Cancer Epidemiol Biomarkers Prev. 2020 Nov 3:cebp.1537.2019. doi: 10.1158/1055-9965.EPI-19-1537. Online ahead of print.
Racial disparities in colorectal cancer (CRC) incidence are widely documented. There are two potential mechanisms for these disparities: differences in access to screening, including screening follow-up, and differences in underlying risk of CRC. We reviewed the literature for evidence of these two mechanisms. We show that higher CRC incidence in blacks relative to whites emerged only after the dissemination of screening and describe evidence of racial disparities in screening rates. In contrast to the strong evidence for differences in CRC screening utilization, there is limited evidence for racial differences in adenoma prevalence. In general, black and white patients who are screened have similar adenoma prevalence, though there is some evidence that advanced adenomas and adenomas in the proximal colon are somewhat more likely in black than white patients. We conclude that higher rates of CRC incidence among black patients are primarily driven by lower rates of CRC screening. Our findings highlight the need to increase black patients’ access to quality screening to reduce CRC incidence and mortality.