RIDGEWOOD, N.J., June 12 — Significant disparities in access to diagnosis and treatment for colorectal cancer exist between minority groups, with particular scarcities being seen for African-Americans, analysis of data from all counties in the U.S. has shown.

• Explain to interested patients that early diagnosis is crucial for colorectal cancer, and that most patients today survive with early detection.
• Acknowledge that minority patients face obstacles to care, such as the need to travel considerable distances for treatment.
• Point out that the decreased access seen for the African-American populations was not seen in the Asian-American population.

For each percentage point increase in the African-American population in an individual county, there was a significant decrease in the number of gastroenterologists (P<0.001) and radiation oncologists (P<0.001), according to Awori J. Hayanga, M.D., of the University of Michigan, and colleagues.

In contrast, each percentage point increase in the Asian-American population was associated with a significant increase in the number of gastroenterologists (P<0.001) and radiation oncologists (P<0.001), the researchers reported in the June Archives of Surgery.

African-Americans have worse outcomes from colorectal cancer than other minorities and a higher mortality than the larger population despite overall declines in incidence and mortality in recent decades, according to the investigators.

Previous studies have suggested that barriers to care include lack of transportation and difficulties in navigating the complexities of the healthcare system, but uncertainty exists as to the influence of geographical residence on access to care for colorectal cancer.

To determine if racial clustering and segregation result in delay in diagnosis of colorectal cancer, the investigators undertook a retrospective analysis of data from the Area Resource File of the U.S. Department of Health and Human Services, which is a nationwide database of demographic, economic, and healthcare statistics for the 3,219 counties in the country.

Aside from the differential access to gastroenterologists and radiation oncologists, the researchers also identified a trend toward a decrease in the number of colorectal surgeons for each percentage point increase in the African-American population (P=0.28).

And after adjusting for socioeconomic status and demographic differences, for each percentage point increase in the Asian-American population in an individual county they found a trend toward an increase in the number of colorectal surgeons (P=0.13).

Not only is mortality higher among African-Americans, but there also are differences in the pathophysiology of the disease, with more common findings of right-sided colon cancer and advanced adenomas.

Because of this, colonoscopy — less likely to be performed by primary care physicians — is preferred over sigmoidoscopy for these patients, which “underscores the leading role that clinical gastroenterologists should have in facilitating the early diagnosis of colon cancer in African-Americans,” the investigators wrote.

However, studies have shown that African-Americans are actually 20% less likely to undergo colonoscopy than other segments of the population — even if they have multiple first-degree relatives with the disease — with the most common reason being a lack of recommendation from healthcare providers.

Disparities also have been identified in the geographic availability of adjuvant therapies including chemotherapy and radiotherapy for patients with stage II or III disease, and evidence suggests that access to these therapies would help improve survival among African-Americans with colorectal cancer.

Moreover, even when they receive a referral for surgery or adjuvant therapy, African-Americans are less likely to have the treatment, possibly because they must travel considerable distances to receive them, the researchers said.

While some studies have suggested that minority patients perceive fewer barriers to care when they reside in communities with a higher prevalence of their own ethnicity, possibly because of close social networks, others have emphasized the negative effects of segregation on health outcomes in general and the all-cause mortality associated with lack of access to subspecialty providers.

The “sheer lack of availability” of colorectal specialists in inner-city communities — where the highest rates of mortality exist — serves as a geographical impediment to appropriate care, “despite the best intentions of referring physicians and surgeons,” the researchers said.

Furthermore, they cautioned, “Access to diagnostic and adjuvant therapies is central to timely screening, diagnosis, follow-up therapy, and surveillance, without which longer-term survival may never be improved and disparities never equalized.”

Limitations of the study include its use of national administrative databases and its cross-sectional design, which does not permit causal inferences to be drawn.

The authors reported no financial disclosures.

Primary source: Archives of Surgery

Source reference:
Hayanga A, et al “Racial clustering and access to colorectal surgeons, gastroenterologists, and radiation oncologists by African Americans and Asian Americans in the United States: A county-level data analysis” 2009; 144: 532-35.

It’s happy hour for Texas wineries.

Research now shows that wines produced in the Lone Star State share the anti-cancer traits known to exist in wines from other producing regions.

Extracts from two Texas red wines decreased cancer cell growth in a comparable magnitude as other wines previously studied, according to Dr. Susanne Talcott, Texas AgriLife Research food and nutrition scientist.

