CRC Disparities Point to Urgent Research, Prevention Needs: Rebecca L. Siegel, MPH

Rebecca L. Siegel, MPH, lead author of the “Colorectal Cancer Statistics, 2026” report recently published in CA: A Cancer Journal for Clinicians, continued her conversation with The American Journal of Managed Care^® (AJMC^®) by highlighting factors contributing to disparities in colorectal cancer (CRC) incidence and mortality across different geographic and racial and ethnic groups.

She concluded by outlining the top priorities to reduce CRC burden nationwide based on the report’s findings.

Read part 1 of this Q&A here.

This transcript has been lightly edited for clarity.

AJMC: The report highlights significant racial and ethnic disparities in CRC incidence and mortality, with Alaska Native people experiencing the greatest burden. What factors contribute to these disparities, and what targeted interventions are needed to address them?

Siegel: It isn't known why the rates are so high, specifically, in Alaska Native people, who have the highest CRC rates in the world. Unfortunately, there hasn't been funding available to support those research efforts, largely because it's a very small population. But there are hypotheses that things that may contribute include a high prevalence of smoking, a poor diet, a diet high in mammal fat, animal fat, and possibly vitamin D deficiencies.

But really, it's not well understood, and that's why we do need more research dollars to understand what's causing this, because the burden in this population is extraordinary. It's unlike any other disparities that we see, and so it's likely low-hanging fruit for discovery.

In terms of the Black population, who also have higher rates than White people, a lot of that is related to both a higher prevalence of risk factors and less access to both preventive care and high-quality treatment.

AJMC: Going off of that, how do geographic differences and regional variations in health care access affect the CRC burden?

Siegel: Health care access impacts it because if you don't have access to insurance, let's say, then you're less likely to be able to go to the doctor for preventive care, like screening. CRC is unique in that it is 1 of only 2 cancers where screening can actually prevent cancer as well as detect early disease. You don't have access to any of these benefits if you don't have health insurance.

As we know, there's quite a difference in the prevalence of people who are uninsured across states. Expansion of Medicaid has really influenced these differences, so that's one factor.

Then, differences in the prevalence of risk factors. The smoking prevalence ranges widely, from very low, under 10%, in Utah to over 20% in Kentucky and many other Southern states. All of these differences contribute to differences in cancer risk.

AJMC: Based on the report’s findings, what are the top priorities to reduce CRC burden nationwide?

Siegel: The research priorities are increasing funding for research to study everything from what's causing the increase in people younger than 65 that was introduced around the 1950s, as well as the extraordinary burden on Alaska Native people.

It is important just to increase awareness, both among the general public and physicians, because cancer often isn't on the radar for doctors when patients come in in their 30s or 40s. So, just increasing awareness that this trend is happening and that advanced diagnosis is common. Follow-up on symptoms consistent with colorectal cancer is important.

Again, just reiterating about increasing awareness of the symptoms among the general population and encouraging people to go to the doctor if they have any of these symptoms. It's also important to realize that at least for CRC overall, we don't know if this applies to the current increase in disease, but more than half of CRCs in total are attributed to potentially modifiable factors like smoking, heavy alcohol consumption, excess body weight, red and processed meat consumption, and low physical activity.

Everyone has the opportunity to reduce their risk of this disease by eating a healthy diet and either not eating processed meat or limiting consumption. Processed meat is categorized as a carcinogen by the International Agency for Research on Cancer solely because of its strong association with CRC, so it's very important for this disease. Especially if you have a family history, I would recommend not eating processed meat. Red meat also has an association, although it's a little less consistent. So, staying physically active and making good choices each day can help reduce your risk of CRC.

Finally, for clinicians, it's important to realize that the landscape of CRC is changing rapidly. Typically, 20 years ago, it was people in their 70s who were being treated. Now, it's people much younger, in their 40s and 50s, being treated for this disease. So, really understanding that you are treating a different patient with unique needs, giving more information about treatment options and side effects of those treatments, like sexual dysfunction and infertility.

Many surveys of young patients report that people don't even find out until months after treatment that they can no longer have children of their own. It's important for clinicians to understand this pain and to make changes in their practice that address these younger patients.