Disparate Outcomes in Patients With Colorectal Cancer

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Abstract
COLORECTAL carcinoma represents the second most common fatal malignancy in the United States and was responsible for approximately 55 000 deaths in 1997.1 Results of several studies2,3 have suggested a racial disparity in cancer survival, with survival in white patients exceeding that of black patients, even after adjusting for tumor stage at presentation. In addition, results of previous studies4,5 suggest that this racial disparity has been increasing since the mid-1970s, with improvements in colorectal cancer detection and overall survival improving among white patients but no comparable improvements among black patients. Several explanations have been proposed for this difference in survival, including a later stage at diagnosis, more aggressive tumor biology, increased patient comorbidity, and socioeconomic factors leading to less aggressive treatment in black patients compared with white patients.6,7 Although each of these factors has been recognized as potentially important, given the magnitude of the problem and the lack of progress in the past 3 decades, closing this disparity gap requires renewed focus on this issue and careful analysis of patient and physician variables.