Racial, Geographic, and Sex Disparities Drive Early-Onset CRC Treatment Delays

Delays in colorectal cancer (CRC) treatment initiation are more common in all-urban populations and appear to disproportionately affect young male patients and those who are Black, Hispanic, or Asian or Pacific Islander, according to a research letter published in JAMA Network Open.¹

CRC Risk, Screening, Risk, and Treatment Timeliness

Earlier this month, the American Cancer Society released “Colorectal Cancer Statistics, 2026,” reporting that CRC incidence is rising among individuals younger than 65, particularly those aged 20 to 49, with many cases diagnosed at later stages.²

In response to these trends, Jordan Karlitz, MD, senior medical officer of screening at Exact Sciences, emphasized 3 key pillars of CRC prevention and early detection in an interview with The American Journal of Managed Care^® (AJMC^®): getting screened on time; knowing your family cancer history; and acting early on concerning symptoms such as rectal bleeding and abdominal pain.

“These are the 3 pillars that everybody needs to be aware of, whether you’re a community member, a health care provider, or working in another role, because I think gaps in any of them could increase the risk of developing CRC and, unfortunately, lead to presenting with more advanced-stage disease,” he told AJMC.

Despite these recommendations, adults with early-onset CRC often experience diagnostic delays that can contribute to advanced-stage diagnoses.¹ Prior research also suggests that male patients and those from racially and ethnically minoritized groups are more likely to face treatment delays, especially those in disadvantaged areas. However, limited studies have examined how sex, geography, and race and ethnicity intersect to influence treatment timeliness.

Treatment Timeliness Across Sex, Race, and Geography

To address this gap, researchers conducted a retrospective analysis evaluating treatment timeliness across 3 postdiagnosis intervals, hypothesizing that rural patients would experience longer delays. They used Surveillance, Epidemiology, and End Results (SEER) Program data from 2006 to 2020. Time to treatment (TTT) was categorized as initiation within 30, 60, or 90 days after diagnosis and was censored if treatment was not initiated. Exposures included race, sex, and census tract–level rurality.

Both unadjusted and adjusted models were applied, and multiple imputation was used to address missing treatment time data for 11,312 patients (14.3%). The researchers also applied a false discovery rate (FDR) adjustment to multivariable analyses to account for multiple comparisons.

The study analyzed 79,090 patients with early-onset CRC. Most patients were male (53.22%) and between the ages of 40 and 49 (73.9%; n = 58,316). The overall mean (SD) TTT was 20.0 (32.4) days, with the shortest times observed in mostly rural areas (17.8 [27.7] days) and the longest in all-urban areas (20.7 [33.2] days). A greater proportion of female patients lived in all urban areas, whereas many male patients resided in all rural areas. Regarding race and ethnicity, minoritized groups predominantly lived in all-urban settings.

The imputed or adjusted model with stratified analyses demonstrated that male patients living in all-urban areas were about 5% less likely to initiate treatment. In addition, Black (HR, 0.95; 95% CI, 0.92-0.98; FDR-adjusted P = .001), Hispanic (HR, 0.93; 95% CI, 0.91-0.95; FDR-adjusted P < .001), and Asian or Pacific Islander (HR, 0.96; 95% CI, 0.93-0.99; FDR-adjusted P = .01) patients in all-urban areas were less likely to receive treatment within 90 days, with similar patterns observed at 30 and 60 days.

Next Steps to Reduce Time to Treatment

The researchers concluded by acknowledging several limitations, including their study’s focus on treatment timing rather than clinical impact. Also, although several associations were statistically significant, the observed HRs were small. Still, they expressed confidence in their findings, using them to identify areas for further research.

“…even modest delays may accumulate meaningful population-level disparities when they persist across sociodemographic groups, warranting additional investigation with more granular treatment timing and clinical data,” the authors wrote.

References

1. Meng-Han T, Coughlin SS, Cortes J, Vega KJ. Geographic, racial, and sex disparities in time to treatment for early-onset colorectal cancer. JAMA Netw Open. 2026;9(3):e261980. doi:10.1001/jamanetworkopen.2026.1980
2. McCormick B. 2026 ACS report shows CRC rising in younger adults despite overall decline. AJMC. March 3, 2026. Accessed March 19, 2026. https://www.ajmc.com/view/2026-acs-report-shows-crc-rising-in-younger-adults-despite-overall-decline
3. McCormick B, Karlitz J. 3 pillars of CRC prevention can curb rising mortality: Jordan Karlitz, MD. AJMC. February 26, 2026. Accessed March 19, 2026. https://www.ajmc.com/view/3-pillars-of-crc-prevention-can-curb-rising-mortality-jordan-karlitz-md