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Gastrointestinal malignancies: when does race matter?

Timothy L Fitzgerald1, Cathy J Bradley, Bassam Dahman

  • 1Department of Surgery, Division of Surgical Oncology, East Carolina University, Greenville, NC, USA.

Journal of the American College of Surgeons
|October 27, 2009
PubMed
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African Americans face poorer survival from gastrointestinal cancers. However, for colorectal cancer, differences in late-stage diagnosis and surgery explain survival disparities, not race itself.

Area of Science:

  • Oncology
  • Health Disparities Research
  • Cancer Epidemiology

Background:

  • African Americans experience significantly poorer survival rates for gastrointestinal cancers compared to Caucasian patients.
  • Socioeconomic factors are hypothesized to be a primary driver of these observed racial disparities in cancer outcomes.

Purpose of the Study:

  • To investigate the impact of race on survival outcomes for major gastrointestinal cancers.
  • To determine if socioeconomic status, stage at diagnosis, and surgical intervention mediate racial differences in survival.

Main Methods:

  • Analysis of a large cohort (18,260 patients) using linked Medicare, Medicaid, and state tumor registry data.
  • Inclusion of patients with colorectal, pancreatic, gastric, and esophageal cancers diagnosed over four years.

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  • Utilized bivariate and Cox proportional hazard models to assess differences in diagnosis stage, surgical rates, and survival between African-American and Caucasian patients.

    • Main Results:

    • Unadjusted analyses revealed African Americans with colorectal and esophageal cancers had higher rates of metastatic disease, lower surgery rates, and poorer survival.
    • Multivariate analysis indicated that for colorectal cancer, the survival difference between races diminished when accounting for late-stage diagnosis and surgical treatment.
    • No significant racial disparities in survival were found for pancreatic, gastric, or esophageal cancers.

    Conclusions:

    • Improving screening and surgical rates for colorectal cancer may help reduce survival disparities between African-American and Caucasian patients.
    • Race appears to have minimal direct influence on the survival of patients with pancreatic, esophageal, or gastric cancers.