Her study, which concluded in May, showed decreased growth of colon and breast cancer cells treated with port and syrah (or shiraz) wine. It was the first such study of the health components of Texas wines, she said.

“These results could definitely be projected to all Texas wines containing similar amounts of bioactive compounds,” Talcott said. “And this will be the basis for a continued intensive study of all the health benefits of wines made in this state.”

Talcott presented her findings at the recent Texas Viticulture and Enology Research Symposium.

She said the findings suggest that people who consume regular, moderate amounts of Texas wine daily — up to a glass and a half — may profit from similar health benefits ascribed to wines from other regions.

“In general, studies show that wine may either prevent cells from mutating into cancer cells, or stop existing cancer cells from growing and causing them to die,” Talcott noted.

The scientific reasons behind her findings don’t exactly make easy party talk, so think of it this way: wines interact with a newly discovered class of molecules in cancer cells, called micro RNAs, a type of nucleic acid associated with chemical activities in a cell. Some of those micro RNAs are involved in causing cancer. Compounds in wine can go after these molecules like cops chasing criminals down a dark alley.

In general, cancer cells merrily proliferate unregulated until the wine compounds interact and “arrest” the cancer cells, causing them to die, Talcott explained.

The compounds also may work to prevent cancer, she said.

The study of the health aspects of Texas wines may coincide with an anticipated continued rise in consumption, according to marketing analysts.

Total wine consumption increased in Texas by 1.25 percent in 2007, according to Natalia Kolyesnikova, at the Texas Wine Marketing Research Institute at Texas Tech University. In the U.S., wine consumption is expected to increase from 292.1 million to 321.5 million cases by 2012.

“If Texas follows this pattern, Texas wine consumption should expect to see similar growth patterns,” Kolyesnikova reported.

Talcott now will begin a more intense study of the health components of Texas wines, including clinical trials and benefits on other ailments such as cardiovascular disease.

“We will not be short in study participants,” she noted.

She also plans a monthly news briefing on the health of Texas wines to the state’s 177 wineries and is available to speak at events and wine tasting rooms to share information on health benefits of wines and specifically Texas wines with the public.

Notes:

The Texas wine studies are part of a project funded by the Texas Department of Agriculture to improve the state’s grapes and wine production and to promote consumption of Texas wines.

Additional information about the Texas wine research and education efforts can be found at http://winegrapes.tamu.edu/ or at http://www.gotexanwine.org/.

Source:
Kathleen Phillips
Texas A&M AgriLife Communications

UroToday.com - The metabolic syndrome is estimated to occur in 25-35% of U.S. adults and is defined by having >3 of the following 5 features; abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, hypertension, and high fasting blood glucose. Studies suggest that the men with the metabolic syndrome are 50% more likely to be diagnosed with prostate cancer (CaP). This report by Jennifer Beebe-Dimmer and colleagues in the online version of Urology examined the association between the metabolic syndrome, its specific features, and CaP in a hospital-based, case-control study of white and African-American (AA) men residing in Detroit, Michigan.

A total of 637 men diagnosed with CaP from 2001 to 2004, and 244 controls, were included for study. They all completed a 2-part interviewer-administered questionnaire and donated a blood sample for DNA analysis and PSA testing. The survey collected sociodemographic data, family history of CaP, smoking, alcohol consumption, physical activity, height, weight, occupational history, diet, and vitamin use.

Patients were more likely than controls to report a family history of CaP (21 vs.13%). Smoking habits, vitamin intake and PSA screening history were similar between the CaP and control men. Significant racial differences were found in the presence of specific features of the metabolic syndrome. AA men had more hypertension and diabetes, but triglyceride and HDL cholesterol levels were significantly greater for white men. Obesity did not differ by race. The prevalence of the metabolic syndrome (>3 features) did not differ by race. For all men, no significant differences were found between men with CaP and controls for the prevalence of the metabolic syndrome or any of its features. However, among white men, those with CaP were 50% less likely to be obese compared to controls, with no overall association among AA men. No other single syndrome feature was associated with CaP risk in either race group. Data stratification by race found metabolic syndrome to be marginally associated with an increased risk of CaP among AA men, but not among white men.

Beebe-Dimmer JL, Nock NL, Neslund-Dudas C, Rundle A, Bock CH, Tang D, Jankowski M, Rybicki BA
Urology. 2009 May 9. Epub ahead of print.
doi: 10.1016/j.urology.2009.03.013

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to:
www.urotoday.com

Copyright © 2009 - UroToday