Since 1998, colorectal cancer incidence rates have been declining rapidly, and survival rates have steadily improved. Between the mid-1970s and 1996-2004, the 5-year survival rate increased from 51% to 65%. However, the graphs in this report show a widening survival gap between whites and various minority groups.

Before 1980, colorectal cancer death rates were higher in whites than in African American men; numbers were similar in women of both races. Since then, ACS researchers see a marked divergence: while colorectal cancer incidence and death rates have plummeted among whites, rates among African Americans and other minorities have declined far more slowly. In 2005, the mortality rates were about 48% higher in African-American men and women than in whites.

"There are many reasons for the survival gap," says Durado Brooks, MD, ACS director of prostate and colorectal cancer. "For one, screening rates among African Americans lag significantly behind whites. If we can increase screening rates in African Americans closer to where they are in whites, we will start to see a narrowing of the gap."

Colorectal cancer typically begins as a non-cancerous growth called a polyp. Screening can find these polyps before they become cancer; removing them can prevent the disease altogether. Regular colorectal cancer screening also is the best way to catch colorectal cancer early. The American Cancer Society recommends that people at average risk for colorectal cancer start screening at age 50; those at high risk might need to begin earlier. (For information on colorectal screening tests, see "Can Colorectal Polyps and Cancer Be Found Early?")

According to this report, half of the US population aged 50 and older has not been tested. The numbers are even lower among minority groups and those who have little education or lack health insurance.

In addition to lagging screening numbers, studies have shown that insurance status plays a big role in survival. A report published by the American Cancer Society last December found that uninsured Americans were less likely to get screened for cancer, more likely to be diagnosed with an advanced stage of the disease, and less likely to survive that diagnosis than their privately insured counterparts. This report shows that among African Americans, the 5-year survival rate for colorectal cancer was 30% higher among patients who are privately insured compared to those without health insurance.

Studies have also shown that African American patients are more likely than whites to be diagnosed when the disease is in its later stages; they're also less likely to receive the recommended surgery, adjuvant chemotherapy, and radiation treatment after a cancer diagnosis.

"Survival rates among people with Medicaid or who are uninsured are dismal, and there are a high proportion of African Americans for whom Medicaid is their primary insurer. These patients may not be getting the same quality of care," says Brooks.

"We've made remarkable progress in reducing death and suffering from colorectal cancer," said Elizabeth "Terry" T.H. Fontham, MPH, national volunteer president of the American Cancer Society. "Tests we have right now allow doctors to detect this killer at its earliest, most treatable stage, or even prevent it altogether. But as this report shows, there's more work to be done to ensure all Americans have access to these lifesaving tests, and that those who do have access to these tests use them."

About 148,810 people will be diagnosed with colorectal cancer in 2008, and about 49,960 people will die from the disease this year, according to American Cancer Society estimates. Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of death in both men and women in the US.

The American Cancer Society recommends you follow these guidelines to prevent or reduce your risk of colorectal cancer:

• Get screened regularly. 
• Maintain a healthy weight throughout life. 
• Adopt a physically active lifestyle. 
• Consume a healthy diet with an emphasis on plant sources. 
• If you drink alcohol, limit your consumption.

The American Cancer Society can help you stay on track. For more information, see "Can Colorectal Cancer Be Prevented?" and Cancer Prevention and Early Detection.

For more information about what the American Cancer Society is doing to bridge the disparities gap, see our Access to Health Care campaign.

Colorectal Cancer: Facts and Figures 2008-2010. American Cancer Society, 2008.