title: Disparities in treatment and survival of white and Native American patients with colorectal cancer: a SEER analysis.
abstract: BACKGROUND
  Minority groups with colorectal cancer have not experienced the decline in incidence and mortality that has been reported in whites. We sought to determine whether differences exist in treatment and survival between white and Native American patients with colorectal cancer because little has been written about this specific minority group.
  
  
  METHODS
  The Surveillance Epidemiology and End Results (SEER) database for colorectal cancer was used to compare treatment and survival in whites (colon, n = 137,949; rectum, n = 46,843) and Native Americans (colon, n = 872; rectum, n = 316). Cox proportional hazards models were used to compare cancer-specific survival in Native Americans with whites, adjusted for stage, sex, age and year of diagnosis, socioeconomic status, and treatment.
  
  
  RESULTS
  Native Americans presented at younger ages than whites for both colon and rectal cancer (p < 0.001). They were diagnosed at more advanced stages of disease than whites for only colon cancer. No significant differences were detected in the proportion of patients recommended for surgery between the two groups, for either cancer at any stage (all p > 0.05). Native Americans with rectal cancer were more likely to receive radiation than whites (p < 0.001), but they received less sphincter-preserving surgery (60.0% vs 65.4%; p = 0.045). Native Americans with colon cancer fared significantly worse than whites (hazard ratio = 1.20; 95% CI = 1.08 to 1.34), but there is no difference in cancer-free survival between races for rectal cancer.
  
  
  CONCLUSIONS
  Compared with whites, Native Americans with colon cancer have worse cancer-specific survival.
authors: Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors: Cristina V
authors: CV
authors: Cueto
authors: Sean
authors: S
authors: Szeja
authors: Betsy C
authors: BC
authors: Wertheim
authors: Evan S
authors: ES
authors: Ong
authors: Vassiliki L
authors: VL
authors: Tsikitis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D018426:SEER Program; D014481:United States; D044465:White People