Social Factors, Not Genetics, Drive Racial Disparities in Colorectal Cancer

Correcting social, economic and health care inequalities may have the most significant impact in reducing survival differences in colorectal cancer between African-Americans and Caucasians, according to a new study by researchers at The University of Texas School of Public Health.

At five years after diagnosis, almost half of African-Americans would be dead from colorectal cancer compared to just one third (35 percent) of white Americans.

Published in the June 1 issue of CANCER, a peer-reviewed journal of the American Cancer Society, a meta-analysis of data from published studies suggests that when socioeconomic factors and treatment utilization were controlled for or equalized, racial disparities were reduced substantially.

Xianglin L. Du, M.D., Ph.D., associate professor in the Division of Epidemiology at the UT School of Public Health, is lead author on the study.

Lower socioeconomic status is well known to be associated with poorer health outcomes, including higher death rates. It is linked to impediments to health care access, suboptimal care, higher risk of exposure to occupational and environmental hazards, riskier behavior, and less healthy lifestyles.

Research indicates that factors such as lower utilization of screening tests, lower rates of surgery and adjuvant chemotherapy, more aggressive tumors, and poor post-treatment surveillance contribute to lower survival rates.

For their new study, the researchers reviewed the literature and aggregated the data from 10 studies that investigated the association between colorectal cancer survival and race/ethnicity after controlling for socioeconomic status and treatment. The authors found that after adjusting for socioeconomic status and treatment, African-Americans had only marginally higher colorectal cancer mortality.

The authors conclude that "efforts to eliminate racial disparities in health care and to minimize disparities in socioeconomic status have the potential to reduce racial inequalities in colon cancer survival."

Other contributing authors from the UT School of Public Health are Tamra E. Meyer, graduate assistant, and Luisa Franzini, Ph.D., associate professor in the Division of Management, Policy and Community Health.

By Rob Cahill, Institutional Advancement

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