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Subsite-Specific Colorectal Cancer Incidence Rates and Stage Distributions among Asians and Pacific Islanders in the United States, 1995 to 1999

¹ School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana; ² Virginia Cancer Registry, Richmond, Virginia; ³ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; ⁴ Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, South Carolina; ⁵ Indiana State Department of Health, Indianapolis, Indiana; and ⁶ American Cancer Society, Atlanta, Georgia

Requests for reprints: Xiaocheng Wu, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112. Phone: 504-568-4796; Fax: 504-568-2493. E-mail: xwu{at}lsuhsc.edu

Objective: This study examined subsite-specific colorectal cancer incidence rates and stage distributions for Asians and Pacific Islanders (API) and compared the API data with data for Whites and African Americans. Methods: Data included 336,798 invasive colorectal cancer incident cases for 1995 to 1999 from 23 population-based central cancer registries, representing about two thirds of API population in the United States. Age-adjusted rates, using the 2000 U.S. standard population, and age-specific rates and stage distributions were computed by anatomic subsite, race, and gender. All rates were expressed per 100,000. SEs and rate ratios were calculated for rate comparison. A significance level of 0.05 was used for all analyses. Results: Overall, age-adjusted colorectal cancer incidence rates were significantly lower in API than in Whites and African Americans across anatomic subsites, particularly for proximal colon cancer in which rates were 40% to 50% lower in API males and females. Exception to this pattern was the significantly (10%) higher rectal cancer incidence rate in API males than in African American males. The incidence patterns by anatomic subsite within API differed from those of Whites and African Americans. Among API, the rate of rectal cancer (19.2 per 100,000) was significantly higher than the rates of proximal (15.2 per 100,000) and distal (17.7 per 100,000) colon cancers in males, with little variations in rates across anatomic subsites in females. In contrast, among White and African American males and females, proximal colon cancer rates were over 25% higher than the rates of distal colon and rectal cancers. Increases in age-specific rates with advancing age were more striking for proximal colon cancer than for distal colon and rectal cancers in Whites and African Americans, while age-specific rates were very similar for different subsites in API with parallel increases with advancing age, especially in API males. Similar to Whites and African Americans, in API, proximal colon cancers (32% to 35%) were also less likely to be diagnosed with localized stage compared with distal colon (38% to 42%) and rectal (44% to 52%) cancers. Conclusion: The patterns of subsite-specific colorectal cancer incidence in API, especially API males, differ from those of Whites and African Americans. Similar to Whites and African Americans, lower percentage of localized disease in API for proximal colon cancer than for distal colon and rectal cancers was also observed.

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