contributes to racial/ethnic disparities in colorectal cancer.

Role of Stress-Survival Pathways and Transcriptomic Alterations in Progression of Colorectal Cancer: A Health Disparities Perspective.

Every year, more than a million individuals are diagnosed with colorectal cancer (CRC) across the world. Certain lifestyle and genetic factors are known to drive the high incidence and mortality rates in some groups of individuals. The presence of enormous amounts of reactive oxygen species is implicated for the on-set and carcinogenesis, and oxidant scavengers are thought to be important in CRC therapy. In this review, we focus on the ethnicity-based CRC disparities in the U.S., the negative effects of oxidative stress and apoptosis, and gene regulation in CRC carcinogenesis. We also highlight the use of antioxidants for CRC treatment, along with screening for certain regulatory genetic elements and oxidative stress indicators as potential biomarkers to determine the CRC risk and progression.

Effects of culturally targeted message framing on colorectal cancer screening among African Americans.

This study examined how standard and culturally targeted versions of gain and loss-framed messaging affect African Americans' colorectal cancer (CRC) screening receptivity and behavior, as well as their anticipation of experiencing racism in undertaking CRC screening. Screening-deficient African Americans (N = 457) viewed an informational video about CRC risks, prevention, and screening and were randomized to receive a gain or loss-framed message about screening. Half of participants viewed an additional culturally targeted message about overcoming racial disparities in CRC by obtaining screening. Using the Theory of Planned Behavior, we measured general receptivity to CRC screening. We also measured arousal of anticipatory racism in response to messaging. Finally, we offered participants a no-cost fecal immunochemical testing kit (FIT Kit) and measured uptake and use. Message framing interacted with culturally targeted messaging to affect CRC screening receptivity and behavior. Participants were no more receptive to CRC screening when standard loss-framing was used, but were more favorable if loss-framing was culturally targeted. Targeted loss-framing also reduced anticipatory racism, which partially mediated effects on screening receptivity. Finally, although participants least often accepted a FIT Kit with standard loss-framing, effects of messaging on FIT Kit uptake and use were not significant. This study adds to growing recognition of important cultural nuance in effective use of message framing. Current finding also suggest that targeted and framed messaging could synergistically impact the extent to which African Americans engage in CRC screening, although specific impacts on FIT Kit screening are less certain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Disparities in Early-Onset Colorectal Cancer.

The incidence and mortality of early-onset colorectal cancer (CRC) are increasing in the United States (US) and worldwide. In the US, there are notable disparities in early-onset CRC burden by race/ethnicity and geography. African Americans, Hispanic/Latinos, and populations residing in specific regions of the Southern U.S. are disproportionately affected with CRC diagnosed at younger ages, while less is known about disparities in other countries. Reasons for these disparities are likely multi-factorial and potentially implicate differences in health determinants including biology/genetics, diet/environment, individual health behaviors, and access to high-quality health services, as well as social and policy factors. This review summarizes current understanding of early-onset CRC disparities and identifies specific research areas that will inform evidence-based interventions at individual, practice, and policy levels to reduce the global burden of this disease.

Gut instinct: a call to study the biology of early-onset colorectal cancer disparities.

Colorectal cancer (CRC) incidence among individuals age younger than 50 years continues to rise with etiologies unknown. Synchronously, early-onset CRC disparities have grown more pronounced. As translational research across diverse populations has been limited, we advocate for mechanistic studies that address this challenge to mitigate CRC disparities among young adults. The incidence of early-onset colorectal cancer (EOCRC) continues to rise and disproportionately affects people of African descent. This Comment advocates for mechanistic studies that can help mitigate EOCRC disparities.

Racial/ethnic disparities in early-onset colorectal cancer: implications for a racial/ethnic-specific screening strategy.

