Colorectal cancer (CRC) is the third most common cancer in the United States, with more than 102,000 new patients diagnosed per year. 1 It is, however, one of the few cancers that is highly preventable through the use of routine screening, 2 which can also prevent death resulting from CRC. 3,4 CRC is also one cancer that continues to demonstrate widening incidence and survival disparities between whites and African Americans. 1,5 Although the reasons for these disparities are multifactorial, advanced stage at diagnosis may explain up to 50% of the survival disparity. 6 This reality is not unique to CRC. Those who are poor, underserved, or minorities are more likely to get cancer and die as a result of it than those who are rich or white. This is a fact, and it is the current reality of cancer care in the United States, as documented in thousands of peer-reviewed articles, including the focus of an Institute of Medicine report. 6a The shame for CRC is that the higher incidence rates and advanced stage of diagnosis are likely affected by differences in screening rates between whites and racial and ethnic minority populations. Multiple studies have documented lower rates of up-to-date screening among minority patients as well as lower rates of screening with colonoscopy. 7-11 Other studies have also found lower rates of follow-up for abnormalities detected on screening among minorities. 12 Lack of insurance and usual sources of care certainly contribute to these disparities, but even when screening is universally provided, such as in the Medicare program, screening rates and follow-up after abnormal findings are still lower among African Americans compared with whites. 7,13,14 Several randomized trials have demonstrated that provision of CRC screening combined with outreach efforts can significantly increase CRC screening rates among minority populations. 15-19 Moreover, patient navigation can increase the proportion of patients who receive appropriate and timely follow-up for abnormalities and facilitate the timely start of treatment. 20-22 In Journal of Clinical Oncology, Robbins et al 23 reported on a study that identified disparities in CRC mortality rates among African American patients with late-stage disease. In an editorial, Paskett 24 suggested three steps to reduce CRC disparities: one, increase CRC
A DEATH RATE depends on the living and the dead. Generally, a cause-specific death rate is calculated by dividing the total number of deaths for a particular unit of time by the total population and multiplying by 100,000. The statistic obtained as a result of this calculation indicates how many people would die in each group of 100,000. This death rate, then, is the result of a division process in which the dividend is made up completely of the dead, and the divisor (the total population) is composed of the living.In the following discussion, we consider the effect that each of these components has on a death rate in general and, in particular, how the makeup of the total population is of great consequence in considering death rates in West Virginia. We then consider in particular, and by illustration, the trends in six major cancer death rates in West Virginia. We hope that this procedure, in addition to shedding light on the cancer situation in West Virginia, will also indicate the usefulness of adjusted rates in making comparisons where it is desirable to limit the effect of variables such as age, sex, and race.
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