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Expert Point of View: John M. Carethers, MD


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The analysis of the National Cancer Database is one of a number of studies describing  sociodemographic-related disparities in colorectal cancer outcomes, according to session Co-Chair John M. Carethers, MD, Professor and Chair of the Department of Internal Medicine at the University of Michigan, Ann Arbor.

John M. Carethers, MD

John M. Carethers, MD

“In general, overall social demographics tend to be associated with risk of death from colorectal cancer, and that’s even if you equalize these factors in African Americans. This tendency is true across all ages,” he said. The question is how to mitigate that and improve outcomes.

A large Delaware initiative tackled the problem via screening.1 “We don’t typically screen under age 50, but for persons over 50, you can essentially eliminate this disparity with navigation services and screening. How do you do that for those under 50? I’m not quite sure,” Dr. Carethers told The ASCO Post. He noted the current push to lower the screening age to 45 to combat the rising incidence among young adults. Whether this can help mitigate the disparities remains unknown. “If you screen everyone, can you eliminate these disparities?” he asked.

There also appear to be inherent biologic differences according to race that could be harder to overcome. “There are a lot of data showing that polyps develop at younger ages and are bigger in certain racial groups, particularly African Americans and American Indians,” Dr. Carethers said. What is driving the biology is unknown, but the microbiome has come under scrutiny, he added.

“So you are a victim of your circumstances,” he speculated. “You are living in a low-income area, you are eating more proinflammatory-type foods, you are getting your polyps earlier, and then you are getting your cancers earlier.” 

DISCLOSURE: Dr. Carethers reported no conflicts of interest.

REFERENCE

1. Grubbs SS, Polite BN, Carney Jr J, et al: Eliminating racial disparities in colorectal cancer in the real world: It took a village. J Clin Oncol 31:1928-1930, 2013.


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