IntroductionEarly‐onset colorectal cancer (EO‐CRC) is a public health concern. Starting screening at 45 years has been considered, but there is discrepancy in the recommendations. Racial disparities in EO‐CRC incidence and survival are reported; however, racial/ethnic differences in EO‐CRC features that could inform a racial/ethnic‐tailored CRC screening strategy have not been reported. We compared features and survival among Non‐Hispanic White (NHW), Non‐Hispanic Black (NHB), and Hispanics with EO‐CRC.MethodsCRC patients from SEER 1973–2010 database were identified, and EO‐CRC was defined as CRC at <50 years. Clinical/pathological features and survival were compared between NHW, NHB, and Hispanics. Cancer‐specific survival (CSS) predictors were assessed in a multivariable Cox proportional hazard model.ResultsOf 166,416 patients with CRC, 16,545 (9.9%) had EO‐CRC. The EO‐CRC frequencies in NHB and Hispanics were higher than NHW (12.7% vs. 16.5% vs. 8.7%, p < 0.001). EO‐CRC in NHB presents more frequently in females, with well/moderately differentiated, stage IV, and is less likely to present in locations targetable by sigmoidoscopy than NHW (54.6% vs. 67.7% OR:1.7, 95% p < 0.001). 5‐year CSS was lower in NHB (59.4% vs. 72.8%, HR: 1.7; 95% CI: 1.54–1.82) and Hispanics (66.4% vs. 72.8%, HR: 1.3; 95% CI: 1.16–1.39) than NHW. A regression model among patients with EO‐CRC showed that being NHB or Hispanic were independent predictors for cancer‐specific mortality, after adjusting for gender, grade, stage, and surgery.ConclusionEO‐CRC is more likely in NHB and Hispanics. Racial disparities in clinical/pathological features and CSS between NHB and NHW/Hispanics were evidenced. A racial/ethnic specific screening strategy could be considered as an alternative for patients younger than 50 years.

A National Study of Colorectal Cancer Survivorship Disparities: A Latent Class Analysis Using SEER (Surveillance, Epidemiology, and End Results) Registries.

Introduction: Long–standing disparities in colorectal cancer (CRC) outcomes and survival between Whites and Blacks have been observed. A person–centered approach using latent class analysis (LCA) is a novel methodology to assess and address CRC health disparities. LCA can overcome statistical challenges from subgroup analyses that would normally impede variable–centered analyses like regression. Aim was to identify risk profiles and differences in malignant CRC survivorship outcomes.Methods: We conducted an LCA on the Surveillance, Epidemiology, and End Results data from 1975 to 2016 for adults ≥18 (N = 525,245). Sociodemographics used were age, sex/gender, marital status, race, and ethnicity (Hispanic/Latinos) and stage at diagnosis. To select the best fitting model, we employed a comparative approach comparing sample-size adjusted BIC and entropy; which indicates a good separation of classes.Results: A four–class solution with an entropy of 0.72 was identified as: lowest survivorship, medium-low, medium-high, and highest survivorship. The lowest survivorship class (26% of sample) with a mean survival rate of 53 months had the highest conditional probabilities of being 76–85 years–old at diagnosis, female, widowed, and non-Hispanic White, with a high likelihood with localized staging. The highest survivorship class (53% of sample) with a mean survival rate of 92 months had the highest likelihood of being married, male with localized staging, and a high likelihood of being non-Hispanic White.Conclusion: The use of a person–centered measure with population-based cancer registries data can help better detect cancer risk subgroups that may otherwise be overlooked.

Racial ethnic disparities in clinical/pathological features, treatment, and survival among patients with early-onset colorectal cancer.

