Colorectal Cancer Disparities in USA: “We Should Be Embarrassed”

What You Need to Know: Lack of education, regardless of race or ethnicity, is the most important factor linked to disparities in mortality rates from colorectal cancer in the United States.

Background: It has long been known that there are disparities in mortality rates from colorectal cancer (CRC) between educated white and uneducated black populations in the United States. The study, led by Ahmedin Jemal, PhD, from the American Cancer Society in Atlanta, looked at the rate of death from CRC in people younger than 65 years (i.e., premature death) in each of the 50 states from 2008 to 2010. The researchers classified CRC patients 25 to 64 years of age by level of education (12 years or fewer, 13 to 15 years, and 16 years or more), race/ethnicity, and state.

Results:

They found there were significantly more premature CRC deaths in states with the lowest education levels than in those with higher levels. In fact, rates of premature death decreased with increased years of education, regardless of race or ethnicity.

  • In the white population, Delaware had the fewest premature CRC deaths, but even in that state, the rate was 15% higher in the least-educated than in the most-educated people (rate ratio [RR], 1.15; 95% confidence interval [CI], 0.66 – 2.01). New Mexico had the most premature CRC deaths; the rate was 3-fold higher in the least-educated than in the most educated people (RR, 3.18; 95% CI, 2.01 – 5.05).
  • In the black population, rate ratios ranged from 0.84 (95% CI, 0.54 – 1.30) in Mississippi to 2.41 (95% CI, 1.62 – 3.59) in Virginia. New York had the lowest death rate (12.9%) among those with the lowest level of education.
  • Blaise Polite, MD, MPP of the University of Chicago expressed this view in an editorial: “The major finding from this study…remains unaltered: If you are black or have low educational attainment, where you live in the United States determines how likely you are to die as a result of colorectal cancer. That is an experiment that has to end in the 21st-century United States.”

My Take: We should be embarrassed. Between 2008 and 2010, more than 23,000 deaths from colon cancer, 50% of the total, could have been prevented if all states had colon cancer equal to the five states with the lowest rates for the most educated whites. An equally important point is the variation among the states; 69% of deaths could have been prevented in Mississippi, compared with only 29% in Utah. While lifestyle factors no doubt contribute to disparities, access to colonoscopy is a key component to reducing your chance of dying from colorectal cancer.

An author of the study adds: “Screening is recommended for people 50 to 75 years. In those with 12 years or less of education, only 40% get screened, compared with 70% of those with a college-level education,” he explained. Even worse, “in the uninsured population, it is only 19%. That is ridiculously low, and highlights the importance of access to care.”

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References: 

 

What’s Your Risk of Colorectal Cancer?

Please click image to see a colonoscopy.

Investigators at Cleveland Clinic (USA) have developed a new tool called CRC-PRO that allows clinicians to quickly and accurately predict an individual’s risk of colorectal cancer.

How They Developed the CRC-PRO Tool: To develop the Colorectal Cancer Predicted Risk Online tool, Brain Wells, MD, PhD and colleagues analyzed over 180,000 patients from a longitudinal study conducted at the University of Hawaii. Patients were followed for up to 11.5 years to determine the factors associated with the development of colon or rectal cancer.

“Creating a risk calculator that includes multiple risk factors offers clinicians a means to more accurately predict risk than the simple age-based cut-offs currently used in clinical practice,” said Dr. Wells. “Clinicians could decide to screen high-risk patients earlier than age 50, while delaying or foregoing screening in low-risk individuals.”

My Take: The Multiethnic Cohort Study include a diverse population. Previously, most research in this area has been performed predominately among whites. Because cancer risk varies dramatically by race, this tool is especially helpful. I think that risk prediction tools such as this will allow us to customize screening for individuals, in addition to pushing higher risk individuals to improve lifestyle factors linked to colorectal and other cancers. I’m Dr. Michael Hunter. Talk to your doctor about this valuable tool, available at http://www.r-calc.com/ExistingFormulas.aspx?filter=CCQHS

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: http://medicalexpress.com/news/2014-01-online-colorectal-cancer.html

Colonoscopy Could Prevent 40% of Colorectal Cancers

A large, long-term study from Harvard School of Public Health suggests that 40% of all colorectal cancers might be prevented if we all underwent regular colonoscopy screenings.

Background: In the USA, nearly 137,000 people were found to have colon cancer in 2009, and nearly 52,000 died that year from the diserase. Colorectal cancer is the second-leading cause of cancer-related death in the USA.

The Study: Researchers analyzed data from 88,902 participants in two long-term studies (the Nurses’ Health Study and the Health Professionals Follow-up Study). Based on questionnaires that participants filled out every two years between 1988 and 2008, the researchers obtained information on colonoscopy and sigmoidoscopy procedures. They documented 1,815 cases of colorectal cancer, and 474 deaths from the disease.

Findings: Both colonoscopy and sigmoidoscopy (the latter screens for cancer in the distal, lower part of the colorectal) lowered the risk of either getting colorectal cancer or dying from it. Only colonoscopy decreased the risk for cancers in the upper (proximal) colon, but not to the degree that it did for lower colorectal cancers.

  1. If all participants had undergone colonoscopy, 40% of colorectal cancers (including 61% distal, and 22% proximal) would have been prevented.
  2. Sigmoidoscopy alone is likely insufficient for reducing the risk of upper colon cancer.
  3. People who get an all-clear report from their colonoscopy have a significantly lower chance of colorectal cancer for up to 15 years after the procedure (although the data support repeat screening at shorter intervals among individuals with a personal history of an adenoma (a benign tumor of the colon, but one that can become cancer over time; also, more frequent if you have higher risk features such as a family history of the disease).
  4. Colorectal cancers found within 5 years of colonoscopy had different molecular characteristics, compared with cancers found more than 5 years after a colonoscopy, and may be more difficult to detect or completely remove.

My Take: This new research supports our current guidelines that call for a colonoscopy every 10 years for those at average risk for colon or rectal cancer. The reduction in risk of getting (or dying from) colon cancer is large. I’m Dr. Michael Hunter, and yes I am due this year for my own colonoscopy. Are you?

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Reiko Nishihara, Kana Wu, Paul Lochhead, Teppei Morikawa, Xiaoyun Liao, Zhi Rong Qian, Kentaro Inamura, Sun A. Kim, Aya Kuchiba, Mai Yamauchi, Yu Imamura, Walter C. Willett, Bernard A. Rosner, Charles S. Fuchs, Edward Giovannucci, Shuji Ogino, Andrew T. Chan. Long-Term Colorectal-Cancer Incidence and Mortality after Lower Endoscopy. New England Journal of Medicine, 2013; 369 (12): 1095 DOI:10.1056/NEJMoa1301969

The Worst Time to Have a Colonoscopy (And Other Procedures)

colonoscopy cartoonYou have probably heard that July is not a great time to have elective surgery, as this is the month that all the new doctors have their first day in the USA. Actually, the data is mixed. Still, there are some times that are more dangerous than others:

  1. Public holidays: If you are admitted to the hospital on an emergency basis on a public holiday, you are nearly 1.5x more likely to be dead a week later!
  2. Late in the day: Colonoscopies are less likely to find polyps, as compared to earlier in the day. With each hour of the day that passes, the average gastroenterologist is 4.6% less likely to find a polyp. And a Duke study showed that the likelihood of anesthesia problems increases over the course of the day: 1% at 9 am, rising to 4.2% for those starting at 4 pm.

Conclusion: Early to bed, early to get the best colonoscopy and surgeries, and stay safely in your home, motionless, on public holidays.

Atlantic Monthly, June 19, 2013

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page. Thanks!

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