There are differences between African-American and white patients with
colorectal cancer, concerning their characteristics before and after diagnosis. Whites are more likely to adhere to screening guidelines. This is also the case among people with positive family history.
Colorectal cancer is more frequent in Blacks. Studies have shown that that since 1985,
colon cancer rates have dipped 20% to 25% for Whites, while rates have gone up for African-American men and stayed the same for African-American women. Overall, African-Americans are 38% to 43% more likely to die from
colon cancer than are Whites. Furthermore, it seems that there is an African-American predominance in right-sited
tumors. African Americans tend to be diagnosed at a later stage, to suffer from better differentiated
tumors, and to have worse prognosis when compared with Whites. Moreover, less black patients receive
adjuvant chemotherapy for resectable
colorectal cancer or
radiation therapy for
rectal cancer. Caucasians seem to respond better to standard
chemotherapy regimens than African-Americans. Concerning toxicity, it appears that patients of African-American descent are more likely to develop
5-FU toxicity than Whites, possibly because of their different
dihydropyridine dehydrogenase status. Last but not least, screening surveillance seems to be higher among white than among black long-term
colorectal cancer survivors. Socioeconomic and educational status account for most of these differences whereas little evidence exists for a genetic contribution in racial disparity. Understanding the nature of racial differences in
colorectal cancer allows tailoring of screening and treatment interventions.