21 Background: Globally, the incidence of early-onset colorectal cancer has risen. Racial disparities in colorectal cancer (CRC) are well-described, however data in EO by race/ethnicity is lacking. We aim to compare the presenting features, treatment, and survival features of patients with metastatic early-onset CRC (EO). Methods: Patients with metastatic CRC diagnosed between 2010-2019 at two NYC hospitals were identified by tumor registry (n = 646). Clinical/pathological features, treatment and survival data was collected by chart review and compared between Non-Hispanic Whites (NHW), Non-Hispanic Blacks (NHB) and Hispanics (H) using Chi-square or Fisher’s exact test. Kaplan Meier curves were plotted to compare overall survival (OS) among groups. Stata v15 was used for statistical analysis. Results: Of 646 CRC patients, 126 (21.5%) were NHW, NHB or H diagnosed with EO with a frequency ranging from 16.6% in NHW to 26.1% in H. Non statistically significant lower frequencies of male gender, low/moderate grade, left-sided tumors,and higher frequency of KRAS mutations were seen in NHB (Table). Metastectomy was performed in 20 patients (13.9%) and did not differ between groups. There was no difference in the use of chemotherapy or biologics in general (Table), but NHW were more likely to get cetuximab than NHB (OR:4.5, p = 0.02) and H (OR:4.7, p = 0.02).There were no differences in median OS (1.8 vs. 2.2 vs. 2 years, p = 0.9)or 1-year OS (72% vs 72.3% vs 70.8%) in NHW, NHB and H, respectively. A lower 5-year OS was seen in NBH (14.5%) and Hispanics (24.4%) compared to NHW (44%). Conclusions: EO-CRC is more frequently seen in minority racial/ethnic groups. Despite no differences in the use of chemotherapy or biologic treatment in general, NHB have a lower 5-year survival rate compared to NHW and H. [Table: see text]

Racial and ethnic disparities in colorectal cancer incidence and mortality.

The occurrence of colorectal cancer (CRC) shows a large disparity among recognized races and ethnicities in the U.S., with Black Americans demonstrating the highest incidence and mortality from this disease. Contributors for the observed CRC disparity appear to be multifactorial and consequential that may be initiated by structured societal issues (e.g., low socioeconomic status and lack of adequate health insurance) that facilitate abnormal environmental factors (through use of tobacco and alcohol, and poor diet composition that modifies one's metabolism, microbiome and local immune microenvironment) and trigger cancer-specific immune and genetic changes (e.g., localized inflammation and somatic driver gene mutations). Mitigating the disparity by prevention through CRC screening has been demonstrated; this has not been adequately shown once CRC has developed. Acquiring additional knowledge into the science behind the observed disparity will inform approaches towards abating both the incidence and mortality of CRC between U.S. racial and ethnic groups.

Racial and Ethnic Disparities in Germline Genetic Testing of Patients With Young-Onset Colorectal Cancer

Up to 20% of younger patients (age <50 years) diagnosed with colorectal cancer (CRC) have germline mutations in cancer susceptibility genes. Germline genetic testing may guide clinical management and facilitate earlier intervention in affected relatives. Few studies have characterized differences in genetic testing by race/ethnicity. We identified young adults (age 18-49 years) diagnosed with CRC between 2009 and 2017 in 2 health systems in Dallas, TX. We evaluated referral to genetic counseling, attendance at genetic counseling appointments, and receipt of germline genetic testing by race/ethnicity. Of 385 patients with young-onset CRC (median age at diagnosis 44.4 years), 176 (45.7%) were Hispanic, 98 (25.4%) non-Hispanic Black, and 111 (28.8%) non-Hispanic White. Most patients (76.9%) received immunohistochemistry (IHC) for mismatch repair proteins, and there was no difference in receipt of IHC by race/ethnicity. However, a lower proportion of Black patients were referred to genetic counseling (50.0% vs White patients 54.1% vs Hispanic patients 65.9%; P = .02) and attended genetic counseling appointments (61.2% vs 81.7% White patients vs 86.2% Hispanic patients; P < .01). Of 141 patients receiving genetic testing, 38 (27.0%) had a pathogenic or likely pathogenic variant in a cancer susceptibility gene. An additional 33 patients (23.4%) had variants of uncertain significance, of which 84.8% occurred in racial/ethnic minorities. In a diverse population of patients diagnosed with young-onset CRC, we observed racial/ethnic differences in referral to and receipt of germline genetic testing. Our findings underscore the importance of universal genetic testing to address racial/ethnic disparities in young-onset CRC.

Community Health Behaviors and Geographic Variation in Early-Onset Colorectal Cancer Survival Among Women.

