(HealthDay News) — Patients with early-onset colorectal cancer (EO-CRC) living in rural areas have lower five-year survival rates than their urban-dwelling counterparts, according to a research letter published online Aug. 28 in JAMA Network Open.
Meng-Han Tsai, Ph.D., from the Georgia Prevention Institute at Augusta University, and colleagues examined the associations of early-onset colorectal cancer mortality with persistent poverty, rurality, and the intersection of persistent poverty and rurality overall and within age groups. The analysis included 58,200 patients with EO-CRC identified from the 2006 to 2015 Surveillance, Epidemiology, and End Results Program.
The researchers found that overall, five-year survival was highest for those living in nonpoverty and nonrural areas (72 percent) and lowest for those living in poverty areas regardless of rurality (67 percent). There was some variation by age group (e.g., survival was 64 percent for those aged 20 to 29 years living in impoverished rural areas).
Patients with early-onset colorectal cancer who lived in rural areas alone had a 1.1-fold to 1.4-fold increased risk for CRC death versus patients living in nonrural areas (hazard ratios, 1.35, 1.26, and 1.12 for those aged 20 to 29, 30 to 39, and 40 to 49 years, respectively). For patients living in both poverty and rural areas, there was a 1.1-fold to 1.5-fold increased risk for CRC death versus patients living in nonrural areas (overall: hazard ratio, 1.29), with notably high estimates seen for those aged 30 to 39 years (hazard ratio, 1.51).
“Potential explanations for this association include patients with early-onset colorectal cancer who lived in rural areas may have been diagnosed with later stage disease more frequently, underinsurance among younger adults, especially in nonexpanded Medicaid states with high rurality, or lower quality treatment received by patients in rural or impoverished areas,” the authors write.
What is early-onset colorectal cancer?
Colorectal cancer, a disease that affects the large intestine and rectum, is a significant public health concern. While it typically develops in individuals over the age of 50, a growing number of cases are being diagnosed in younger individuals. This phenomenon, known as early-onset colorectal cancer, is raising alarm among healthcare professionals and researchers.
Early-onset colorectal cancer (EO-CRC), defined as a diagnosis before the age of 50, has seen a steady increase in recent decades. The exact causes of this trend remain unclear, but several factors are likely contributing. Lifestyle choices such as a diet high in red meat and processed foods, lack of physical activity, obesity, and excessive alcohol consumption are known risk factors. Additionally, genetic predisposition and certain medical conditions can increase the risk of developing colorectal cancer at a younger age.
The impact of early-onset colorectal cancer on individuals and families is profound. It can disrupt careers, financial stability, and overall quality of life. In many cases, the diagnosis is a shock, as it is often unexpected at a young age. Early detection and treatment are crucial for improving outcomes, but unfortunately, many younger individuals may not be aware of the risk or may delay seeking medical attention.
How does early-onset colorectal cancer affect Black Americans?
Black Americans are disproportionately affected by early-onset colorectal cancer. Studies have consistently shown that this population has a higher incidence and mortality rate compared to white Americans. Several factors contribute to this disparity, including socioeconomic disparities, access to healthcare, and cultural factors.
Socioeconomic disparities play a significant role in the higher incidence of colorectal cancer among Black Americans. Poverty is often associated with limited access to nutritious foods, healthcare services, and preventive screenings. Individuals from lower-income communities may be more likely to engage in unhealthy behaviors, such as smoking, excessive alcohol consumption, and lack of physical activity, which increase the risk of colorectal cancer.
Access to healthcare is another critical factor. Black Americans are more likely to be uninsured or underinsured, which can limit their ability to receive necessary preventive care and treatment. Additionally, racial bias in the healthcare system can lead to disparities in the quality of care, including delays in diagnosis and treatment.
Cultural factors can also influence the risk and outcomes of colorectal cancer among Black Americans. Cultural beliefs and practices may affect the willingness to seek medical attention, adhere to treatment plans, and engage in preventive behaviors. Addressing these cultural factors is essential for improving health outcomes in this population.
How does poverty affect cancer care?
Poverty is a pervasive issue that has far-reaching consequences for health. It can limit access to essential resources, including healthcare, nutritious food, and safe housing. These factors can significantly impact an individual’s ability to prevent, detect, and treat cancer.
Poor individuals may be more likely to delay seeking medical attention due to financial concerns. They may also have limited access to preventive screenings, such as colonoscopies, which are crucial for early detection of colorectal cancer. Once diagnosed, individuals from low-income communities may face challenges in accessing necessary treatments, including surgery, chemotherapy, and radiation therapy.
Additionally, poverty can profoundly impact a patient’s overall well-being. Financial stress, lack of social support, and housing insecurity can exacerbate the emotional and psychological burden of a cancer diagnosis. These factors can negatively affect a patient’s quality of life and treatment outcomes.
Addressing the intersection of poverty and cancer care requires a multi-faceted approach. This includes increasing access to affordable healthcare, expanding preventive screening programs, providing financial assistance for treatment costs, and addressing social determinants of health. By addressing these issues, we can help to improve the outcomes for individuals with cancer, regardless of their socioeconomic status.