State Disparities in Colorectal Cancer Mortality Patterns in the United States

Abstract

Background: Colorectal cancer (CRC) mortality rates have been decreasing for many decades in the United States, with the decrease accelerating in the most recent time period. The extent to which this decrease varies across states and its influence on the geographic patterns of rates is unknown.Methods: We analyzed the temporal trend in age-standardized CRC death rates for each state from 1990 to 2007 using joinpoint regression. We also examined the change in death rates between 1990-1994 and 2003-2007 using rate ratios with 95% confidence intervals and illustrated the change in pattern using maps. The relationship between the change in mortality rates and CRC screening rates for 2004 by state was examined using Pearson's correlation.Results: CRC mortality rates significantly decreased in all states except Mississippi between 1990 and 2007 based on the joinpoint model. The decrease in death rates between 1990-1994 and 2003-2007 ranged from 9% in Alabama to greater than 33% in Massachusetts, Rhode Island, New York, and Alaska; Mississippi and Wyoming showed no significant decrease. Generally, the northeastern states showed the largest decreases, whereas southern states showed the smallest decreases. The highest CRC mortality rates shifted from the northeastern states during 1990 to 1994 to the southern states along the Appalachian corridor during 2003 to 2007. The decrease in CRC mortality rates by state correlated strongly with uptake of screening (r ¼ À0.65, P < 0.0001).Conclusions: Progress in reducing CRC mortality varies across states, with the Northeast showing the most progress and the South showing the least progress.Impact: These findings highlight the need for wider dissemination of CRC screening. Cancer Epidemiol Biomarkers Prev; 20(7); 1296-302. Ó2011 AACR.

Patient–Provider Discussions about Colorectal Cancer Screening: Who Initiates Elements of Informed Decision Making?

“…This was counted as a patient to provider interaction mortality in the U.S. 1,3 Unfortunately, CRC disparities exist among minority and low-income populations partially due to lower CRC screening rates. 31 To reduce CRC disparities, it is imperative to increase CRC screening rates among underserved populations.…”

“…[1][2][3] Certain segments of the population, however, have not benefitted equally from screening and continue to have elevated CRC incidence and mortality rates. 1,3 The U.S. Preventative Services Task Force (USPSTF) recommends routine screening for CRC by the fecal occult blood test (FOBT), sigmoidoscopy, or colonoscopy for average-risk adults ages 50 to 75. 4 These CRC screening tests, however, are associated with different risks, benefits, and need to be completed at different frequencies causing confusion for some patients.…”

Colorectal Cancer Trends in California and the Need for Greater Screening of Hispanic Men

“…34 In several states with large Hispanic populations, rates of CRC have declined faster among whites, who now have lower CRC incidence and mortality than Hispanic men. 35 Despite these similarities, California's Hispanic population differs from the rest of the U.S. in several ways: California has a larger proportion of Hispanics of Mexican descent, a higher proportion born outside the United States, and a higher proportion speaking a language other than English at home. Tailoring interventions to the needs of these specific groups will be important in creating effective CRC prevention strategies.…”

DNA Methylation

“…As we mentioned previously, several types of aberration in DNA methylation and in the proteins involved in DNA methylation occur in cancer: hypermethylation of tumour suppressor genes, aberrant expression of DNMT1 and other DNMTs, and hypomethylation of unique genes and repetitive sequences [110,111]. Silencing of tumour suppressor genes by DNA methylation provides a powerful molecular mechanism by which DNA methylation can trigger cancer, and also provides a rationale for therapeutics aimed at inhibition of DNA methylation and re-expression of silenced tumour suppressor genes.…”