INTRODUCTION:Despite overall reductions in colorectal cancer (CRC) morbidity and mortality, survival disparities by sex persist among young patients (age <50 years). Our study sought to quantify variance in early-onset CRC survival accounted for by individual/community-level characteristics among a population-based cohort of US women.METHODS:Geographic hot spots—counties with high early-onset CRC mortality rates among women—were derived using 3 geospatial autocorrelation approaches with Centers for Disease Control and Prevention national mortality data. We identified women (age: 15–49 years) diagnosed with CRC from 1999 to 2016 in the National Institutes of Health/National Cancer Institute's Surveillance, Epidemiology, and End Results program. Patterns of community health behaviors by hot spot classification were assessed by Spearman correlation (ρ). Generalized R2 values were used to evaluate variance in survival attributed to individual/community-level features.RESULTS:Approximately 1 in every 16 contiguous US counties identified as hot spots (191 of 3,108), and 52.9% of hot spot counties (n = 101) were located in the South. Among 28,790 women with early-onset CRC, 13.7% of cases (n = 3,954) resided in hot spot counties. Physical inactivity and fertility were community health behaviors that modestly correlated with hot spot residence among women with early-onset CRC (ρ = 0.21 and ρ = −0.23, respectively; P < 0.01). Together, individual/community-level features accounted for distinct variance patterns in early-onset CRC survival among women (hot spot counties: 33.8%; non–hot spot counties: 34.1%).DISCUSSION:Individual/community-level features accounted for approximately one-third of variation in early-onset CRC survival among women and differed between hot spot vs non–hot spot counties. Understanding the impact of community health behaviors—particularly in regions with high early-onset CRC mortality rates—is critical for tailoring strategies to reduce early-onset CRC disparities.

Abstract PO-018: How to improve health equity and colorectal cancer awareness: A Community Health Educator initiative

Abstract Purpose: Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. As part of the NIH NCI’s long-term outreach and education plan to provide education and increase awareness about cancer risk reduction, the National Outreach Network Community Health Educator (NON-CHE) program was established to reach underserved areas through strong community partnerships. The NON-CHE project identified barriers to CRC screening and implemented the Screen 2 Save (S2S), a national initiative, to increase community knowledge, awareness, and engagement activities. In this study, we assessed the impact of this initiative in rural and underserved communities. Methods: Descriptive and comparative analyses were used to examine the role of the NON-CHE on CRC knowledge and CRC screening intent. Participants included the Massey Cancer Center (MCC) catchment area where 170 surveys were collected from rural and underserved communities. Data included demographics, participants’ current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to participants’ survey scores for CRC knowledge. All analyses were done in R 3.5.2. Results: NON-CHE engaged 441 participants in rural and underserved communities. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p=0.007) more questions on average. After the NON-CHE intervention, this difference was not statistically significant. The difference in participants’ CRC knowledge had an overall mean of 0.92, with a standard deviation of 2.56. Female participants exhibited significantly higher CRC knowledge after controlling for the effect of other demographic variables (p = 0.004). Female study participants also had significantly higher differences between their CRC knowledge scores, exhibiting an average gain in CRC knowledge of 1.08 questions higher than men (p = 0.043). Older participants also tended to demonstrate less improvement – specifically, a one-year increase in participant age corresponded to an adjusted average decrease in improvement of 0.02 questions. Greater than 95% of participants agreed that S2S sessions impacted their intent to get screened for CRC. Conclusions: The NON-CHE facilitated community connections and increased awareness of CRC risk reduction, screening, treatment, and research. Such programs should be considered as mechanisms that increase the knowledge, awareness, and engagement of rural and underserved communities. Equity of access to health information and the health care system can be achieved with precision population health strategies. The NON-CHE combined with S2S is a powerful way to engage rural and underserved communities and impact participants’ intent to “Get Screened”. Citation Format: Michael A. Preston, Debbie Cadet, Rachel Hunley, Reuben Retnam, Sarah Arezo, Vanessa B. Sheppard. How to improve health equity and colorectal cancer awareness: A Community Health Educator initiative [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-018.

