Cancer doesn’t discriminate. And yet, when it comes to colorectal cancer — one of the most common cancers in the U.S. — Black Americans are 40 percent more likely to die of the disease than white Americans, according to the American Cancer Society.
This may be because Black Americans can have difficulty accessing the best colorectal treatments for stage IV metastatic colorectal cancer (mCRC), some of which have greatly improved over the past 20 years, says Sanjay Goel, MD, a medical oncologist and director of the phase I/investigational therapeutics program at Rutgers Cancer Institute of New Jersey.
Much of this comes down to insurance coverage. Statistics from the Kaiser Family Foundation show that, as of 2021, nearly 11 percent of Black Americans are uninsured compared to about 7 percent of white Americans.
When given access to the same treatments for colorectal cancer, Black Americans can fare just as well as white Americans. For example, Dr. Goel’s research, published in JAMA Network Open in December 2021, found that when Black and white Americans were given a combination therapy of biologics — which Dr. Goel calls “the standard of care” for certain people with colorectal cancer — and chemotherapy, both groups benefited equally from the treatment.
“A Black patient with access to good health coverage such as Medicare will enjoy the same outcome as a white patient,” concludes Goel.
It’s a similar story with surgery. While the five-year survival rate for distant colorectal cancer averages about 14 percent, that number can climb as high as 50 percent if the cancer has only spread to the liver and is treated with surgery and the right medications, says Mustafa Raoof, MD, a surgical oncologist at City of Hope, a National Cancer Institute–designated comprehensive cancer center in Duarte, California.
Black people can be less likely than white people to undergo surgery, however. Dr. Raoof’s research among colorectal cancer patients living in California, published in a 2020 study in JAMA Network Open, found that only 6.2 percent of Black patients had liver surgery compared to 10.3 percent for non-Hispanic whites. Black patients were also 17 percent more likely to die. But for those who underwent liver surgery, says Raoof, “there was no difference in survival between Black and white patients.”
The Difference of Quality Healthcare
In Harris County in Texas, a diverse and heavily populated area that includes the city of Houston, a pioneering program shows just how effective access to evidenced-based care for people with mCRC can be.
The public hospital Ben Taub treats a largely uninsured, primarily minority population and is affiliated with Baylor College of Medicine and its National Cancer Institute–designated Dan L. Duncan Comprehensive Cancer Center.
In a 2020 study published in Clinical Colorectal Cancer, researchers studied 103 patients with metastatic colorectal cancer, of which 40 percent were Black, 49 percent Hispanic, and 12 percent Asian or Middle Eastern.* Everyone received state-of-the-art treatment, including chemotherapy, biologics, or immunotherapy, at little to no cost. They found no survival difference between their patients and that of white people from another large, randomized controlled trial.
“This health disparity may be as simple as access to healthcare rather than tumor biology,” says study senior author Benjamin L. Musher, MD, associate professor of medicine at Baylor College of Medicine in Houston. “When Black people with metastatic colorectal cancer who don’t have health insurance are treated in a place where they can receive aggressive, standard-of-care therapy, their outcomes are as good as insured white patients treated in community or university hospitals. The disparity disappears.”
Leveling the Playing Field
If you are a Black person with metastatic colorectal cancer, find a doctor you can trust. “You need someone in your corner,” says Musher. “Look for a physician who is willing to sit down with you, be honest, explain what’s going on and what the treatment options are, and then spend time answering your questions so you can make an informed decision.” If that description doesn’t describe your doctor, look for another one.
In addition, it’s important to seek a multidisciplinary care team. “Find the right team of specialists that have specific expertise in treating metastatic colorectal cancer,” says Raoof. That may mean seeking a second opinion at a major cancer hospital. If distance is an issue, ask about telehealth visits. You may be able to develop a care plan that can then be executed at your local hospital or facility. If a clinical trial is available for you, ask for help in overcoming any challenges you may have in participating, such as transportation or housing costs.
*Numbers don’t add up to 100 percent due to rounding.