Disparities in Colon Cancer Survival in the United States (2001–2009): Findings from the CONCORD-2 Study

Authors:

Arica White (Presenter)
Centers for Disease Control and Prevention

Djenaba Joseph, Centers for Disease Control and Prevention
Sun Rim, Centers for Disease Control and Prevention
Christopher Johnson, Cancer Data Registry of Idaho
Michel Coleman, London School of Hygiene and Tropical Medicine
Claudia Allemani, London School of Hygiene and Tropical Medicine

Public Health Statement: Cancer survival estimates are useful in developing and prioritizing cancer control strategies, as well as in determining the impact of cancer control activities within states. However, previous analyses of cancer survival in the U.S. were based on data covering a limited proportion of the population and only a few have examined cancer survival by state. Disparities in survival by race/ethnicity between and within states, have been widely reported but no studies have used a nationally representative dataset.

Purpose: In the first CONCORD study, five-year survival for colon cancers diagnosed during 1990–1994 in the U.S. was among the highest in the world (60%), but there were large racial disparities in most participating states. The objective of this study was to update these findings and estimate national and state-specific colon cancer survival by race and stage, from 2001 to 2009 using high-quality data from the CONCORD-2 study.

Methods/Approach: We analyzed data from 37 state cancer registries, covering approximately 80% of the U.S. population, for patients diagnosed with colon cancer during 2001–2009 and followed through 2009. Survival up to five years was adjusted for background mortality (net survival) using state– and race-specific life tables, and age-standardized using the International Cancer Survival Standard weights. Survival is presented by race, stage, state, and calendar period (2001–2003 and 2004–2009) to account for changes in methods used to collect stage.

Results: Five-year net survival was 63.7% for those diagnosed during 2001–2003 and 64.6% for 2004–2009, which was among the highest in the world. More black than white patients were diagnosed at distant stage, both in 2001–2003 (21.5% vs. 17.2%, respectively) and in 2004–2009 (23.3% vs 18.8%). Survival varied widely between states and there was a slight increase in many states. Survival improved for both blacks and whites, but blacks had lower survival than whites diagnosed during 2001-2003 (54.7% vs. 64.5%) and 2004-2009 (56.6% vs. 65.4%).

Conclusions/Implications: Five-year net survival from colon cancer remained stable over time. Survival remained lower in blacks than in whites but the gap narrowed. These findings suggest a need for more targeted efforts to improve screening and to ensure timely, appropriate treatment.