Abstract PO-253: Increasing colorectal cancer screening in rural underserved communities with multilevel interventions: Formative evaluation of accelerating colorectal cancer screening and follow-up through implementation science in Appalachia

Abstract Background: Colorectal cancer (CRC) screening is lower in Appalachian regions of Kentucky and Ohio than in their non-Appalachian counterparts, with lower screening contributing to increased CRC incidence and mortality. To address CRC disparities in these underserved regions, researchers from the University of Kentucky and The Ohio State University partnered with two federally qualified health centers (FQHCs) to develop and implement multilevel interventions (MLIs) during year one of a 5-year National Cancer Institute funded Cancer Moonshot project to increase CRC screening and follow-up in Appalachian Kentucky and Ohio. Methods: Drawing from the Model for the Analysis of Population Health and Health Disparities and using a social determinants of health framework, researchers selected and partnered with Community Advisory Boards (CAB) to guide project formation in two Appalachian counties, one in Kentucky and one in Ohio. These formative activities included creating community profiles, conducting key informant interviews with clinic and community champions, and completing data inventories to assess clinic capacity, ultimately resulting in two primary care clinics being selected for pilot year implementation activities. Results: Key informant interviews revealed barriers to CRC screening at multiple levels: patient (e.g., fear of screening results), provider (e.g., competing priorities), clinic (e.g., lack of reminder or tracking systems), and community (e.g., cultural norms). Clinic champions were provided with menus of evidence-based interventions (EBIs) to address barriers at each level and were encouraged to select locally relevant, implementable EBIs. Clinics chose to implement the following EBIs: improved patient education materials (patient-level), additional provider education (provider-level), improvement of electronic health record (EHR) reporting and creation of clinic-wide screening protocols (clinic-level), and provision of interactive screening education at community events (community- level). Conclusion: Results from pilot year activities were used to refine the project approach for years two through five. Project activities will be expanded to 10 more Appalachian counties in Kentucky and Ohio using a design wherein counties will be paired by participating clinic patient volume. As in pilot year activities, clinic/community champions will be encouraged to select EBIs appropriate to their patients, providers, clinics, and communities. To measure clinical outcomes, self- reported screening will be monitored using data from county-wide telephone surveys with additional data from clinic EHRs. Using an MLI approach may be well- received in underserved rural Appalachian communities and may ultimately be successful at reducing CRC screening disparities. Citation Format: Aaron J. Kruse-Diehr, Jill M. Oliveri, Mira L. Katz, Mark Cromo, Robin C. Vanderpool, Michael L. Pennell, Darrell M. Gray II, Paul L. Reiter, Bin Huang, Gregory S. Young, Darla Fickle, Melinda Rogers, David Gross, Sue Russell, Electra D. Paskett, Mark Dignan. Increasing colorectal cancer screening in rural underserved communities with multilevel interventions: Formative evaluation of accelerating colorectal cancer screening and follow-up through implementation science in Appalachia [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-253.

Patterns of Early-Onset Colorectal Cancer Among Nigerians and African Americans.

PURPOSEColorectal cancer (CRC) incidence rates are increasing among individuals < 50 years of age (early-onset CRC) globally with causes unknown. Racial/ethnic disparities in early-onset CRC have also grown more pronounced, because Black individuals have higher early-onset CRC incidence and poorer survival compared with White individuals. We describe the prevalence and burden of early-onset CRC among Africans in Nigeria and African Americans (AAs) in the United States.PATIENTS AND METHODSWe identified Black individuals diagnosed with a first primary CRC ages 18 to 49 years between 1989 and 2017 at Ahmadu Bello University Teaching Hospital in Zaria, Nigeria (Nigerians), and in the United States (AAs) using the National Institutes of Health/National Cancer Institute’s SEER program of cancer registries. Multivariable logistic regression models were used to investigate clinical and demographic differences between Nigerians and AAs with early-onset CRC, adjusted for age, sex, tumor site, and histology.RESULTSA total of 5,019 Black individuals were diagnosed with early-onset CRC over the study period (379 Nigerians; 4,640 AAs). Overall, approximately one third of young Black patients were diagnosed with rectal tumors (35.8%). Nigerian individuals with early-onset CRC were eight-fold more likely to be diagnosed with rectal tumors (odds ratio [OR], 8.14; 95% CI, 6.23 to 10.62; P < .0001) and more likely to be diagnosed at younger ages (OR, 0.87; 95% CI, 0.86 to 0.89; P < .0001) compared with young African Americans in adjusted models.CONCLUSIONCompared with AA individuals diagnosed with early-onset CRC, Nigerian individuals harbor distinct features of early-onset CRC. Additional investigation of the histopathologic and biologic heterogeneity of early-onset CRCs among Black individuals is critical for understanding racial disparities in susceptibility and outcomes, which may have implications for tailored early-onset CRC prevention, detection, and treatment strategies.

