Racial Disparity in Colorectal Cancer Related to Healthcare Utilization

A new study has found that black patients who underwent flexible sigmoidoscopy were less likely to schedule recommended follow-up colonoscopy than white patients, which may lead to higher rates of colorectal cancer (CC) mortality.

Researchers at Howard University (Washington, DC, USA) reviewed the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) screening trial to explore the origins of racial disparities in CC. In all, data from 57,561 white patients and 3,011 black patients (ages 55 to 74) that underwent flexible sigmoidoscopy without biopsy were included. Polyps or mass lesions were found in 25.5% of blacks and 23.9% of whites; all were advised to get a follow-up colonoscopy, which was not paid for by the trial. Of those, 72.4% of whites and 62.6% of blacks had a colonoscopy within one year.

The study investigators reviewed the results and found no significant difference between the races in the prevalence of polyps, advanced adenomas, advanced pathology in small adenomas, or CC. After adjustment for age, education, sex, body mass index, smoking, family history of CC, colon examination within the previous three years, personal history of polyps, and screening center, blacks were 12% less likely to have a colonoscopy. There were no other significant differences based on race in the characteristics of the lesions found during colonoscopy. The study was published in the April 21, 2010, issue of the Journal of the National Cancer Institute.

"This suggests that the biology of colorectal cancer may not be materially different by race, at least in the early stages of carcinogenesis, but instead that healthcare utilization differences among the races may play a more important role in the observed disparities in colorectal cancer,” concluded lead author Adeyinka Laiyemo, M.D., M.P.H., and colleagues of the division of gastroenterology. "A lack of knowledge of cancer prevention may contribute to low uptake of diagnostic testing, and lack of cultural competence on the part of care providers may also constitute a barrier to healthcare utilization.”

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