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Cited by 201Colorectal Cancer Screening and DetectionGlobal Cancer Incidence and ScreeningHealth disparities and outcomes

Eliminating racial disparities in colorectal cancer in the real world: It took a village

Open access
Grubbs, Stephen S., Polite, Blase N., Carney, John, Bowser, William, Rogers, Jill, Katurakes, Nora, Hess, Paula, Paskett, Electra D.·2013·Journal of Clinical Oncology
DOI 10.1200/jco.2012.47.8412PMC PMC3661932
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Abstract

Colorectal cancer (CRC) is the third most common cancer in the United States, with more than 102,000 new patients diagnosed per year. 1 It is, however, one of the few cancers that is highly preventable through the use of routine screening, 2 which can also prevent death resulting from CRC. 3,4 CRC is also one cancer that continues to demonstrate widening incidence and survival disparities between whites and African Americans.1,5 Although the reasons for these disparities are multifactorial, advanced stage at diagnosis may explain up to 50% of the survival disparity.6 This reality is not unique to CRC.Those who are poor, underserved, or minorities are more likely to get cancer and die as a result of it than those who are rich or white.This is a fact, and it is the current reality of cancer care in the United States, as documented in thousands of peer-reviewed articles, including the focus of an Institute of Medicine report.6a The shame for CRC is that the higher incidence rates and advanced stage of diagnosis are likely affected by differences in screening rates between whites and racial and ethnic minority populations.Multiple studies have documented lower rates of up-to-date screening among minority patients as well as lower rates of screening with colonoscopy.[7][8][9][10][11] Other studies have also found lower rates of follow-up for abnormalities detected on screening among minorities.12 Lack of insurance and usual sources of care certainly contribute to these disparities, but even when screening is universally provided, such as in the Medicare program, screening rates and follow-up after abnormal findings are still lower among African Americans compared with whites.7,13,14 Several randomized trials have demonstrated that provision of CRC screening combined with outreach efforts can significantly increase CRC screening rates among minority populations.[15][16][17][18][19] Moreover, patient navigation can increase the proportion of patients who receive appropriate and timely follow-up for abnormalities and facilitate the timely start of treatment.[20][21][22] In Journal of Clinical Oncology, Robbins et al 23 reported on a study that identified disparities in CRC mortality rates among African American patients with late-stage disease.In an editorial, Paskett 24 suggested three steps to reduce CRC disparities: one, increase CRC

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  • The Delaware CRC program produced cost savings: the annual bill was $7 million and annual savings from reduced CRC incidence were $8.5 million.

    “The annual bill for the screening and treatment program was $7 million but the annual savings from reduced incidence of CRC was $8.5 million.”

    From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [59]

  • In Delaware, the mortality gap was almost eliminated by 2009, with a mortality decline of 42% for blacks and 13% for whites.

    “The mortality gap was almost eliminated by 2009 with a mortality decline of 42% for blacks and 13% for whites.”

    From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [59]

  • A statewide colorectal cancer initiative in Delaware illustrates that a concerted effort can produce striking changes in a relatively short time.

    “A statewide colorectal cancer (CRC) initiative in the state of Delaware illustrates that a concerted effort can produce striking changes in a relatively short time [59].”

    From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [59]

  • By 2009, colonoscopy screening rates in Delaware had increased by 54% for blacks and 29% for whites, and the racial gap in screening was eliminated.

    “By 2009, colonoscopy screening rates had increased by 54% for blacks and 29% for whites and the racial gap in screening was eliminated.”

    From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [59]

  • In Delaware, a 34% decline in CRC incidence for African Americans and a 26% decline for whites led to equalization of incidence rates.

    “Similarly, a 34% decline in CRC incidence for African Americans and a 26% decline for whites led to the equalization of the incidence rates.”

    From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [59]

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Authors
Grubbs, S. S., Polite, B. N., Carney, J., Bowser, W., Rogers, J., Katurakes, N., Hess, P., & Paskett, E. D.
Affiliations
  • Delaware Cancer Consortium, Dover; and Helen F. Graham Cancer Center, Newark, DE
  • The University of Chicago, Chicago, IL
  • United States House of Representatives (US)
  • Delaware Cancer Consortium, Dover, DE
  • Delaware Division of Public Health (US)
  • The Ohio State University (US)
ORCID
Venue
Journal of Clinical Oncology
Publisher
American Society of Clinical Oncology (ASCO)
Published
2013-06-01
Volume
31
Issue
16
Pages
1928-1930
ISSN
  • 0732-183X (ISSN-L)
  • 1527-7755
DOI
10.1200/jco.2012.47.8412
PMC
PMC3661932
OpenAlex
W2131142429
Cited by
201
References
31
Citations by year
2026: 5 · 2025: 22 · 2024: 28 · 2023: 18 · 2022: 18 · 2021: 12 · 2020: 11 · 2019: 17 · 2018: 7 · 2017: 8 · 2016: 15 · 2015: 19 · 2014: 18 · 2013: 3
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Oncology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Cancer Institute (P30CA016058)
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Social Sciences › Health › Health disparities and outcomes
Keywords
colorectal cancer, racial disparities, African Americans, colorectal cancer screening, patient navigation, screening outreach, colonoscopy, delayed diagnosis, health disparities, underserved populations
MeSH terms
Black or African American, Female, Humans, Male, Colorectal Neoplasms, White People, Healthcare Disparities

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