A new study published in the Journal of the National Cancer Institute, has found that reducing disparities between Black and White people in colonoscopy follow-up completion rates and the quality of colonoscopy screenings would dramatically reduce colon cancer deaths.
According to the study’s findings, efforts aimed at eliminating these disparities could lead to significant improvements in colorectal cancer (CRC) incidence, mortality rates, and life-years gained among Black individuals. Specifically, the study estimates that such efforts could reduce CRC incidence by up to 15%, mortality by 19%, and life-years gained by 7%.
“People have long known that racial disparities in cancer exist,” said the paper’s lead author, Oguzhan Alagoz, PhD, an industrial engineering professor at the University of Wisconsin-Madison, who also works in the Department of Population Health Sciences. “Usually, the focus has been on eliminating differences in adherence to screening, which reduces cancer deaths. However, our study shows that it’s not enough to just get everyone screened; the quality of care during screening and follow-up must also be similar for Black and White adults. To truly close the racial gap in cancer deaths and achieve health equity, we need to find innovative solutions.”
The benefits of colorectal cancer screening programs rely on patients completing a follow-up colonoscopy if doctors first discover an abnormal result in the initial non-colonoscopy test patients over 50 get as part of their normal treatment. The quality of a colonoscopy screening is also particularly important. Existing data shows significantly lower follow-up colonoscopy rates among Black patients, with the study authors noting that financial barriers and out-of-pocket costs have historically hindered adherence to follow-up colonoscopies.
This understanding led Medicare to eliminate out-of-pocket costs for follow-up colonoscopy starting last January.
But disparities in the quality of colonoscopy screenings were also noted as a significant contributor to disparities in CRC outcomes. The study found that Black adults are more likely than White adults to receive lower-quality colonoscopies, as measured by the adenoma detection rate of endoscopists.
“We found that disparities in outcomes can still be substantial because Black adults are more likely than White adults to receive lower-quality colonoscopy,” the authors wrote. They underscored the importance of addressing disparities not only in screening adherence but also in the quality of care provided during screenings and follow-up.
Despite improvements in screening rates overall, disparities persist due to various factors including socioeconomic status, access to healthcare, and systemic biases. The authors suggested that multifaceted interventions at the system, provider, and patient levels are necessary to achieve health equity in CRC outcomes.
Limitations of the study include the need for more robust data on racial disparities in adenoma detection rates and follow-up colonoscopy rates. The authors also noted the lack of data on socioeconomic status other determinants of health, which require additional research.
The authors conclude that focusing on closing gaps in follow-up colonoscopy rates and improving the quality of colonoscopy screenings, significant strides could be made toward reducing CRC incidence and mortality disparities. The authors call for continued research and innovative solutions to eliminate racial disparities in CRC control and improve overall health equity in the United States.
“As our study suggests, addressing these underappreciated contributors to racial disparities in CRC control may lead to innovative solutions for improving health equity and overall CRC outcomes in the United States,” they wrote.