What Disparities Are Seen in Colorectal Cancer Treatment?
More Programs and Publications Featuring Dr. Fola May
In this program:
Colorectal cancer incidence and treatment have some variation by patient population. Dr. Fola May from UCLA Health shares insight about disparities between patient groups, time to diagnosis and treatment, and lifestyle factors that can increase colorectal cancer risk.
Transcript
Interviewer:
So there are many factors that can negatively impact outcomes where families are facing a colorectal cancer diagnosis, and the questions we've received make that clear. So what are the notable health disparities consistently seen in treating patients living with colorectal cancers?
Dr. Fola May:
I'm glad that we're talking about disparities and colorectal cancer too, and this is actually the area of my research focus. I'm a researcher at UCLA as mentioned, and all of the work that I do in my lab focuses on why we have racial-ethnic differences and colorectal cancer outcomes in colorectal cancer screening and treatment. Right now, African Americans are 20 percent more likely to get colorectal cancer than white Americans, and we are 40 percent more likely to die from colorectal cancer than white Americans. After African Americans, the group with the second-highest rates of colorectal cancer are American Indian, Alaska Natives, and then after that group, white Americans have the third highest incidence, our rates of colorectal cancer after them, the Latino population, and then Asian Americans have the lowest rates. Now, I want to emphasize though, that in all of these groups, colorectal cancer has a significant burden, so even when you look at the Asian Americans who have the lowest rates comparatively, colorectal cancer is still the number two killer if you look at cancers among Asian Americans. So in all of these groups, we need to be focusing on reducing the burden of colorectal cancer, but I'd say especially among Black Americans, Native Americans, we've got a lot of work to do. Black Americans I mentioned are more likely to get disease, we’re likely to die from it.
Black Americans, once diagnosed with colorectal cancer are less likely to survive it. We think that some of these differences and outcomes are due to differences in lifestyle, I mentioned before that colorectal cancer risk is related to our diet, is related to our lifestyle characteristics and behavior, and we do know that African Americans are more likely to have a high meat, low fiber, low vitamin D diet. We also know that African Americans are more likely to have a diet that's high in processed food and less fiber, so we do think that those are playing a role. We think it's less about genetics, and we actually think that the other factor that's really important is differences in care in the hospital and healthcare system. So African Americans are less likely to participate in screening and prevention of colorectal cancer, and, unfortunately, our group has done studies that even in people who are diagnosed with colorectal cancer, if you're low income or African American, you're less likely to get timely treatment. So it's the combination of all of these disparities and everything from risk factors of disease to screening, to diagnosis, to treatment. Those add up, and that has added up to a 50 percent higher mortality in Black Americans compared to white Americans, so this is a major research area and colorectal cancer screening and prevention, and one that I've been very honored to work in for the last several years.
Interviewer:
Well, thank you for that because there's a lot of complexity there, and you can't just reduce it to genetics, and it's good to hear that because it's hard for me to imagine that it's Black folks because of our genes, we are more predisposed to have colorectal cancer.
Dr. Fola May:
Yeah, and you know, it's actually really interesting because when I was coming up through medical school, honestly, Broderick, the teaching was that there must be some genetic difference between white people and Black people that are explaining all of these medical differences. That's what they pounded it into our head, and now we're pulling away from that teaching. When I teach my med students, I'm teaching something very different now. We are talking more about social determinants of health, we're talking about racism and how we structure our neighborhoods, how Black neighborhoods are more likely to be located next to freeways and toxins that are affecting our health. And those further downstream are leading to poor health outcomes, these are the things we may be focusing on more than genetics. And I'm just very thrilled that in the medical community, there's been a little bit of an evolution of thought that some of these factors are things that we actually can change and improve in our communities and have better outcomes.
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