The accumulation of screening and treatment disparities are contributing to colorectal cancer incidence and mortality disparities, said Folasade (Fola) May, MD, PhD, gastroenterologist, health services researcher at University of California, Los Angeles, at Digestive Disease Week 2022.
At Digestive Disease Week 2022, we met with Folasade (Fola) May, MD, PhD, gastroenterologist, health services researcher at University of California, Los Angeles, who explained the ongoing disparities in colorectal cancer screening and treatment, and trends following new United States Preventive Services Task Force (USPSTF) screening recommendations.
What are some of the disparities we’re seeing in the diagnosis and treatment of colorectal cancer?
Colorectal cancer is the second most common cause of cancer-related deaths in the United States. It impacts men and women, it's unfortunately something that can happen without symptoms; It's something we all need to be aware of. This cancer also disproportionately impacts people of color, so African Americans are more likely to get and die from colorectal cancer. We also know that American Indian Alaskan natives are more likely to get and die from colorectal cancer than White individuals.
The treatment disparities that we see are also very interesting. There are some differences in the time to treatment that individuals with colorectal cancer are seeing. There's a longer period of time between when an individual is diagnosed with colorectal cancer and the initiation of treatment, if you are Black or African American than if you are White. Unfortunately, it's the accumulation of all of these differences—everything from risk factors of disease to screening disparities and to treatment disparities—that have contributed to these incidence and mortality disparities.
Have you seen any changes or trends following last year’s USPSTF recommendation that people begin colorectal cancer screening at age 45 instead of 50?
In May of 2021, the United States Preventive [Services] Task Force recommended for the first time that all individuals begin screening for colorectal cancer at age 45. It was very interesting because we've actually seen an increase in the number of individuals under age 50 getting this diagnosis for a couple of decades, but it takes time for us to accrue the data to support a guideline change. We were happy when this news came because we have been seeing colorectal cancer in younger and younger adults, and I don't know yet if we've seen an impact.
Unfortunately, those guidelines came out while we were in a global pandemic, we already were having very low rates of colorectal cancer screening at about 65% to 67% of the population, lower in certain ethnic and racial groups. So I think the time will tell whether we recover from the COVID-19 pandemic, and whether these guidelines have an impact. But I certainly have seen more individuals under age 50 talking about getting screened and hopefully following through with that process.