Burden of Colorectal Cancer Mortality Shifts to Poor

A significant proportion of deaths due to colorectal cancer in southern states, and half of deaths due to colorectal cancer nationwide are a result of racial/ethnic, socioeconomic, and geographic disparities, according to the results of a study published recently in the Journal of Clinical Oncology.

“The clinical implication of our findings is that the majority of colorectal deaths in the United States could be avoided by changing behaviors (quitting smoking, maintaining a healthy body weight, and adopting a physically active lifestyle), and by undergoing regular screening,” study author Ahmedin Jemal, DVM, PhD, of the American Cancer Society told Cancer Network. “But this requires a health care system that ensures that health care providers counsel their patients on these behaviors and recommend colorectal cancer screening to all eligible patients.”

According to Jemal, eliminating health disparity-including colorectal cancer-between subpopulations is an overarching goal of the Healthy People 2020 goal, as well as the American Cancer Society. The Affordable Care Act was designed to address this inequality by improving access to quality healthcare to all populations.

In this study, Jemal and colleagues calculated age-standardized colorectal cancer death rates for three educational categories, by race/ethnicity, and by state among individuals aged 25 to 64 years from 2008 to 2010. In addition, they calculated the proportion of premature death due to colorectal cancer that could be avoided.

Results of the study showed that in almost every state, individuals with the least education had significantly higher colorectal cancer death rates for each racial/ethnic group compared with those individuals with the most education.

“Compared to persons with 16 years of education or more, persons with 12 years of education or less had a disproportionately higher burden of colorectal cancer mortality regardless of their race and residence,” Jemal said.

One example given by the researchers was that rate ratios ranged from 1.15 in Delaware to 3.18 in New Mexico among white individuals and from 0.84 in Mississippi to 2.41 in Virginia among blacks.

The researchers calculated that if the lowest death rates of the most educated whites were applied nationwide, more than half of premature deaths from colorectal cancer-7,690 deaths-could have been avoided.

“In addition, we found large state variations in colorectal cancer mortality rates, with rates significantly higher in the southern states than in the northeastern states,” Jemal said.

In these southern states, as much as 60% to 70% of premature deaths could potentially be avoided.