Racial and Ethnic Disparities in Colon Cancer Screening in North Carolina

Colorectal cancer (CRC) is the 3rd most common cancer in both men and women; in 2015 there were 132,700 new cases in the United States, representing 8% of all new cases of cancer [1]. In terms of mortality, there were 49,700 colon cancer deaths in 2015, comprising 8.4% of all cancer-related deaths in the United States [1]. Within North Carolina, the incidence of CRC was 39.6 per 100,000 population, and there were an average of 4,067 new cases annually between 2010 and 2014 [2]. The incidence of CRC has decreased in the United States over the past 2 decades, with similar patterns in North Carolina. Improving trends in CRC incidence are thought to relate to improved rates of screening for colon cancer. Screening allows for removal of premalignant polyps and early detection of cancer, thus improving both incidence and mortality. Although the incidence and death rates from CRC have decreased, racial and ethnic disparities still exist, especially in North Carolina. The incidence of CRC among non-Hispanic whites in North Carolina in the period 2009–2013 was 37.1 per 100,000 people [3, 4] compared to an incidence among non-Hispanic blacks of 46.6 per 100,000 people [3, 4]. Similarly, the death rate due to CRC is much higher among black North Carolinians (20.1 per 100,000) compared with their non-Hispanic white counterparts (13.1 per 100,000) [5, 6]. Mediators for racial disparities in colon cancer include lifestyle factors such as alcohol ingestion, cigarette smoking, obesity, and diet [5, 6]. Tumor biology may also contribute to…