title: Late presentation of colorectal cancer in a vulnerable population.
abstract: OBJECTIVE
  We examined colorectal cancer (CRC) stage at presentation and mortality in a vulnerable population compared with nationally representative data.
  
  
  METHODS
  CRC cases were identified from San Francisco General Hospital (SFGH) and the Surveillance Epidemiology and End Results (SEER) database.
  
  
  RESULTS
  Fifty-five percent of the SFGH cohort presented with advanced disease, compared with 44% of the SEER cohort. Increased risk of advanced stage at presentation at SFGH compared with SEER was most evident among blacks and Asians. There was weak evidence for worse survival at SFGH compared with SEER overall. This varied by race with poorer survival at SFGH among whites and possibly blacks but some evidence for better survival among Asians. Among CRC patients at SFGH, Asians and Hispanics had better survival than whites and blacks. At SFGH, 44% had a diagnosis of CRC within 1 year of establishing care there. Of those who had established care at SFGH for at least 1 year, only 22% had exposure to CRC screening tests.
  
  
  CONCLUSIONS
  These findings allow examination of CRC presentation by ethnicity in vulnerable populations and identify areas where access and utilization of CRC screening can be improved.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, CA 94143, USA. chanda.ho@ucsf.edu
authors.forename: Chanda
authors.initials: C
authors.lastname: Ho
authors.forename: Rachel
authors.initials: R
authors.lastname: Kornfield
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: John
authors.initials: J
authors.lastname: Inadomi
authors.forename: Hal
authors.initials: H
authors.lastname: Yee
authors.forename: Ma
authors.initials: M
authors.lastname: Somsouk
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality; D055088:Early Detection of Cancer; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018426:SEER Program; D012495:San Francisco; D015996:Survival Rate; D035862:Vulnerable Populations
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