Review
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 14, 2009; 15(30): 3734-3743
Published online Aug 14, 2009. doi: 10.3748/wjg.15.3734
Disparities in colorectal cancer in African-Americans vs Whites: Before and after diagnosis
Anastasios Dimou, Kostas N Syrigos, Muhammad Wasif Saif
Anastasios Dimou, Kostas N Syrigos, Muhammad Wasif Saif, Yale Cancer Center, Yale School of Medicine, New Haven, CT 06520, United States
Author contributions: Saif MW designed the research; Dimou A performed the research and wrote the paper; Syrigos KN and Saif MW reviewed and finally approved the paper.
Correspondence to: Muhammad Wasif Saif, MD, Associate Professor, Division of Medical Oncology, 333 Cedar Street, FMP 116, New Haven, CT 06520, United States. wasif.saif@yale.edu
Telephone: +1-203-7371569
Fax: +1-203-7853788
Received: February 10, 2009
Revised: June 16, 2009
Accepted: June 23, 2009
Published online: August 14, 2009
Abstract

There are differences between African-American and white patients with colorectal cancer, concerning their characteristics before and after diagnosis. Whites are more likely to adhere to screening guidelines. This is also the case among people with positive family history. Colorectal cancer is more frequent in Blacks. Studies have shown that that since 1985, colon cancer rates have dipped 20% to 25% for Whites, while rates have gone up for African-American men and stayed the same for African-American women. Overall, African-Americans are 38% to 43% more likely to die from colon cancer than are Whites. Furthermore, it seems that there is an African-American predominance in right-sited tumors. African Americans tend to be diagnosed at a later stage, to suffer from better differentiated tumors, and to have worse prognosis when compared with Whites. Moreover, less black patients receive adjuvant chemotherapy for resectable colorectal cancer or radiation therapy for rectal cancer. Caucasians seem to respond better to standard chemotherapy regimens than African-Americans. Concerning toxicity, it appears that patients of African-American descent are more likely to develop 5-FU toxicity than Whites, possibly because of their different dihydropyridine dehydrogenase status. Last but not least, screening surveillance seems to be higher among white than among black long-term colorectal cancer survivors. Socioeconomic and educational status account for most of these differences whereas little evidence exists for a genetic contribution in racial disparity. Understanding the nature of racial differences in colorectal cancer allows tailoring of screening and treatment interventions.

Keywords: African-American; Caucasian; Chemotherapy; Colorectal cancer; Dihydropyrimidine dehydrogenase; 5-FU; Irinotecan; Oxaliplatin; Socioeconomic; Stage