RAND Corporation, Santa Monica, California.
Institute for Technology Assessment, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Cancer Epidemiol Biomarkers Prev. 2021 Jan;30(1):3-12. doi: 10.1158/1055-9965.EPI-19-1537. Epub 2020 Nov 3.
Racial disparities in colorectal cancer incidence are widely documented. There are two potential mechanisms for these disparities: differences in access to screening, including screening follow-up, and differences in underlying risk of colorectal cancer. We reviewed the literature for evidence of these two mechanisms. We show that higher colorectal cancer incidence in blacks relative to whites emerged only after the dissemination of screening and describe evidence of racial disparities in screening rates. In contrast to the strong evidence for differences in colorectal cancer screening utilization, there is limited evidence for racial differences in adenoma prevalence. In general, black and white patients who are screened have similar adenoma prevalence, though there is some evidence that advanced adenomas and adenomas in the proximal colon are somewhat more likely in black than white patients. We conclude that higher rates of colorectal cancer incidence among black patients are primarily driven by lower rates of colorectal cancer screening. Our findings highlight the need to increase black patients' access to quality screening to reduce colorectal cancer incidence and mortality.
结直肠癌发病率的种族差异已得到广泛证实。这些差异可能有两种潜在机制：筛查（包括筛查随访）机会的差异，以及结直肠癌潜在风险的差异。我们回顾了相关文献，以寻找这两种机制的证据。我们发现，黑人相对于白人的结直肠癌发病率较高，这一现象仅在筛查普及后才出现，并描述了筛查率方面存在的种族差异的证据。与结直肠癌筛查利用方面的明显差异证据相比，腺瘤患病率方面的种族差异证据有限。一般来说，接受筛查的黑人和白人患者的腺瘤患病率相似，但有一些证据表明，黑人患者中高级别腺瘤和近端结肠腺瘤的可能性略高于白人患者。我们的结论是，黑人患者结直肠癌发病率较高主要是由于结直肠癌筛查率较低所致。我们的研究结果强调了增加黑人群体获得高质量筛查的机会的必要性，以降低结直肠癌的发病率和死亡率。
