Half of all premature deaths from colorectal cancer in the United States — at least 7,500 a year — could be avoided if socioeconomic and geographic disparities were done away with, according to a troubling new study from the American Cancer Society.
Education is a major factor in these preventable deaths. In all 50 states, the study found, people with the least education are significantly more likely to die from colorectal cancer, even within racial and ethnic groups. For example, non-Hispanic whites without a college degree are more than twice as likely to die from colorectal cancer than those with a degree.
But geography also plays a role. Many more preventable colorectal-cancer deaths occur in southern states than in northern and western ones, even among people with higher educations. For example, among college-educated whites, the colorectal-cancer death rate per 100,000 persons is 8.9 in Mississippi, but only 3.8 in Connecticut, according to the study’s findings. (In Minnesota, it’s 5.9.)
A historical shift
Colorectal cancer is the third leading cause of cancer deaths in the United States. Most of these deaths are preventable, for, when caught in its early stages, this particular cancer is highly treatable. Preventive screening — colonoscopies, sigmoidoscopies and fecal occult blood tests — is very effective at catching colorectal cancer early, and is recommended for adults, beginning at age 50. Indeed, preventive screening is credited with dramatic drops over the past 15 years in the rates at which Americans are being diagnosed — and dying — from the disease.
Decades ago, whites, northerners and people in higher socioeconomic groups had the highest death rates from colorectal cancer. In recent years, however, those demographics have changed. Today, the highest deaths rates are found among blacks, southerners and people with the lowest socioeconomic status.
Access to colorectal-cancer screening appears to be a major factor behind this shift, say the authors of the new study. Colorectal-cancer screening rates vary greatly by race, socioeconomic status and geography, with blacks, low-income people and southerners being the least likely to have undergone such screening within the past five years (or at all). Insurance coverage is also a significant factor. As the American Cancer Society researchers point out, the colorectal-cancer screening rate was 19 percent among uninsured Americans in 2010 compared with 62 percent among those with private insurance coverage.
Another possible explanation of the recent demographic shift in colorectal-cancer deaths is risk. People living in poverty in the U.S. have high rates of obesity, smoking and physical inactivity — all major risk factors for the disease, the researchers note.
Affordable Care Act expands screening
The data for this study is from the years 2008 through 2010, before the Affordable Care Act (ACA), which was signed into law in March 2010, became fully implemented. The ACA has removed some of the cost barriers to preventive health services, including colorectal-cancer screening. Only 27 states, however, have used the ACA to expand Medicaid programs to low-income qualified residents. That means that many Americans still cannot afford preventive colorectal-cancer screening.
Future studies should examine the premature death rates from colorectal cancer (and other conditions) in states that have expanded their Medicaid program versus those that haven’t, say the American Cancer Society researchers.
Although, we already have a good idea of what those studies will find. For, as the American Cancer Society study notes, the state with the smallest difference in colorectal-cancer death rates between its least and most educated residents was Delaware.
And Delaware implemented universal access to colorectal-cancer screening and treatment in 2002.
The American Cancer Society study was published Tuesday in the Journal of Clinical Oncology. You can read it in full at the journal’s website.
