Cancer Epidemiology Biomarkers & Prevention, Vol 6, Issue 12 1087-1093, Copyright © 1997 by American Association for Cancer Research

ARTICLES

Aggressiveness of colon carcinoma in blacks and whites. National Cancer Institute Black/White Cancer Survival Study Group

VW Chen, CM Fenoglio-Preiser, XC Wu, RJ Coates, P Reynolds, DL Wickerham, P Andrews, C Hunter, G Stemmermann, JS Jackson and BK Edwards
Department of Pathology, Louisiana State University Medical Center, New Orleans 70112, USA.

Black patients with colon cancer in the Black/White Cancer Survival Study were found to have a poorer survival than white patients. More advanced-stage disease at diagnosis was the primary determinant, accounting for 60% of the excess mortality. After adjusting for stage, factors such as poverty, other socioeconomic conditions, and treatment did not further explain the remaining survival deficit. This study examined the aggressiveness of colon tumors in blacks and whites to explore its role in the racial survival differences. Tumor characteristics of 703 cases of newly diagnosed invasive colon adenocarcinoma were centrally evaluated by a gastrointestinal pathologist, blinded in regard to the age, race, and sex of the patients. Blacks were less likely to have poorly differentiated (grade 3) tumors [odds ratio (OR), 0.44; 95% confidence interval, 0.22-0.88] and lymphoid reaction (OR, 0.49; 95% confidence interval, 0.26-0.90) when compared with whites. These black/white (B/W) differences remained statistically significant after adjusting for age, sex, metropolitan area, summary stage, socioeconomic status, body mass index, and health care access and utilization. In addition, blacks were less likely to have high-grade (grade 3) nuclear atypia, mitotic activity, and tubule formation, although these ORs did not reach a statistical significance level of 0.05. Similar B/W differences were observed for patients with advanced disease but not with early stage. Comparison by anatomical subsite showed that blacks had statistically significantly better differentiated tumors for cancers of the proximal and transverse colon but not for the distal. No racial differences were found for blood vessel and lymphatic invasion, necrosis, fibrosis, and mucinous type of histology. The findings, therefore, are the opposite of those hypothesized. After adjusting for stage, more aggressive tumor characteristics do not explain the adverse survival differential in blacks. This suggests that there may be racial differences in environmental exposure, and that the intensity and mode of delivery of carcinogen insult as well as host susceptibility may differ by race and anatomical subsite. Future studies should explore the B/W differences in tumor biology using molecular markers that precede the conventional histological parameters evaluated here.

This article has been cited by other articles:

				C. E. Basch, R. L. Wolf, C. H. Brouse, C. Shmukler, A. Neugut, L. T. DeCarlo, and S. Shea Telephone Outreach to Increase Colorectal Cancer Screening in an Urban Minority Population Am J Public Health, December 1, 2006; 96(12): 2246 - 2253. [Abstract] [Full Text] [PDF]

				B. N. Polite, J. J. Dignam, and O. I. Olopade Colorectal Cancer Model of Health Disparities: Understanding Mortality Differences in Minority Populations J. Clin. Oncol., May 10, 2006; 24(14): 2179 - 2187. [Abstract] [Full Text] [PDF]

				K. Irby, W. F. Anderson, D. E. Henson, and S. S. Devesa Emerging and widening colorectal carcinoma disparities between blacks and whites in the United States (1975-2002). Cancer Epidemiol. Biomarkers Prev., April 1, 2006; 15(4): 792 - 797. [Abstract] [Full Text] [PDF]

				C. F. Garland, F. C. Garland, E. D. Gorham, M. Lipkin, H. Newmark, S. B. Mohr, and M. F. Holick The Role of Vitamin D in Cancer Prevention Am J Public Health, February 1, 2006; 96(2): 252 - 261. [Abstract] [Full Text] [PDF]

				L. Le Marchand, L. R. Wilkens, L. N. Kolonel, and B. E. Henderson The MTHFR C677T Polymorphism and Colorectal Cancer: The Multiethnic Cohort Study Cancer Epidemiol. Biomarkers Prev., May 1, 2005; 14(5): 1198 - 1203. [Abstract] [Full Text] [PDF]

				E. P. Mitchell Prognosis After Rectal Cancer Treatment in Blacks and Whites: Advanced Stage at Diagnosis or Other Factors? J. Clin. Oncol., February 1, 2003; 21(3): 397 - 398. [Full Text] [PDF]

				J. J. Dignam, Y. Ye, L. Colangelo, R. Smith, E. P. Mamounas, H. S. Wieand, and N. Wolmark Prognosis After Rectal Cancer in Blacks and Whites Participating in Adjuvant Therapy Randomized Trials J. Clin. Oncol., February 1, 2003; 21(3): 413 - 420. [Abstract] [Full Text] [PDF]

				A. D. McCollum, P. J. Catalano, D. G. Haller, R. J. Mayer, J. S. Macdonald, A. B. Benson III, and C. S. Fuchs Outcomes and Toxicity in African-American and Caucasian Patients in a Randomized Adjuvant Chemotherapy Trial for Colon Cancer J Natl Cancer Inst, August 7, 2002; 94(15): 1160 - 1167. [Abstract] [Full Text] [PDF]

				L. J. Wudel Jr, W. C. Chapman, Y. Shyr, M. Davidson, A. Jeyakumar, S. O. Rogers Jr, T. Allos, and S. C. Stain Disparate Outcomes in Patients With Colorectal Cancer: Effect of Race on Long-term Survival Arch Surg, May 1, 2002; 137(5): 550 - 556. [Abstract] [Full Text] [PDF]

				J. J. Dignam, L. Colangelo, W. Tian, J. Jones, R. Smith, D. L. Wickerham, and N. Wolmark Outcomes Among African-Americans and Caucasians in Colon Cancer Adjuvant Therapy Trials: Findings From the National Surgical Adjuvant Breast and Bowel Project J Natl Cancer Inst, November 17, 1999; 91(22): 1933 - 1940. [Abstract] [Full Text] [PDF]