Dec. 15, 2008 -- Despite "unprecedented" progress in reducing both the incidence and death rates of colorectal cancer, the gap between African-Americans and whites is still widening, the American Cancer Society says in a new report.
Death rates for colorectal cancer are about 45% higher in African-Americans than in whites, says the report, Colorectal Cancer Facts &amp; Figures 2008-2010, the second edition of a study issued in 2005.
Progress in early diagnosis can be attributed to greater efforts to spread the word in the African-American community that the disease can be detected early and cured, Durado Brooks, MD, director of prostate and colorectal cancer for the American Cancer Society, tells WebMD.
"Screening rates among African-Americans lag significantly behind whites," says Brooks. "There are multiple factors. Some of it is related to knowledge and attitude about colorectal cancer. There are access issues, particularly if you are uninsured or underinsured. And some people believe if it's found, it's an automatic death sentence. But it's not."
He says that if the cancer is found early enough, the five-year survival rate is 90%, but that drops to 10% if the disease is detected later.
"The ACS has advertising focused on the African-American community," Brooks tells WebMD. ''We have partnered with the National Medical Association, the largest African-American physicians' group, to actively promote discussion of this on the front lines."
Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the U.S., the study says.
The ACS estimates that 148,810 people will be diagnosed with colorectal cancer this year and 49,960 people will die of the disease.
Although incidence and mortality rates continue to decrease in both blacks and whites, the rates are still higher and declines have been slower among blacks, the study shows. What's more, differences in incidence and mortality between African-Americans and whites have grown since the last report was published.
In that report, the incidence rate in white men was 63.1 per 100,000, compared to 72.9 in African-American men. In the current report, the incidence rate in white men is 58.9 per 100,000, versus 71.2 among African-American men.
The report says that:
- 91% of new cases and 94% of deaths occur in people 50 and older.
- The incidence rate is 14 times higher in adults 50 and older than in people under 50.
- Colorectal cancer incidence and death rates are 35% higher in men than in women, possibly attributable to a higher frequency of abdominal obesity, smoking, and drinking in men, as well as hormonal differences.
- Colorectal cancer incidence rates are more than 20% higher for African-Americans than whites, and death rates 45% higher.
"We've made remarkable progress in reducing death and suffering from colorectal cancer," says Elizabeth Fontham, MPH, DrPH, of Louisiana State University, who is the national volunteer president of the ACS. "But as this report shows, there's more work to be done to ensure all Americans have access to" tests for detecting the disease very early or even preventing it.
Scientists still aren't completely certain they know all the reasons why the racial disparity exists, Brooks says.
"Something to keep in mind is that African-Americans have been hearing for years they have highest rates for cancers, bad this, bad that," Brooks says. "It's important to make the point that African-American colorectal cancer and incidence rates and death rates are falling and have been falling for over a decade. They are being screened at much higher rates. There is a question whether or not there may be some biologic differences that we don't have a clear explanation for."
He says "lifestyle issues may be involved, as well as obesity," but no one yet knows for sure. It's likely, Brooks adds, that the disparity between blacks and whites can be attributed to screening patterns and cultural differences in attitudes.
Brooks says many people put off or avoid colonoscopies, which he calls the "gold standard" of screening, because of the high cost and the requirement for people to cleanse their bowels before procedures. But there are other less invasive and uncomfortable methods doctors can use, he says.
"We will narrow the gap," Brooks says. "We need to get African-Americans screened early at rates at least as high as their white counterparts."