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Black patients more likely to die of young-onset colorectal cancer
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Non-Hispanic black patients with young-onset colorectal cancer experienced poorer survival outcomes than their white counterparts, according to results of a SEER analysis.
Survival disparities persisted at all disease stages, including patients with early-stage disease, results showed.
Elena M. Stoffel
“It is well known that there are racial disparities in colorectal cancer incidence and survival in the United States, but the reason for these differences remains unclear,” Elena M. Stoffel, MD, MPH, assistant professor of internal medicine at University of Michigan Health System, told HemOnc Today. “We chose to look at survival among patients diagnosed before the age of 50 years because colorectal cancer incidence is rising among patients previously considered too young to be screened, and twice as many non-Hispanic black patients are being diagnosed at young ages.”
Stoffel and colleagues used the SEER database to identify 28,145 patients diagnosed with colorectal cancer between the ages of 20 years and 49 years, from 2000 to 2009.
Non-Hispanic white individuals comprised the majority of the cohort (n = 19,497), followed by non-Hispanic black individuals (n = 4,384) and Hispanic individuals (n = 4,264).
Approximately one-quarter of patients (n = 6,686) received their diagnosis before the age of 40 years, with Hispanic individuals more likely to be diagnosed at a younger age (median, 41.4 years) than non-Hispanic black individuals (median, 42.9 years) or non-Hispanic white individuals (median, 43 years; P < .001).
A significantly higher proportion of non-Hispanic black individuals (39.9%) presented with cancer in the proximal colon than non-Hispanic white individuals (30.3%) and Hispanic individuals (30.7%). Further, women comprised a greater number of the non-Hispanic black patient population (50.3%) than the non-Hispanic white cohort (45.8%) and Hispanic cohort (46.3%; P < .001).
Non-Hispanic black individuals were also more likely to present at an advanced disease stage (stage III or stage IV) and to have higher-grade tumors than their non-Hispanic white or Hispanic counterparts.
Researchers used survival data and proportional hazard models to compare stage-specific 5-year OS among racial groups.
Five-year OS rates were 54.9% among non-Hispanic black individuals, compared with 68.1% for non-Hispanic white individuals and 62.9% for Hispanic individuals (P < .001).
Results of analyses adjusted for age, sex, race, stage, county-level poverty and treatment history showed that compared with non-Hispanic white individuals, non-Hispanic black individuals had a significantly higher likelihood of cancer-specific death of colon cancer (HR = 1.35; 95% CI, 1.26-1.45) and rectal/rectosigmoid junction cancer (HR = 1.51; 95% CI, 1.37-1.68).
No significant survival differences persisted between non-Hispanic white individuals and Hispanic individuals.
The greatest racial disparities in cancer-specific survival occurred among non-Hispanic black individuals and non-Hispanic white individuals diagnosed with stage II cancers of the colon (HR = 1.69; 95% CI, 1.33-2.14) and stage III cancers of the rectum (HR = 1.98; 95% CI, 1.63-2.4).
The researchers acknowledged limitations of their study, including their inability to ascertain the influence of chemotherapy receipt, which SEER does not record. Further, they did not have access to data regarding comorbidities, environmental factors and family histories of colorectal cancer.
“Our findings prompt the question of whether colorectal cancers that develop in young patients may actually be more aggressive and more likely to benefit from adjuvant treatments that have demonstrated only marginal benefit in older patients,” Stoffel said. “It is clear that further study is needed to identify if and how colorectal cancer tumors that develop in young individuals differ from tumors in older patients. This will enable clinicians to personalize care by selecting the treatments that will be most effective.” – by Cameron Kelsall
For more information:
Elena M. Stoffel, MD, MPH, can be reached at estoffel@med.umich.edu.
Disclosure: The researchers report no relevant financial disclosures.
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