Washington residents who identify as racial or ethnic minorities die from colorectal cancer at younger ages than non-Hispanic white residents, according to a study led by recent WSU College of Medicine graduate Ashley Edwards, MD, during her time at the college. The study also found that residents living far from endoscopy screening services die younger on average from the disease, regardless of race or ethnicity.
Colorectal cancer is one of the most common cancers in the U.S., but it is also one of the most preventable by screening and highly treatable if detected in early stages. Equitable access to endoscopy clinics, which conduct colonoscopies for preventative and diagnostic screening, is vital for eliminating colorectal cancer disparities.
Published in the American Journal of Surgery, the study analyzed the state death records of more than 7,500 Washington residents who died of colorectal cancer between 2011 and 2018. It found that residents identified as Hispanic or Latinx, Black, American Indian, or Alaska Native were five years younger on average when they died compared to their non-Hispanic white counterparts.
“These findings are a call to action,” said senior author Anjali Kumar, MD, MPH, FACS, FASCRS, professor and vice chair of surgery in the College of Medicine. “As a practicing colorectal surgeon and endoscopist, I can’t just see a disparity like this and be okay with it.”
Residents who lived more than 10 km (6.2 miles) from the nearest endoscopy clinic died about 1.5 years younger than those who lived closer, regardless of race or ethnicity. These differences appeared additive—people of color living farther from endoscopy clinics died on average seven years younger than white residents who lived closer.
“We know that there are racial disparities in health care outcomes, but seeing the difference in the sheer number of years was surprising,” said Edwards, who conducted this research as part of her scholarship and discovery project and is now an internal medicine resident at Providence Portland Medical Center. She won first prize for her research at the 2022 Northwest Society of Colon and Rectal Surgeons meeting and 2023 North Pacific Surgical Association meeting.
Translating Research Findings into Action through Community Partnerships
Spurred by the study’s findings, Kumar and two other College of Medicine faculty, Associate Professor Clemma Muller, PhD, and Postdoctoral Research Associate Juliana Garcia, PhD, are collaborating with health care providers, community organizations, and private companies in southeast Washington to understand what is causing these disparities and take meaningful steps to address them.
“I feel strongly about taking this type of analysis and quickly translating it into something that can actually benefit people,” said Muller, who was not involved with the original study. “My personal goal is that our work will lead to tangible, measurable improvement in the disparities for screening and diagnosis as quickly as possible.”
The researchers met with providers and colorectal cancer survivors last year in Richland, Wash., to kickstart the initiative. They plan to meet again this year, supported by $25,000 grants from Genentech and Exact Sciences.
Although the study focused on the broad groups of white and non-white residents, the team also worked with Ofer Amram, PhD, associate professor and director of the college’s Community Health and Spatial Epidemiology Lab, to create a heat map to better see which groups are most affected by colorectal cancer health inequities. The heat map compares endoscopy center locations with residents’ home addresses at the time of death from colorectal cancer.
The spatial epidemiology analysis showed concentrations of premature mortality far from screening services among non-white residents in areas with large Hispanic or Latinx farmworkers and Indigenous populations, including the Yakama Nation, Puyallup Tribe, and the Tulalip Tribes.
Further research is needed to establish at a more granular level which groups are experiencing these health inequities, said Muller, and to learn about how to improve their access to care.
“If we ask, the communities often can tell us exactly what they think the solutions are,” she said.
Geographic distance isn’t the only barrier to colorectal cancer screening, which is recommended to start at age 45 for average-risk adults. Other hurdles can include lack of transportation, inadequate insurance, and lack of paid time off for procedures like a colonoscopy. The same factors affect access to care for cancer diagnosis and treatment.
To reduce these barriers, the researchers see potential in mobile health units to bring services to work sites and provide access to non-invasive options like stool-based screenings and emerging biomarker blood tests.
For Kumar, implementing such accessible, preventative measures is the key to changing health care outcomes.
“We know that there is a large population of migrant farmworkers and our largest tribal nation in the Yakima area,” said Kumar. “What can we do to bring prevention to them rather than asking them to come to us?”