Rural-urban and racial/ethnic trends and disparities in early-onset and average-onset colorectal cancer.

Incidence rates (IRs) of early-onset colorectal cancer (EOCRC) are increasing, whereas average-onset colorectal cancer (AOCRC) rates are decreasing. However, rural-urban and racial/ethnic differences in trends by age have not been explored. The objective of this study was to examine joint rural-urban and racial/ethnic trends and disparities in EOCRC and AOCRC IRs. Surveillance, Epidemiology, and End Results data on the incidence of EOCRC (age, 20-49 years) and AOCRC (age, ≥50 years) were analyzed. Annual percent changes (APCs) in trends between 2000 and 2016 were calculated jointly by rurality and race/ethnicity. IRs and rate ratios were calculated for 2012-2016 by rurality, race/ethnicity, sex, and subsite. EOCRC IRs increased 35% from 10.44 to 14.09 per 100,000 in rural populations (APC, 2.09; P < .05) and nearly 20% from 9.37 to 11.20 per 100,000 in urban populations (APC, 1.26; P < .05). AOCRC rates decreased among both rural and urban populations, but the magnitude of improvement was greater in urban populations. EOCRC increased among non-Hispanic White (NHW) populations, although rural non-Hispanic Black (NHB) trends were stable. Between 2012 and 2016, EOCRC IRs were higher among all rural populations in comparison with urban populations, including NHW, NHB, and American Indian/Alaska Native populations. By sex, rural NHB women had the highest EOCRC IRs across subgroup comparisons, and this was driven primarily by colon cancer IRs 62% higher than those of their urban peers. EOCRC IRs increased in rural and urban populations, but the increase was greater in rural populations. NHB and American Indian/Alaska Native populations had particularly notable rural-urban disparities. Future research should examine the etiology of these trends.

Race, Ethnicity, and Socioeconomic Status Are Associated With Prolonged Time to Treatment After a Diagnosis of Colorectal Cancer: A Large Population-Based Study

Race, Ethnicity, and Socioeconomic Status Are Associated With Prolonged Time to Treatment After a Diagnosis of Colorectal Cancer: A Large Population-Based Study

S0215 Gender and Racial Disparities in Colorectal Cancer Incidence and Survival: A Population-Based Study

