A study published in the journal Cancer (94:2327-2332, 2002) suggests that African-Americans who have colon cancer and live in poverty are at much greater risk of dying from the disease.
Colorectal cancer is the most common cancer in the United States and the second leading cause of cancer death. Nearly 7% of Americans will develop colon cancer at some point in their lives. Although the death rate has been declining since 1985, colon cancer continues to take a higher toll among African-Americans. The overall 5-year survival for African-Americans in 1992 was 52.4%. In impoverished areas such as New York City’s Harlem, where 41% of families have incomes below the government’s poverty line, the problem is magnified.
"The 5-year survival rates [in Harlem] were much lower," said Harold P. Freeman, MD, and Tarek A. Alshafie, MD, of the Harlem Hospital Center and authors of the study. "Although colorectal carcinoma mortality continues to decline nationally, in this population of poor blacks the mortality rate remains extremely high and unchanged. We attribute this primarily to late-stage disease at the time of initial treatment."
Symptomatic at Presentation
For the study, the authors reviewed the tumor registry records of 615 patients treated for colorectal cancer at Harlem Hospital in New York City from 1973 to 1992. African-Americans comprised 97% of patients, and virtually all were poor. The authors looked at patient age, gender, symptoms, associated illnesses, family history of cancer, the pathologic staging of the tumor, whether the tumor recurred after treatment, and the status of the patient at 5 years.
All those treated presented with symptoms of their disease at the initial evaluation. These included such signs of serious disease as bleeding, abdominal pain, weight loss, bowel obstruction, jaundice, and anemia. In contrast, the larger trend is toward early diagnosis, with some studies showing that nearly 30% of those diagnosed with colorectal cancer do not yet have symptoms. Furthermore, the overall 5-year survival for these patients was 19.7%, significantly lower than the national average, which rose from 49.5% in 1974 to 61.5% in 1992.
In addition, even though the most common cause of large bowel obstruction is colorectal carcinoma, only 14% of patients nationwide present with bowel obstruction when first seen by a doctor. At Harlem Hospital, 21.1% of patients had bowel obstruction at diagnosis. The overall prognosis is generally worse with this presentation because it is associated with a more advanced stage of disease. Previous studies have shown that disease stage at the time of diagnosis is the most important prognostic factor for colorectal carcinoma.