Toward the Elimination of Colorectal Cancer Disparities Among African Americans

Abstract

Background In the USA, race and socioeconomic status are well-known factors associated with colorectal cancer incidence and mortality rates. These are higher among blacks than whites and other racial/ethnic groups. Methods In this article, we review opportunities to address disparities in colorectal cancer incidence, mortality, and survivorship among African Americans. Results First, we summarize the primary prevention of colorectal cancer and recent advances in the early detection of the disease and disparities in screening. Then, we consider black-white disparities in colorectal cancer treatment and survival including factors that may contribute to such disparities and the important roles played by cultural competency, patient trust in one’s physician, and health literacy in addressing colorectal cancer disparities, including the need for studies involving the use of colorectal cancer patient navigators who are culturally competent. Conclusion To reduce these disparities, intervention efforts should focus on providing high-quality screening and treatment for colorectal cancer and on educating African Americans about the value of diet, weight control, screening, and treatment. Organized approaches for delivering colorectal cancer screening should be accompanied by programs and policies that provide access to diagnostic follow-up and treatment for underserved populations.

Colorectal cancer statistics, 2017

“…incidence is attributed to a higher prevalence of risk factors, such as obesity, unhealthy diet, and smoking, 26 while differences in screening are estimated to account for 40% of the racial disparity. 27 The larger mortality disparity reflects inequities in comorbidities, access to care and treatment, 28 and perhaps delayed follow-up of screendetected abnormalities. 29 It is important to recognize that the burden of CRC varies greatly within the broadly defined racial/ethnic groups presented in Figure 1.…”

Relating Stool Microbial Metabolite Levels, Inflammatory Markers and Dietary Behaviors to Screening Colonoscopy Findings in a Racially/Ethnically Diverse Patient Population

“…Colorectal cancer (CRC) is the third leading cause of cancer death overall in the United States [ 1 ]. CRC incidence and death rates vary by race/ethnicity; African Americans (AA) suffer the greatest incidence and mortality rate and are diagnosed at later stages than other racial/ethnic groups in the US, despite comparable screening rates [ 2 , 3 ]. Further, the magnitude of disparity for mortality is twice as high as that for incidence between non-Hispanic African Americans and non-Hispanic Whites [ 2 ].…”

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient‐provider communication

“…5,6 Although CRC screening is a critical tool in combating CRC, the receipt of CRC screening remains low, especially among vulnerable and underserved populations. [7][8][9][10] A lack of access to health care, insurance coverage, urban and rural disparities, and low education and income levels are important sociodemographic risk factors affecting the receipt of CRC screening. [11][12][13] In addition, lower screening rates and late-stage diagnoses contribute to increased disease prevalence and mortality among racial and ethnic minority groups in comparison with non-Hispanic whites.…”

“…[11][12][13] In addition, lower screening rates and late-stage diagnoses contribute to increased disease prevalence and mortality among racial and ethnic minority groups in comparison with non-Hispanic whites. 7,14 Beyond sociodemographic disparities, factors associated with the receipt of CRC screening include a patient's personal belief in his or her individual risk for CRC, a patient's reliance on physicians for screening recommendations, and a patient's adherence to physician recommendations and understanding of the value of prevention. [15][16][17] Moreover, high-quality patient-provider communication can influence a patient's willingness to follow through with CRC screening.…”