Black patients ‘not caught up’ to whites in early-onset CRC survival over 20-year period
SAN DIEGO — Five-year relative survival for early-onset colorectal cancer improved over a 20-year period only among white patients, with no improvements for Black, Asian or Hispanic patients, per data at Digestive Disease Week 2022.
“Our most stunning finding was that even over a 20-year span, Blacks had not caught up to whites in surviving early-onset CRC,” Timothy A. Zaki, MD, an internal medicine resident at the University of Texas Southwestern Medical Center, said in a press release. “Survival for Blacks diagnosed from 2003 to 2013 remained even lower than for whites diagnosed a decade earlier.”
To assess disparities in cancer survival among a diverse population of patients, Zaki and colleagues used the National Cancer Institute’s Surveillance, Epidemiology and End Results program of cancer registries to identify patients with newly diagnosed early-onset CRC (n = 33,777) between January 1, 1992, and December 31, 2013.
For each racial and ethnic group — including non-Hispanic white (58.5%), non-Hispanic Black (14%), non-Hispanic Asian or Pacific Islander (13%) and Hispanic (14.5%) —researchers calculated 5-year relative survival, overall and by sex, tumor site and stage at diagnosis. To demonstrate temporal trends, they juxtaposed 5-year relative survival in 1992 to 2002 vs. 2003 to 2013 and used Cox proportional hazards regression models to examine any links between race and ethnicity and all-cause mortality, adjusting for age at diagnosis, sex, tumor site and stage at diagnosis.
According to study results, 5-year relative survival ranged from 69.1% for white patients to 57.6% for Black patients, and relative survival over the 20-year period improved only for white patients, without any improvement for Black, Asian or Hispanic patients.
“Our study’s identification of disparities among younger Hispanic and Asian adults adds to existing literature,” Zaki said in the release. “However, we lack information, such as what treatment these individuals received, that could help explain the disparities, so we are still left with the question of why they exist.”
Researchers further observed that survival for Black patients diagnosed in 2003 to 2013 (59.3%; 95% CI, 57.3-61.3) was lower than survival for whites diagnosed in 1992 to 2002 (66.6%; 95% CI, 65.6-67.6), with a similar pattern for sex, tumor site and stage at diagnosis.
Zaki and colleagues also determined that survival was lowest for Black men (56.5%; 95% CI, 54.4-58.6) and highest for white women (70.6%; 95% CI, 69.6-71.5), lowest for Blacks with proximal colon tumors (55.3%; 95% CI, 52.8-57.7) and highest for whites with rectal tumors (72.2%; 95% CI, 71.2-73.2) and lowest for Blacks with distant stage disease (13.1%; 95% CI, 11.4-15.0).
In adjusted analysis, researchers found that being Black (adjusted HR = 1.42; 95% CI, 1.36-1.49), Asian (aHR = 1.06; 95% CI, 1.01-1.12) or Hispanic (aHR = 1.16; 95% CI, 1.10-1.21) was associated with all-cause mortality.
“With recommendations now that CRC screening start at age 45 vs. 50, one concern is whether health disparities will worsen as a result,” Zaki said in the release. “If more are screened who have the means and inclination to do so — but we fail to make progress in other populations — we could see these gaps widening.”
Collapse
Zaki TA. Abstract 895. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
Read more about