Clinical and pathologic outcomes of colorectal cancer in a multi-ethnic population.
OBJECTIVE
The influence of birthplace on the clinical and pathologic outcomes of colorectal cancer (CRC) in Australia is unknown. Addressing inequalities in health care provision in immigrant groups may improve the overall quality of CRC care.


METHODS
The South Western Sydney Colorectal Tumour Group registry prospectively collects data on new patients with CRC from a population of 800,000. Survival data were cross-linked with the New South Wales population death registry.


RESULTS
From 1997 to 2004 there were 1496 patients (55% males) who were recruited and grouped according to country of birth: Australia, 64%; Southern Europe, 19%; Asia, 12%; and the Middle East, 5%. Significant heterogeneity in CRC characteristics was found, especially in Asians. Compared with Australians, Asians were diagnosed at a younger age (median age, 64 vs 70 y; P < .001, 25.6% were younger than 50 years vs 9.5%; P < .001), had fewer poorly differentiated cancers (8.9% vs 17.7%; P = .004), and fewer metastatic cancers (12.1% vs 21.0%; P = .001). Being Asian-born was associated with improved overall survival independent of age, emergency surgery, grade, and stage (hazard ratio, 0.66; 95% confidence interval, 0.47-0.93; P = 0.02). CRC screening was especially low among Asian- and Middle Eastern-born patients. Complications and treatment were not affected by birthplace, indicating no differences in the provision or acceptance of care based on birthplace.


CONCLUSIONS
Despite an equitable distribution of resources, we found significant heterogeneity in presentations and outcomes according to birthplace, with improved survival in Asian-born patients. The lower rates of screen-detected CRC in Asian- and Middle Eastern-born patients and their younger ages at diagnosis indicate that targeted screening strategies may need to be implemented.
Koo
Jenn Hian
JH
Gastroenterology and Liver Services, Evidence Management and Surveillance, Sydney South West Area Health Service, Sydney, Australia. kenjhkoo@yahoo.com.au
Kin
Siu
S
Wong
Cyril
C
Jalaludin
Bin
B
Kneebone
Andrew
A
Connor
Susan J
SJ
Leong
Rupert W L
RW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D012307:Risk Factors; D016019:Survival Analysis