title: Black Patients with Colorectal Cancer Have More Advanced Cancer Stage at Time of Diagnosis: A Community-Based Safety-Net Hospital Experience.
abstract: Colorectal cancer (CRC) remains a leading cause of morbidity and mortality in the U.S. Disparities in access to care contribute to advanced CRC stage at diagnosis, and these disparities are most pronounced among underserved populations and ethnic minorities. We aim to evaluate race/ethnicity-specific disparities in CRC stage at diagnosis among an ethnically diverse, urban safety-net hospital. We retrospectively evaluated all adult CRC patients diagnosed from January 1, 2009 to October 1, 2015. CRC cases were confirmed by histopathology specimens from biopsies and/or surgical resection. CRC staging utilized American Joint Committee on Cancer (AJCC) staging systems and were stratified by race/ethnicity. Multivariate logistic regression models were utilized to evaluate disparities in AJCC stage at presentation (stage 3-4 vs. stage 0-2). Among 311 patients with CRC [51.5% male, 25.3% black, 18.7% Hispanic, 32.0% Asian, and mean age at diagnosis 58.1 years (SD 10.3)] 61.4% had advanced ACC stage 3-4 CRC at diagnosis. Among black patients with CRC, 73.3% had AJCC stage 3-4 cancer at time of diagnosis. On multivariate regression, blacks were nearly four times more likely to have advanced AJCC stage 3-4 CRC at diagnosis compared to whites (OR 3.70; 95% CI 0.97-14.11; p = 0.055). Among a diverse underserved population, over 60% of CRC were AJCC stage 3-4 at diagnosis, and nearly 75% of blacks with CRC had AJCC stage 3-4 at diagnosis. Advanced stage CRC at diagnosis limits options for potentially curative therapies, and increases the risk for cancer recurrence and mortality.
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA.
authors.forename: Chuck
authors.initials: C
authors.lastname: Chan
authors.affiliation: Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, USA.
authors.forename: Aristeo
authors.initials: A
authors.lastname: Lopez
authors.affiliation: Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, USA.
authors.forename: Garland
authors.initials: G
authors.lastname: Castaneda
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA.
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA.
authors.forename: Benny
authors.initials: B
authors.lastname: Liu
authors.affiliation: Division of Hematology and Oncology, Alameda Health System - Highland Hospital, Oakland, CA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Yee
authors.affiliation: Division of Hematology and Oncology, Alameda Health System - Highland Hospital, Oakland, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Irwin
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA. Rowong@alamedahealthsystem.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
mesh_terms: D001741:Black or African American; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology* / Q000473:pathology; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D044469:Racial Groups; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012737:Sex Factors
keywords: AJCC; Cancer outcomes; Colon cancer; Racial disparities; Safety-net