Half of Premature Colon Cancer Deaths Linked to Disparities

American Cancer Society researchers have found that half of all premature colon cancer deaths in the U.S. are linked to racial, socioeconomic, and geographic inequalities. The findings show that deaths from colon cancer are significantly higher among people with the least education, and many of these deaths could be prevented.

The report was published online November 10, 2014 in the Journal of Clinical Oncology.

Historical shift

Decades ago, death rates from colon cancer were higher in those with higher socioeconomic status, in whites, and in northern states. But in the past 30 years or so, the numbers have reversed, and now more preventable deaths from colon cancer occur among people with the lowest socioeconomic status, in blacks, and in southern states.

According to lead researcher and American Cancer Society Vice President, Surveillance and Health Services, Ahmedin Jemal, DVM PhD, the shift came about because of increased colon cancer testing among people with higher socioeconomic status, in whites, and in northern states. Jemal says if all people were screened at the same rates, those disparities would disappear.

Comparing risk among populations

The study used data from the National Vital Statistics System of the National Center for Health Statistics to look at colon cancer death rates in people ages 25 to 64 from 2008 through 2010. Researchers compared death rates by state, race, and education. They used education to determine socioeconomic status. The group with the least education had 12 years of education or less.

The researchers found significantly higher colon cancer death rates in people with the least education no matter what state they lived in, and for Hispanics, non-Hispanic whites and non-Hispanic blacks – the racial groups they studied. They found similar results when they looked only at people ages 50 to 64 years, which is the age group for which colon cancer testing is recommended.

For example, in New Mexico non-Hispanic whites with the least education had more than 3 times the risk of dying from colon cancer as non-Hispanic whites with the most education (more than 16 years). The researchers calculated that half the colon cancer deaths in the study would have been avoided if everyone had experienced the lowest death rates of the most educated whites. That adds up to 7,690 premature colon cancer deaths every year nationwide.

The authors say more premature deaths were avoidable in southern states (60% to 70%) than in northern and western states (30% to 40%). They say the factors that contribute to the disparities are complex and caused by many different factors. These may include differences in income, education, insurance status, and geographic location, which result in inequalities in risk factors for colon cancer and access to testing and treatment services.

Lowering colon cancer risk

Jemal says reducing the disparities in colon cancer death rates requires changes at the policy level, health care level, and individual level.

Policies can ensure that all people have access to high quality health care, specifically preventive, early detection, and treatment services. In an effort to increase colon cancer testing nationwide, several organizations, including the American Cancer Society and the Centers for Disease Control and Prevention, are supporting an initiative to increase colon cancer testing rates to 80% by 2018. The initiative is focusing a lot of its efforts on community health centers and other safety-net providers.

In addition, the Affordable Care Act is designed to address racial and socioeconomic inequalities by improving access to quality health care for all Americans through expansion of state Medicaid programs and health insurance exchange subsidies. The health care law is designed to remove cost as a barrier to preventive health services, including colon cancer testing.

At the health care level, providers should recommend screening to all eligible patients. Studies have found that a doctor’s recommendation increases the chances someone will get tested for colon cancer whether they’re insured or not.

At the individual level, people can make lifestyle changes that can lower their risk for colon cancer:

  • If you smoke, quit. Almost a third (30%) of people who have 12 years of education or less are smokers, compared with only 9% of those who have more than 12 years of education. Long-term smokers are more likely than non-smokers to develop and die from colon cancer.
  • Get to and stay at a healthy body weight. Being obese or very overweight increases your risk of getting and dying from colon cancer.
  • Adopt a physically active lifestyle. If you don’t get regular exercise, you have a greater chance of developing colon cancer. Increasing your activity may help reduce your risk.
  • Eat healthy food. Diets that include lots of vegetables, fruits, and whole grains have been linked with a decreased risk of colon cancer. Be sure to get your fiber from food, not supplements; studies have not been able to show that supplements help lower risk. Eat less red meat (beef, pork, or lamb) and processed meats (hot dogs and some luncheon meats), which have been linked with an increased risk of colon cancer.
  • Limit alcohol consumption. Colon cancer has been linked to heavy drinking. The American Cancer Society recommends no more than 2 drinks a day for men and 1 drink a day for women.
  • Get tested. Screening tests can often prevent colon cancer by finding growths called polyps that can be removed before they turn into cancer. These tests also can find colon cancer earlier, when treatments are more likely to be successful. The American Cancer Society recommends testing starting at age 50 for most people; talk to your doctor about when you should start and which tests might be right for you.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Inequalities in Premature Death From Colorectal Cancer by State. Published online November 10, 2014 in the Journal of Clinical Oncology. First author Ahmedin Jemal, DVM, PhD, American Cancer Society, Atlanta, Ga.

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