INTRODUCTION: Colorectal cancer (CRC) is the third common cause of cancer death in the US. The incidence of CRC is higher in minority racial and ethnic groups. Traditionally, CRC has had a higher mortality rate in men when compared to women. However, studies assessing trends among sex and racial groups on the incidence and mortality of CRC is lacking. We aim to investigate disparities in CRC by reviewing a large national cancer registry. METHODS: This is a retrospective cross-sectional study of the Surveillance, Epidemiology and End Results Registry (SEER) of individuals aged 45–79 years from 2000 to 2017. Race was classified as White, Black, American Indian/Alaska Native, and Asian or Pacific Islander. Annual percent change (APC) and incidence risk ratios (IRR) were calculated for sex and race. Kaplan-Meier estimations and log-rank tests were used to evaluate cancer-specific survival outcomes. Statistical significance was set at P < 0.05. RESULTS: Among 690,450 patients, there were 512,285 patients age 45–79 years diagnosed with CRC from 2000 to 2017. A higher proportion of patients had distal tumors versus proximal tumors (62% vs 38%, P < 0.001). SEER summary staging showed that most tumors were localized (40%) compared to regional (35%), distant cancer (20%), and unknown (4%). Approximately 23% of tumors on presentation occurred in the rectum (n = 114,873), followed by 21% in the sigmoid (102,850), 14% in the cecum (70,084), 12% in the ascending colon (n = 60,227), and 29.5% other locations. During the study period, the incidence of CRC decreased for both males and females, respectively (APC −2.14 vs −1.81). Amongst all racial groups, African American showed the least decline in incidence of CRC. African American females showed the highest risk for CRC (IRR 1.34; 95% CI 1.32–1.36, P < 0.001) compared to other females or males from different racial groups [Figure 1]. Subgroup analysis using Kaplan Meier estimations showed that African American females had the poorest 5-year survival rate (56%) compared to White females (66%), American Indian/Alaska Native females (58%), and Asian or Pacific Islander females (66%). Among males, American Indian/Alaska Natives had the poorest 5-year survival (54%) compared to African American males (61%), White males (66%), and Asian or Pacific Islander males (66%). CONCLUSION: Overall, the incidence of colorectal cancer is declining. However, the incidence of CRC remains highest in African Americans females who are also burden with poor survival rates.Figure 1.: Forest plot for Incidence Rate Ratios (IRR) for colorectal cancer (CRC) based on gender and race/ethnicity.Table 1.: One through 5-year survival rates based on gender and race/ethnicity.

Changes in the quality of care of colorectal cancer in Estonia: a population-based high-resolution study

ObjectivesLarge disparities in colorectal cancer (CRC) management and survival have been observed across Europe. Despite recent increases, the survival deficit of Estonian patients with CRC persists, particularly for rectal cancer....

S3118 Patient Language Does Not Affect Access to Colonoscopy but Did Reduce Quality of Prep at an Academic Medical Center

INTRODUCTION: Disparities in colorectal cancer (CRC) screening continues to exist for minority groups in the US. Some studies have suggested that improved communication between patients and providers leads to increased rates of CRC screening. In this study, we examined whether language plays a role in scheduling colonoscopies and or the quality of colonoscopy preparation in a rural based primary care setting that serves as a safety net for Central Virginia. METHODS: We performed a single center review of all colonoscopy case requests (n = 1266) from an academic primary care clinic from March 2018 to February 2020. We categorized patients as English (n = 1062) or non-English speaking (n = 204) and then evaluated whether patients were scheduled for procedure, the time from request to scheduled case, whether the case was completed, and the quality of prep. The quality of the prep was categorized as adequate or inadequate from the endoscopy report. Cases that were not scheduled were grouped into reasons for why they were not scheduled. Statistical comparisons were performed using Chi-square test between the two groups. RESULTS: There were 1266 case requests and 711 were scheduled (56%). For English speakers there were 589 scheduled cases (589/1062, 55%) and 465 completed (465/589, 79%). For non-English speakers there were 122 scheduled cases (122/204, 60%) and 105 completed (105/122, 86%). The average time to completed case was 82 days for English speakers and 80 days for non-English speakers. The quality of prep for English speakers was adequate in 410 cases (410/465, 88%). The quality of prep for non-English speakers was adequate in 85 cases (85/105, 81%). When English speaking patients were compared to non-English speaking patients there was reduced quality of prep (P = 0.04), but not scheduling (P = 0.25) or completed cases (P = 0.07) (Table 1). CONCLUSION: Studies have suggested that improved communication between patient and provider may lead to increased CRC screening rates. Our study suggests that the language a patient speaks may play a role in prep adequacy, with fewer adequate preps found in non-English speakers. Patient language does not seem to affect scheduling, completed cases or time to completed case. Analysis of the reasons for not scheduling a colonoscopy showed that the most common reason was the inability to be reached by phone (Table 2). Further studies are needed to evaluate whether patient-provider language plays a role in access to colonoscopy and prep adequacy.Table 1.: Scheduled Colonoscopies, Completed Cases, Days to Complete Case, and Quality of Prep in English and Non-English Speaking PatientsTable 2.: Reasons for Unsuccessful Scheduling of Colonoscopies in All Patients

From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology

From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology