Racial disparities in colon cancer

• Published in: Cancer Vol. 109; no. S2; pp. 378 - 385
• Main Authors: Lloyd, Stephen C., Harvey, Norman Robert, Hebert, James R., Daguise, Virginie, Williams, Deloris, Scott, Delores B.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15-01-2007
• Subjects: colon cancer; colonoscopy; community outreach; disparities; epidemiology; faith‐based initiatives; primary care; race
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.22362

Colon cancer is a condition whose far‐reaching effects have been well documented nationally and within the state of South Carolina. Fortunately, the disease is amenable to both primary and secondary prevention through screening colonoscopy. Despite the conceptual simplicity of recommending colonoscopy, barriers exist to universal (or even widespread) screening. Currently the infrastructure necessary to achieve screening goals set by the American Cancer Society (ACS), the American College of Gastroenterology (ACG), and the South Carolina Department of Health and Environmental Control (DHEC) has not been established. At current rates of training gastroenterologists, the medical community will not be able to come close to achieving widespread screening. Given the discrepancy between the public health benefit of achieving the goals and the deaths that have occurred because of the resource shortfall, we propose alternative measures to screen the at‐risk population for consideration. This need is most acute in the black community, in which where screening rates tend to be lower and polyps have been found to progress more quickly than among white populations. In South Carolina, one model has used primary care physicians as the labor force to provide routine screening colonoscopy for their own patients. This model makes screening much more accessible to minority patients, as the wait is shorter and the cost typically lower. In combination with a faith‐based partnership with minority religious organizations, this model has begun to make needed inroads toward addressing the disparities associated with colon cancer. Cancer 2007. © 2006 American Cancer Society.
Members of the black community have much higher colon cancer mortality rates than their white counterparts. Higher mortality is due, in large part, to later stage at diagnosis, which, in turn, is related to lower screening rates. We propose two potentially related solutions to remove some barriers to early detection: training primary care physicians to screen their own patients and developing partnerships with organizations in minority communities that will produce increased outreach to those individuals less likely to be screened.