Despite being one of the most preventable and treatable cancers, colorectal cancer continues to claim more lives in Black communities than in any other racial group in the United States. Incidence and mortality rates remain about 20% and 30% higher for Black individuals compared with White individuals, making it a leading driver of racial health disparities.
A new review co-led by Dr. Folasade May , a gastroenterologist and cancer prevention researcher at the UCLA Health Jonsson Comprehensive Cancer Center , provides a deeper look into why these disparities persist and what can be done to eliminate them.
Published in Nature Reviews Gastroenterology & Hepatology , the review examines the social determinants of health, such as access to health care, socioeconomic conditions and systemic inequities that prevent Black Americans from receiving timely screening, diagnosis and treatment for colorectal cancer.
"Although overall colorectal cancer rates have declined over the past four decades, the decline has been slower among Black Americans, resulting in a persistently higher burden of disease," said May, an associate professor of medicine at the David Geffen School of Medicine at UCLA and first author of the paper. "But for too many people, the chance to avoid a colorectal cancer diagnosis or for cure if diagnosed just doesn't exist, not because of biological differences, but because of how social and environmental factors influence access to high-quality screening and care."
May and her colleagues point to a combination of modifiable risk factors and long-standing social determinants of health as key drivers of colorectal cancer disparities across the U.S. These include:
- Lifestyle and environmental risk factors such as obesity, lack of access to healthy foods and low vitamin D levels.
- Lower screening rates due to limited access to care, financial barriers, transportation issues and mistrust of the medical system.
- Poor access to evidence-based and contemporary medical, surgical, and radiation treatments in a timely manner.
- Structural racism that affects everything from provider recommendations to the quality of care available in different neighborhoods and healthcare settings.
But these disparities are not inevitable, May noted. The paper also highlights several proven strategies that have already helped close the gap in colorectal cancer outcomes. These include:
- Culturally tailored education to raise awareness of colorectal cancer risk and screening options.
- Patient navigation programs to help individuals complete screenings and access care.
- Policies like the Affordable Care Act, which expanded access to preventive care.
- Health system changes, such as automated screening reminders and team-based care.
- Organized efforts in cities, states, and communities that include multi-component interventions to increase screening participation for Black individuals.
"We've found in systems that provide equal access to all eligible users, like the Veterans Health Administration, racial disparities in screening don't exist," said May. "Eliminating differences in coverage policy or access to care can help address screening disparities."
May and her team emphasize a two-pronged approach to eliminate inequities in colorectal cancer outcomes and to reduce the disease's overall impact. The first step would be to ensure that all individuals have health insurance—regardless of background—and the ability to receive screening and guideline-based treatment. These measures have been shown to improve outcomes within just five to 10 years.
The second step involves a longer-term commitment to addressing adverse social determinants of health, such as poverty, discrimination and unequal healthcare infrastructure. By understanding how these factors influence cancer risks and treatment outcomes, researchers and policymakers can develop targeted interventions that create lasting change.
"This is a solvable problem," May said. "We have the knowledge and resources necessary to move beyond reporting inequities to making a generational commitment to resolving the inequities in colorectal outcomes that Black people face. By taking action now, we can save lives today and create a healthier, more equitable future for all."
The paper's senior author is Dr. Samir Gupta from the University of California, San Diego. Other authors are Dr. Winta Mehtsun from the University of California, San Diego and Dr. Ahmedin Jemal from the American Cancer Society.
