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Racial and geographic disparities in stage-specific incidence and mortality in the colorectal cancer hotspot region of eastern North Carolina, 2008–2016

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Abstract

Background

Despite improvements in colorectal cancer (CRC) outcomes, geographic disparities persist. Spatial mapping identified distinct “hotspots” of increased CRC mortality, including 11 rural counties in eastern North Carolina (ENC). The primary aims of this study were to measure CRC incidence and mortality by stage and determine if racial disparities exist within ENC.

Methods

Data from 2008 to 2016 from the NC Central Cancer Registry were analyzed by stage, race, and region. Age-adjusted incidence and death rates (95% CI) were expressed per 100,000 persons within hotspot counties, all ENC counties, and Non-ENC counties.

Results

CRC incidence [43.7 (95% CI 39.2–48.8) vs. 38.4 (95% CI 37.6–39.2)] and mortality rates [16.1 (95% CI 16.6–19.7) vs. 13.9 (95% CI 13.7–14.2)] were higher in the hotspot than non-ENC, respectively. Overall, localized, and regional CRC incidence rates were highest among African Americans (AA) residing in the hotspot compared to Whites or Non-ENC residents. Incidence rates of distant disease were higher among AA but did not differ by region. CRC mortality rates were highest among AA in the hotspot (AA 22.0 vs. Whites 15.8) compared to Non-ENC (AA 19.3 vs. Whites 13.0), although significant stage-stratified mortality differences were not observed.

Conclusions

Patients residing in the hotspot counties have higher age-adjusted incidence of overall, localized, regional, and distant CRC and mortality rates than patients in non-hotspot counties. Incidence and mortality rates remain highest among AA residing in the hotspot.

Impact

Increased CRC incidence and mortality rates were observed among all patients in the hotspot and were highest among AA, suggestive of ongoing racial and geographic disparities.

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References

  1. Siegel RL, Miller KD, Jemal A (2020) Cancer statistics, 2020. CA Cancer J Clin 70(1):7–30

    Article  PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34

    Article  PubMed  Google Scholar 

  3. Survival Rates for Colorectal Cancer [Internet]. 2019. [updated February 1]. Available from: https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html

  4. Laiyemo AO, Doubeni C, Pinsky PF, Doria-Rose VP, Bresalier R, Lamerato LE et al (2010) Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities. J Natl Cancer Inst 102(8):538–546

    Article  PubMed  PubMed Central  Google Scholar 

  5. Laiyemo A (2014) Reducing racial disparity in colorectal cancer burden. Dig Dis Sci 59(9):2025–2027

    Article  PubMed  Google Scholar 

  6. Singh GK, Williams SD, Siahpush M, Mulhollen A (2011) Socioeconomic, rural-urban, and racial inequalities in US cancer mortality: part I—all cancers and lung cancer and part II—colorectal, prostate, breast, and cervical cancers. J Cancer Epidemiol 2011:107497–107527

    Article  PubMed  Google Scholar 

  7. Siegel RL, Sahar L, Robbins A, Jemal A (2015) Where can colorectal cancer screening interventions have the most impact? Cancer Epidemiol Biomark Prev 24(8):1151–1156

    Article  Google Scholar 

  8. Lea CS, King A (2014) Cancer in a 29-county area in eastern North Carolina: an opportunity to reduce health inequities. N C Med J 75(4):287–290

    PubMed  Google Scholar 

  9. QuickFacts Population Data [Internet]. [cited March 12, 2019]. Available from: https://www.census.gov/quickfacts/

  10. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds) SEER Cancer Statistics Review, 1975–2017, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2017/, based on November 2019 SEER data submission, posted to the SEER web site, April 2020

  11. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A et al (2017) Colorectal cancer statistics, 2017. CA Cancer J Clin 67(3):177–93

    Article  PubMed  Google Scholar 

  12. Chan C, Lopez A, Castaneda G, Bhuket T, Liu B, Yee S et al (2017) Black patients with colorectal cancer have more advanced cancer stage at time of diagnosis: a community-based safety-net hospital experience. J Community Health 42(4):724–729

