Time dependent ethnic convergence in colorectal cancer survival in Hawaii.
BACKGROUND
Although colorectal cancer death rates have been declining, this trend is not consistent across all ethnic groups. Biological, environmental, behavioral and socioeconomic explanations exist, but the reason for this discrepancy remains inconclusive. We examined the hypothesis that improved cancer screening across all ethnic groups will reduce ethnic differences in colorectal cancer survival.


METHODS
Through the Hawaii Tumor Registry 16,424 patients diagnosed with colorectal cancer were identified during the years 1960-2000. Cox regression analyses were performed for each of three cohorts stratified by ethnicity (Caucasian, Japanese, Hawaiian, Filipino, and Chinese). The models included stage of diagnosis, year of diagnosis, age, and sex as predictors of survival.


RESULTS
Mortality rates improved significantly for all ethnic groups. Moreover, with the exception of Hawaiians, rates for all ethnic groups converged over time. Persistently lower survival for Hawaiians appeared linked with more cancer treatment.


CONCLUSIONS
Ethnic disparities in colorectal cancer mortality rates appear primarily the result of differential utilization of health care. If modern screening procedures can be provided equally to all ethnic groups, ethnic outcome differences can be virtually eliminated.
Pagano
Ian S
IS
Cancer Research Center of Hawai'i, University of Hawai'i, Lauhala Street, Honolulu, HI, USA. ian@crch.hawaii.edu
Morita
Shane Y
SY
Dhakal
Sanjaya
S
Hundahl
Scott A
SA
Maskarinec
Gertraud
G
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D006254:Hawaii / Q000208:ethnology; D006801:Humans; D008297:Male; D009367:Neoplasm Staging / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D044469:Racial Groups; D012042:Registries / Q000706:statistics & numerical data; D018426:SEER Program / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate