Race may be a factor in treatment of rectal cancer patients

02/05/04

CHICAGO Black patients with rectal cancer are diagnosed at a younger age and with more advanced stage of disease than white patients, but are less likely to receive radiation treatment, according to an article in the February issue of The Archives of Surgery, one of the JAMA/Archives journals.

Colorectal cancer is the third most common cancer diagnosed in the United States and is the second leading cause of cancer death, according to the article. Recently, there has been a decline in colorectal cancer and deaths caused by the disease, but black patients have not experienced the same declines. The article states that from 1992 to 1998, the annual decrease in death rates for white males was 2.1 percent compared with 0.9 percent for black males; and the annual decrease in death rates for white females was 1.9 percent compared with 0.6 percent for black females. However, no evidence suggests that colorectal cancer affects blacks and whites differently.

Arden M. Morris, M.D., M.P.H., of the University of Minnesota, Minneapolis, and colleagues investigated whether there were racial disparities in the delivery of care to black and white rectal cancer patients. Dr. Morris is now at the University of Michigan, Ann Arbor.

The researchers studied data from 52,864 patients with rectal cancer who were diagnosed between 1988 and 1999, were older than 35 years, and had no prior colorectal or other pelvic cancers. Of the patients, 3,851 were black and 44,010 were white.

The researchers found that black patients were younger than white patients and had more advanced disease. Among patients who underwent operations, the rates of sphincter-ablating procedures (resulting in the need for a permanent colostomy bag) were 37 percent for whites and 43 percent for blacks. Additionally, 53 percent of whites and 56 percent of blacks received no radiation therapy for stage II or III cancer.

"Blacks with rectal cancer were diagnosed at a younger age and more advanced disease stage than whites, implying a need for more aggressive screening," the authors write. "Our data suggest that treatment disparities may contribute to differences in outcome among racial/ethnic groups with rectal cancer, and they highlight the need for improving access to state-of-the-art surgical care for minority patients with rectal cancer."

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