    Article  PubMed  Google Scholar 

  13. Warren Andersen S, Blot WJ, Lipworth L, Steinwandel M, Murff HJ, Zheng W (2019) Association of race and socioeconomic status with colorectal cancer screening, colorectal cancer risk, and mortality in southern US adults. JAMA Netw Open 2(12):e1917995

    Article  PubMed  PubMed Central  Google Scholar 

  14. Crosby RA, Collins T (2017) Correlates of community-based colorectal cancer screening in a rural population: the role of fatalism. J Rural Health 33(4):402–405

    Article  PubMed  Google Scholar 

  15. Lyratzopoulos G, Liu MP, Abel GA, Wardle J, Keating NL (2015) The association between fatalistic beliefs and late stage at diagnosis of lung and colorectal cancer. Cancer Epidemiol Biomark Prev 24(4):720–726

    Article  Google Scholar 

  16. Carmichael H, Cowan M, McIntyre R, Velopulos C (2019) Disparities in colorectal cancer mortality for rural populations in the United States: does screening matter? Am J Surg 219(6):988–992

    Article  PubMed  Google Scholar 

  17. Jackson CS, Oman M, Patel AM, Vega KJ (2016) Health disparities in colorectal cancer among racial and ethnic minorities in the United States. J Gastrointest Oncol 7(Suppl 1):S32-43

    PubMed  PubMed Central  Google Scholar 

  18. Lansdorp-Vogelaar I, Kuntz K, Knudsen A, Ballegooijen M, Zauber A, Jemal A (2012) Contribution of screening and survival differences to racial disparities in colorectal cancer rates. Cancer Epidemiol Biomark Prev 21(5):728–736

    Article  Google Scholar 

  19. Smith S, Smith S, Alema-Mensah E, Alema-Mensah E, Yoo W, Yoo W et al (2017) Persons who failed to obtain colorectal cancer screening despite participation in an evidence-based intervention. J Community Health 42(1):30–34

    Article  PubMed  PubMed Central  Google Scholar 

  20. Simpson DR, Martínez ME, Gupta S, Hattangadi-Gluth J, Mell LK, Heestand G et al (2013) Racial disparity in consultation, treatment, and the impact on survival in metastatic colorectal cancer. J Natl Cancer Inst 105(23):1814–1820

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gross CP, Smith BD, Wolf E, Andersen M (2008) Racial disparities in cancer therapy: did the gap narrow between 1992 and 2002? Cancer 112(4):900–908

    Article  PubMed  Google Scholar 

  22. Lai Y, Wang C, Civan JM, Palazzo JP, Ye Z, Hyslop T et al (2016) Effects of cancer stage and treatment differences on racial disparities in survival from colon cancer: a United States population-based study. Gastroenterology 150(5):1135–1146

    Article  PubMed  Google Scholar 

  23. Demissie K, Oluwole OO, Balasubramanian BA, Osinubi OO, August D, Rhoads GG (2004) Racial differences in the treatment of colorectal cancer: a comparison of surgical and radiation therapy between Whites and Blacks. Ann Epidemiol 14(3):215–221

    Article  PubMed  Google Scholar 

  24. Ayanian JZ, Zaslavsky AM, Guadagnoli E, Fuchs CS, Yost KJ, Creech CM et al (2005) Patients’ perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J Clin Oncol 23(27):6576–6586

    Article  PubMed  Google Scholar 

  25. Albain KS, Unger JM, Crowley JJ, Coltman CA, Hershman DL (2009) Racial disparities in cancer survival among randomized clinical trials patients of the southwest oncology group. J Natl Cancer Inst 101(14):984–992

    Article  PubMed  PubMed Central  Google Scholar 

  26. Yothers G, Sargent DJ, Wolmark N, Goldberg RM, O’Connell MJ, Benedetti JK et al (2011) Outcomes among black patients with stage II and III colon cancer receiving chemotherapy: an analysis of ACCENT adjuvant trials. J Natl Cancer Inst 103(20):1498–1506

    Article  PubMed  PubMed Central  Google Scholar 

  27. Alese OB, Jiang R, Zakka KM, Wu C, Shaib W, Akce M et al (2019) Analysis of racial disparities in the treatment and outcomes of colorectal cancer in young adults. Cancer Epidemiol 63:101618

