While the third leading cause of cancer-related deaths in the U.S used to affect mostly wealthy, white northerners, this trend has shifted, with the current populations at higher risk being poor, black southerners, according to a study published in the Journal of Clinical Oncology.
The paper, titled “Inequalities in Premature Death From Colorectal Cancer by State”, wanted to determine to what extent disparities in colorectal cancer (CRC) with regard to race, socioeconomic status and geography, are contributing to premature death.
The team of researchers, led by Dr. Ahmedin Jemal, vice-president of surveillance and health services research at the American Cancer Society, calculated age-standardized CRC death rates for three broad educational categories as a marker of socioeconomic status by race/ethnicity and state among individuals age 25 to 64 years from 2008 through 2010. Furthermore, the team applied the average death rate for the five states with the lowest rates among the most educated whites to all populations, this way calculating the number of premature CRC deaths that could have been prevented in each state.
“It’s not about your skin color. It does matter,” Dr. Jemal said in a Shots interview. However, the effect of race “is very small compared to the disparities that you see by socioeconomic status”, he added.
The study found that non-Hispanic whites who didn’t finish college were two times more likely to die of colorectal cancer than those who had at least a bachelor’s degree. Additionally, smoking is a risk factor for the development of colorectal cancer, and seems to be more common among low-income groups.
“I think the reason that you’re finding it in blacks and in lower incomes is probably less access to [health] care,” Ann Zauber, an attending biostatistician at Memorial Sloan Kettering Cancer Center added.
During the late 1980’s early detection tests, such as colonoscopies, became more common, however, people with access to health insurance were more likely to get screened and prevent precancerous polyps from becoming cancerous.
The study also found that geography can be a contributing factor, even among the most educated whites. The death rate of CRC in Mississippi was 8.9 per 100,000 people, compared to 3.8 per 100,000 in Connecticut, numbers that could be partially explained by the low taxes on cigarettes.
The authors conclude that most premature deaths from CRC occur in southern states, and half these deaths nationwide are due to racial/ethnic, socioeconomic, and geographic inequalities.
“Colorectal cancer is one of the most preventable cancers by reducing risk factors and by improving access to care”, Dr. Jemal concluded.