Race and socioeconomics impact emergency colorectal cancer diagnosis

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Among patients with colorectal cancer, 29% in a nationally representative sample were diagnosed after an emergency, such as an obstruction or perforation of the bowel. Additionally, African Americans and those living in high-poverty areas were more likely to present with an emergency diagnosis.

“Overall, there are high rates of emergency presentation of colorectal cancer in the United States,” said study author Sandi L. Pruitt, PhD, MPH, assistant professor in the department of clinical sciences at The University of Texas Southwestern Medical Center in Dallas. “Screening for colorectal cancer using tests including colonoscopy is recommended for all healthy, asymptomatic adults starting at age 50 [years]. But these high rates of emergencies indicate that there are multiple missed opportunities for screening. As a result, many patients are not diagnosed until they have an emergency, such as an obstruction or perforation of the bowel, which leads to more complications and a higher risk for death from cancer.”

This study evaluated disparities in emergency colorectal cancer presentation using nationally representative Surveillance Epidemiology and End Results-Medicare data from 1992 to 2005 of US adults 66 years and older with invasive colorectal cancer. The research team identified 88,859 patients with colorectal cancer, and 29% of those presented as emergencies. Of these patients, 81.3% had an emergency admission, with 31.6% having obstructions and 4.2% having perforations.

Unadjusted analyses found that African American patients with colorectal cancer were 64% more likely to present as emergency cases. Emergency presentation was 31% more likely for those patients with colorectal cancer who lived in census tracts with the highest poverty rate, which was defined as greater than or equal to 20% versus 10% poverty.

An analysis controlling for multiple factors that included cancer stage, patient health status, and sociodemographic factors, African Americans were 29% more likely to present with emergency cases, and those living in census tracts with the highest poverty rate were 10% more likely to present with emergency colorectal cancer.

This study was presented at the 11th Annual American Association for Cancer Research International Conference on Frontiers in Cancer Prevention Research, held October 16-19 in Anaheim, California. The research team plans future research that will investigate how emergency presentation of colorectal cancer contributes to racial and economic disparities in death from colorectal cancer.
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