Locally Advanced Rectal Cancer Outcomes Reveal Racial Disparities

(HealthDay News) — Treatment outcomes for locally advanced rectal cancer (LARC) are less favorable for Hispanic and non-Hispanic Black patients versus non-Hispanic White patients, according to a study published online Feb. 29 in JAMA Network Open.

Rebecca M. Shulman, M.D., from the Fox Chase Cancer Center in Philadelphia, and colleagues assessed whether racial and ethnic disparities in treatment outcomes among patients with LARC could be accounted for by social determinants of health and demographic, clinical, and pathologic factors known to be associated with treatment response. The analysis included 34,500 patients with T3 to T4 or N1 to N2 LARC treated with neoadjuvant therapy and surgery (2004 through 2017).

The researchers found that Hispanic patients achieved tumor downstaging (48.9 versus 51.8 percent) and pN0 status (66.8 versus 68.8 percent) less often than non-Hispanic White patients. Black race, but not Hispanic ethnicity, was associated with less tumor downstaging (odds ratio [OR], 0.86), less frequent pN0 status (OR, 0.91), and less frequent pathologic complete response (pCR; OR, 0.81). A reduced rate of pCR was also associated with rural location (OR, 0.80), lack of or inadequate insurance (OR for Medicaid, 0.86; OR for no insurance, 0.65), and treatment in a low-volume center (OR for first quartile, 0.73; OR for second quartile, 0.79; OR for third quartile, 0.86).

“These findings suggest that racial and ethnic disparities in LARC treatment outcomes may be multifactorial, with an independent association with non-Hispanic Black race, suggesting unidentified biological variables or social determinants of health that warrant exploration,” the authors write.

Several authors disclosed ties to relevant organizations.

Related: Colorectal Cancer: Blacks More Likely to Undergo Emergency Surgery, in 23%

What is rectal cancer?

Rectal cancer, also known as colorectal cancer, refers to cancer that develops in the rectum, which is the final portion of the large intestine located just before the anus. It is one of the most common types of cancer worldwide, with significant variations in incidence rates across different populations.

Rectal cancer begins as abnormal growths, called polyps, in the rectum lining. Over time, some of these polyps can develop into cancerous tumors. Like other types of cancer, rectal cancer can spread to nearby lymph nodes and other organs if not detected and treated early. Symptoms of rectal cancer may include changes in bowel habits, rectal bleeding, abdominal pain, and unintentional weight loss. However, early-stage rectal cancer may not cause noticeable symptoms, highlighting the importance of regular screening for early detection.

Related: Barriers and Facilitators to Colorectal Cancer Screening in African-American Men

What causes rectal cancer?

Several factors can increase an individual’s risk of developing rectal cancer. Age is a significant risk factor, with most cases occurring in individuals over age 50. However, rectal cancer can affect people of all ages, including young adults. Other risk factors for rectal cancer include family history and unhealthy lifestyle factors such as a diet high in red and processed meats, low in fiber, physical inactivity, obesity, smoking, and heavy alcohol consumption.

Related: Cancer Deaths Are Down, But Cancer Diagnoses Affecting Black Americans Are Up

How to prevent rectal cancer

Regular screening tests, such as colonoscopies, sigmoidoscopies, and fecal occult blood tests (FOBT), can help detect precancerous polyps or early-stage cancer in the rectum and colon. Screening guidelines recommend starting regular screenings at age 50 for average-risk individuals, with earlier and more frequent screenings recommended for those at higher risk.

Adopting a healthy lifestyle can lower the risk of rectal cancer—including maintaining a balanced diet rich in fruits, vegetables, and whole grains, limiting consumption of red and processed meats, engaging in regular physical activity, maintaining a healthy weight, avoiding smoking, and limiting alcohol intake.

Genetic counseling and testing for individuals with a family history of colorectal cancer or certain hereditary conditions associated with an increased risk of rectal cancer can be beneficial. This can help identify high risk individuals and guide personalized prevention and screening strategies.

Recognizing the signs and symptoms of rectal cancer and seeking prompt medical attention can lead to early detection and improved treatment outcomes. It’s essential for individuals to be aware of potential symptoms and to undergo regular screenings as recommended by their healthcare provider.

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