Racial Disparities and Young-Onset Colorectal Cancer Outcomes

A negative impact despite income or education status

Black patients with young-onset colorectal cancer (CRC) were more likely to present with late-stage disease and have worse outcomes regardless of insurance type, income or education level, according to a study of over 1 million patients presented at the 2021 American Society of Clinical Oncology Gastrointestinal Cancers Symposium.

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“Many studies have shown that Black patients with colorectal cancer unfortunately have worse outcomes, with lower socioeconomic status being the biggest factor. Our study was unique in demonstrating that younger Black patients with high socioeconomic status still experience worse outcomes,” says Suneel Kamath, MD, a colorectal cancer specialist at Cleveland Clinic Cancer Center and lead author of the study. 

Young-onset colorectal cancer

The overall incidence of CRC is rising in people under the age of 50, and Black and Hispanic patients have felt this disease burden more severely. This study included 1,061,204 patients with CRC from the National Cancer Database from 2004 to 2015. Just over ten percent of the patients were under age 50. Researchers tracked and compared differences in demographics, socioeconomic factors and disease and treatment characteristics in older (> 50 years of age) versus younger (50 years of age or less) patients.

Younger patients were more likely to be Black (15.1% vs. 11.3%) or Hispanic (8.6% vs. 4.6%) and to be diagnosed with stage 4 disease (24.9% vs. 17.0%) than older patients (P < 0.0001 for all). Black patients had the lowest median overall survival (OS) (58.3 months) when compared with White (67 months), Hispanic (91.6 months) and Asian (104.9 months) patients (P < 0.0001).

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Researchers also analyzed patients by insurance level and found that Black early-onset CRC patients with private insurance had worse OS than White patients at every income and education level. The same was not true for Asian and Hispanic patients, or for older patients with CRC.

“Now that we have the data to show that patients in the Black community have been hit harder by this increase in early onset colorectal cancer, we can begin the work of addressing the environmental issues and health disparities behind it,” says David Liska, MD, Director of the Sanford R. Weiss, MD, Center for Hereditary Colorectal Neoplasia at Cleveland Clinic’s Digestive Disease & Surgery Institute and coauthor of the study.

Many factors are likely at play. “Our future work will use metabolomics to understand how differences in the interactions between our cellular processes and environmental exposures like diet could lead to higher risk for CRC,” says Dr. Kamath. The gut microbiome could also impact CRC risk and is another active area of research at Cleveland Clinic. “We also plan to investigate different insurance plans to see if reduced coverage for important things such as screening colonoscopies or specialist referrals might contribute to this study’s results,” he adds.

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New Center for Young-Onset Colorectal Cancer

While a cancer diagnosis at any age calls for expert treatment, young patients with colorectal cancer often have diagnostic and treatment considerations that are specific to their early age of onset.

To meet this challenge, Cleveland Clinic established the Center for Young-Onset Colorectal Cancer with the aim of providing young colorectal cancer patients with personalized, comprehensive and coordinated world-class care. The center brings together caregivers in surgery, oncology, radiation therapy, genetics, gastroenterology, fertility, psychology and lifestyle medicine. Patients can also benefit from genetic testing and the expertise of the Weiss Center for Hereditary Colorectal Neoplasia.

Researchers with the center are exploring contributors to the rise in young-onset CRC, including health disparities, as well as developing screening recommendations and novel treatments for this population. To refer a patient to the Center for Young-Onset Colorectal Cancer, call 216.444.6470.