Racial Disparities in Incidence of Young-Onset Colorectal Cancer and Patient Survival

Abstract

From 1992-1996 [ ] to 2010-2014 [ ], increases in young-onset colorectal cancer have been largely due to increases in rectal cancer, especially in whites. In the most time recent period, blacks and whites have similar incidence and survival of rectal cancer, a sharp contrast to the striking disparities in colon cancer. 1 1.5 2 2.5 3 3.5 4 4.5 5 30 40 50 60 70 80 90 100 Whites, rectum Blacks, rectum Whites, distal colon Blacks, distal colon Whites, proximal colon Blacks, proximal colon Incidence per 100,000 Five-year relative survival (%) See editorial on page 858. BACKGROUND & AIMS: Increasing rates of young-onset colorectal cancer (CRC) have attracted substantial research and media attention, but we know little about racial disparities among younger adults with CRC. We examined racial disparities in young-onset CRC by comparing CRC incidence and relative survival among younger (<50-year-old) adults in 2 time periods. METHODS: Using data from the Surveillance, Epidemiology, and End Results program of cancer registries, we estimated CRC incidence rates (per 100,000 persons 20-49 years old) from 1992 through 2014 for different periods (1992-1996 vs 2010-2014) and races (white vs black). Relative survival was calculated as the ratio of observed survival to expected survival in a comparable cancer-free population. RESULTS: From 1992-1996 to 2010-2014, CRC incidence increased from 7.5 to 11.0 per 100,000 in white individuals and from 11.7 to 12.7 per 100,000 in black individuals. The increase in rectal cancer was larger in whites (from 2.7 to 4.5 per 100,000) than in blacks (from 3.4 to 4.0 per 100,000); in the 2010-2014 period, blacks and whites had similar rates of rectal cancer. Compared with whites, blacks had smaller increases in relative survival with proximal colon cancer but larger increases in survival with rectal cancer (from 55.3% to 70.8%). CONCLUSION: In an analysis of the Surveillance, Epidemiology, and End Results database, we found racial disparities in incidence of young-onset CRC and patient survival for cancer of the colon but minimal difference for rectal cancer. Well-documented and recent increases in young-onset CRC have largely been due to increases in rectal cancer, especially in whites.

A Summary of the Fight Colorectal Cancer Working Meeting: Exploring Risk Factors and Etiology of Sporadic Early-Age Onset Colorectal Cancer

“…Increasing rates of rectal (vs proximal colon) cancer have largely driven increasing incidence of early-onset CRC, particularly among whites. 7 Rectal cancer increased by 80% from the early 1990s through 2015 (from 2.6 to 4.7 per 100,000), 3,5 compared with an increase of about 40% in colon cancer. Differences in incidence by anatomic subsite Figure 1.…”

Rising and Falling Trends in Incidence Rates of Vulvar and Vaginal Cancers in the United States, 2000-2016

“…To the best of our knowledge, previous studies have not taken these features into account when evaluating the incidence and survival rates of these two cancers. Racial disparities of incidence and survival rates were well documented in several common carcinomas such as malignant meningioma, hepatocellular carcinoma, uterine corpus carcinoma, prostate carcinoma, and pancreatic carcinoma (6)(7)(8)(9)(10)(11). However, little is known about the racial disparities in the incidence and survival rates of vulvar and vaginal carcinomas.…”

Differential Immune Signatures in the Tumor Microenvironment are Associated with Colorectal Cancer Racial Disparities: A Cohort Study of Biorepository Data

“…However, CRC racial health disparity remains profound despite improved CRC screening in AA patients. (3)(4)(5)(6)(7)(8) Growing evidence has demonstrated that CRC in AAs has unfavorable tumor biology. A 2018 study by Sineshaw and colleagues using the National Cancer Database found that while access to care and tumor stage accounted for three quarters of the AA-EA survival disparity in patients under 65, fully 25% of the survival difference remains unexplained by these factors suggesting that tumor biology and immune factors may play a role in this disparity.…”