    Article  PubMed  Google Scholar 

  28. Ellis L, Canchola AJ, Spiegel D, Ladabaum U, Haile R, Gomez SL (2018) Racial and ethnic disparities in cancer survival: the contribution of tumor, sociodemographic, institutional, and neighborhood characteristics. J Clin Oncol 36(1):25–33

    Article  CAS  PubMed  Google Scholar 

  29. Buehler JW, Castro JC, Cohen S, Zhao Y, Melly S, Moore K (2019) Personal and neighborhood attributes associated with cervical and colorectal cancer screening in an urban African American population. Prev Chronic Dis 16:E118

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hastert TA, Banegas MP, Hamel LM, Reed AR, Baird T, Beebe-Dimmer JL et al (2019) Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors. J Cancer Surviv 13(3):429–437

    Article  PubMed  PubMed Central  Google Scholar 

  31. Rawla P, Sunkara T, Barsouk A (2019) Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol 14(2):89–103

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Mainous AG (2004) Race, rural residence, and control of diabetes and hypertension. Ann Fam Med 2(6):563–568

    Article  PubMed  PubMed Central  Google Scholar 

  33. Centers for Disease Control and Prevention (2020) National diabetes statistics report, 2020. Centers for Disease Control and Prevention, Atlanta, GA

    Google Scholar 

  34. Shavers VL (2007) Racial/ethnic variation in the anatomic subsite location of in situ and invasive cancers of the colon. J Natl Med Assoc 99(7):733–748

    PubMed  PubMed Central  Google Scholar 

  35. Kang M, Shen XJ, Kim S, Araujo-Perez F, Galanko JA, Martin CF et al (2013) Somatic gene mutations in African Americans may predict worse outcomes in colorectal cancer. Cancer Biomark 13(5):359–366

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Staudacher JJ, Yazici C, Bul V, Zeidan J, Khalid A, Xia Y et al (2017) Increased frequency of KRAS mutations in african americans compared with Caucasians in sporadic colorectal cancer. Clin Transl Gastroenterol 8(10):e124

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Yoon HH, Shi Q, Alberts SR, Goldberg RM, Thibodeau SN, Sargent DJ et al (2015) Racial differences in BRAF/KRAS mutation rates and survival in stage III colon cancer patients. J Natl Cancer Inst 107(10):djv186

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research was supported by a Diversity and Inclusion Research and Scholarship Award from the Office of Equity and Diversity at East Carolina University and Brody School of Medicine.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA

    Tyler Hinshaw, Alexander A. Parikh & Rebecca A. Snyder

  2. Department of Public Health, East Carolina University Brody School of Medicine, Greenville, NC, USA

    Suzanne Lea & Rebecca A. Snyder

  3. North Carolina Central Cancer Registry, N.C. Department of Health and Human Services, Raleigh, NC, USA

    Justin Arcury

  4. Department of Public Health, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Surgical Oncology Suite 4S-24, Greenville, NC, 27834, USA

    Rebecca A. Snyder

Authors
  1. Tyler Hinshaw
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  2. Suzanne Lea
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  4. Alexander A. Parikh
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  5. Rebecca A. Snyder
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Contributions

TH: Conception/design of the work; acquisition of the data, data analysis, and interpretation of the data; drafting manuscript; final approval of the manuscript. SL: Conception/design of the work; acquisition of the data, data analysis, and interpretation of the data; final approval of the manuscript. JA: Acquisition of the data, data analysis, and interpretation of the data. AAP: Conception/design of the work; data analysis and interpretation of the data; critical revision of the manuscript; final approval of the manuscript. RAS: Conception/design of the work; acquisition of the data, data analysis, and interpretation of the data; drafting manuscript; final approval of the manuscript. All authors agree to be accountable for all aspects of the work.

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Correspondence to Rebecca A. Snyder.

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The authors have no relevant financial conflicts or disclosures. This manuscript has been seen and approved by all authors.

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Hinshaw, T., Lea, S., Arcury, J. et al. Racial and geographic disparities in stage-specific incidence and mortality in the colorectal cancer hotspot region of eastern North Carolina, 2008–2016. Cancer Causes Control 32, 271–278 (2021). https://doi.org/10.1007/s10552-020-01381-2

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  • DOI: https://doi.org/10.1007/s10552-020-01381-2

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